Neuropsychological Test Results Research Articles

Efficacy and safety of butylphthalide in patients with mild cognitive impairment: a multicentre, randomised, double-blind, placebo-controlled trial (EBMCI study)

IntroductionThe efficacy of multitarget neuroprotective drug DL-3-n-butylphthalide (NBP) in improving cognitive function has been confirmed in patients with vascular cognitive impairment without dementia. However, its efficacy in patients with symptomatic...

Transient global amnesia after the right temporal epilepsy surgery: A case report.

Transient global amnesia (TGA) is characterized by sudden and temporary memory impairment, while transient epileptic amnesia (TEA) represents amnestic attacks as the main manifestation of focal epilepsy with presumed temporal origin. We present a 48-year-old patient who experienced transient amnesia 10 weeks after right selective amygdalo-hippocampectomy for right temporal lobe epilepsy. Despite TEA being a plausible explanation for amnesia in patients with temporal lobe epilepsy, no epileptiform discharges were found during the amnestic episode and key features indicative of TGA, including long duration, isolated occurrence, and dense anterograde amnesia of the episode, argued against a diagnosis of TEA in this case. Notably, the patient has remained seizure-free (now 4,5 years) and stopped taking antiseizure medication 32 months after surgery. Although TGA clinical criteria formally exclude patients with recent active epilepsy, neurologists should be aware that TGA can occur after epilepsy surgery in the temporal lobe. Therefore, we consider it of high clinical relevance to establish a careful differential diagnosis between TGA and epileptic amnestic attacks after epilepsy surgery to avoid unnecessary reintroduction or continuation of antiseizure medication. Additionally, this case presents the first comparison of detailed neuropsychological test results before and after a presumed TGA episode, revealing a complete recovery of anterograde memory functions within 1 day. PLAIN LANGUAGE SUMMARY: A 48-year-old patient experienced an episode of transient amnesia 10 weeks after epilepsy surgery. Given the patient's history, an epileptic origin of the episode initially seemed likely. However, tests revealed no seizure activity during the episode and the characteristics matched a condition called transient global amnesia. This case highlights the importance of correctly diagnosing memory impairments after epilepsy surgery to prevent unnecessary treatment.

Correlation between cancer-related cognitive impairment and resting cerebral glucose metabolism in patients with ovarian cancer

BackgroundAn increasing number of research have applied neuroimaging techniques to explore the potential neurobiological mechanism of Cancer-related cognitive impairment (CRCI). PurposeTo explore the correlation between resting brain glucose metabolism and CRCI using 18F-FDG PET/CT in ovarian cancer (OC) patients. MethodsFrom December 2021 to March 2022, 38 patients with OC were selected as the study group, and 38 healthy women of the same age (±1 year) who underwent routine physical examination using PET/CT were selected as the control group. Patients received further assessment with the Montreal Cognitive Assessment Scale (MoCA) and Perceived Deficit Questionnaire (PDQ). Independent sample t-test and Spearman correlation were conducted for data analysis. ResultsThe resting brain glucose metabolism in the OC group was significantly lower than in the healthy controls. 60.52% patients had neuropsychological impairment and retrospective memory were the most serious perceived cognitive impairments. The resting brain glucose metabolism in OC patients did not significantly correlate with neuropsychological performance but had significant positive correlation with subjective cognitive evaluation DiscussionResting glucose metabolism was low in OC patients and associated with subjective cognitive impairment but not objective neuropsychological test results. 18F-FDG PET/CT can be used to evaluate brain function in OC patients and provide reliable imaging indicators for early recognition of and intervention for changes in cognitive function.

Structural and functional comparisons in cognitive impairments in patients with multiple sclerosis

Background. Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease characterized by a variety of neurological symptoms. Cognitive impairment is an important clinical aspect of MS and require careful interviewing and neuropsychological testing to detect it. Contrast-enhanced magnetic resonance imaging (MRI) is the primary diagnostic method in MS, which helps confirm the presence and assess the extent of structural damage to the brain and spinal cord. The purpose of the study was to determine the frequency and severity of cognitive impairment in patients with relapsing-remitting multiple sclerosis, taking into account the localization of brain lesions according to MRI. Materials and methods. Seventy-two patients with a diagnosis of relapsing-remitting MS according to the McDonald criteria (2017) were examined. All of them underwent a thorough neurolo-gical, neuropsychological, and instrumental examination. The average duration of the disease was 8.2 ± 0.8 years. The average score on the Expanded Disability Status Scale was 3.38 ± 0.18 points. Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test 3 (PASAT-3), and Montreal Cognitive Assessment (MoСA) were used to assess the neuropsychological status of patients. All participants underwent a 1.5T MRI of the brain with dotavist contrast enhancement. Results. A thorough survey of examined patients with MS revealed the presence of complaints of cognitive decline in 91.67 % of cases (66 patients). The average score on the SDMT was 32.6 ± 1.6 (controls 57.1 ± 0.9), on the PASAT-3 — 30.3 ± 1.8 (controls 56.8 ± 0.5), the evaluation score on the MoСA was 22.4 ± ± 0.5 points compared to the control group (28.4 ± 0.2 points). The conducted correlation analysis revealed statistically significant negative correlations in the corpus callosum (MoCA: r = –0.255; SDMT: r = –0.263; PASAT-3: r = –0.171; p < 0.05) and in the brainstem (MoCA: r = –0.191; SDMT: r = –0.209; PASAT-3: r = –0.214; p < 0.05). The results of the analysis of variance confirmed the correlations described above between the localization of brain lesions and the results of neuropsychological testing and revealed statistically significant differences in the scores on the MoCA and SDMT depending on the localization of lesions (MoCA: F(14, 57) = 5.052, p < 0.001; SDMT: F(14, 57) = 2.609, p < 0.05). Conclusions. Patients with relapsing-remitting multiple sclerosis quite often have cognitive impairment, which is confirmed by the results of neuropsychological testing. Correlation analysis revealed a significant negative relationship between the localization of foci in the corpus callosum and the brainstem and cognitive decline according to the results of tests (MoCA, SDMT, PASAT-3). The results of our study confirm the presence of structural and functional connections between the localization of focal brain lesions and the development of cognitive disorders, which has important diagnostic and prognostic value.

Cognitive impairment following breast cancer treatments: an umbrella review.

Cancer-related cognitive impairment (CRCI) refers to a cognitive decline associated with cancer or its treatments. While research into CRCI is expanding, evidence remains scattered due to differences in study designs, methodologies, and definitions. The present umbrella review aims to provide a comprehensive overview of the current evidence regarding the impact of different breast cancer therapies on cognitive functioning, with a particular focus on the interplay among objective cognitive deficits (ie, measured with standardized tests), subjective cognitive concerns, (ie, self-reported), and other mediating psycho-physical factors. The search was made in Pubmed, Embase, and Scopus for articles published until July 2023, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol. Chemotherapy and endocrine therapy appear consistently associated with CRCI in patients with breast cancer, primarily affecting memory, attention/concentration, executive functioning, and processing speed. Subjective cognitive concerns were often found weakly or not associated with neuropsychological test results, while overall CRCI seemed consistently associated with psychological distress, fatigue, sleep quality, and inflammatory and biological factors. Current evidence suggests that CRCI is common after chemotherapy and endocrine therapy for breast cancer. However, heterogeneity in study designs and the scarcity of studies on more recent treatments such as targeted therapies and immunotherapies, highlight the need for more systematic and harmonized studies, possibly taking into account the complex and multifactorial etiology of CRCI. This may provide valuable insights into CRCI's underlying mechanisms and potential new ways to treat it.

Incidence and Prevalence of Dementia: A 2015–2020 Population-Based Study in the Campania Region of Italy

Plain Language SummaryDementia is a loss of memory and other functions related to thinking and to the ability to do everyday chores, usually occurring in the elderly and getting worse over time. The most common kind is Alzheimer’s dementia. Here, we estimated the number of people who are sick with dementia (prevalence) and how many new cases of dementia there are (incidence) in the Campania region (South Italy) from 2015 to 2020. We included individuals aged 65 years and above who have used dementia medications, were admitted to hospitals due to dementia, and/or had payment exemptions for dementia. Among 1,118,545 individuals older than 65 years living in the Campania region of Italy (among 5,624,260 inhabitants), we identified 80,392 people older than 65 years with dementia (62.4% females; age about 80 years), among which 35,748 people had Alzheimer’s dementia (63.0% females; age about 79 years). Based on these numbers, we estimated 77 people living with dementia per 1,000 people (85 for females and 67 for males) and 34 with Alzheimer’s dementia per 1,000 people (37 for females and 29 for males). The number of new cases per year was 82 per 100,000 for any dementia and 59 for Alzheimer’s dementia. We showed that our data were accurate by comparing results of tests measuring memory and other functions and found that only 1.7–3.0% of cases remained undetected. These measures will be important to identify risk factors, guide prevention strategies, and improve care and support for affected individuals and their families.

The prevalence of mild cognitive impairment in breast cancer patients receiving chemotherapy according to the criteria of the National Institute on Aging-Alzheimer's Association (NIA-AA).

Breast cancer patients receiving chemotherapy can develop cognitive impairment. There is no gold standard for defining cognitive impairment. We applied the National Institute on Aging-Alzheimer's Association (NIA-AA) criteria for mild cognitive impairment (MCI) to determine its prevalence in breast cancer patients receiving adjuvant chemotherapy and examine differences between patients with and without MCI. We used pre-existing cognitive data on 5 neuropsychological test outcomes (verbal memory, processing speed, executive functioning, and verbal fluency) gathered from 240 breast cancer patients who received adjuvant conventional (n = 154) or high-dose chemotherapy (n = 86). Assessments occurred 6 or 12months post-chemotherapy and results were compared with data from 66 women without cancer. MCI was defined by the following: (i) presence of concern regarding a change in cognition, (ii) impairment in one or more cognitive tests (1.5 standard deviation below a normative mean), (iii) preservation of independence in functional abilities, and (iv) the absence of dementia. Twenty percent (n = 49) of breast cancer patients who received chemotherapy (conventional therapy n = 29 (12%), high-dose therapy = 20 (8.3%)) met the criteria for MCI, compared with 7.6% (n = 5) of controls. Prevalence was significantly different between patients and controls (P = 0.020, and corrected for IQ P < 0.001). Patients with MCI had significant lower education levels (P < 0.002) and premorbid IQ (P = 0.001) compared with patients without MCI. Twenty percent of breast cancer patients treated with chemotherapy met NIA-AA criteria for MCI, compared with 7.6% of the controls. These criteria, which include formal test performance as well as a person's symptoms and functional status, can be useful in clinical practice and scientific research.

Impact of serum leptin and adiponectin levels on brain infarcts in patients with mild cognitive impairment and Alzheimer's disease: a longitudinal analysis.

The adipokines leptin and adiponectin have been associated with atherosclerosis and the risk of cerebral infarcts. Pre-clinical studies, however, suggest a protective role against ischemic brain damage. In this study we analyzed the relationship between serum leptin and adiponectin levels and the onset or progression of brain infarcts in subjects with mild cognitive impairment (MCI) and Alzheimer's disease (AD). All data were extracted from the ADNI database. The final population included 566 subjects, with 58 healthy controls, 396 MCI and 112 AD. All patients with available serum leptin and adiponectin levels at baseline were selected. Demographics, neuropsychological test results, CSF biomarkers, regional brain metabolism with FDG-PET data and the number of brain infarcts on longitudinal MRI scans were extracted. Leptin levels were significantly lower in patients with MCI than controls at baseline, while adiponectin levels were not different between the groups. Multivariate logistic regression analysis at baseline for the presence of brain infarcts showed a predictive value for leptin but not for adiponectin. Multivariate longitudinal analysis showed that age was the only significant predictor of brain infarcts development at 15-year follow-up, while serum leptin and adiponectin levels did not play a role in this population. The evidence on the pathogenetic or protective role of adipokines on ischemic brain damage is mixed. In this MCI and AD population, serum leptin and adiponectin were not associated with the development of brain infarcts; therefore, these results do not support the use of adipokines as biomarkers of cerebrovascular pathology in this population.

Prefrontal intra-individual ERP variability and its asymmetry: exploring its biomarker potential in mild cognitive impairment

BackgroundThe worldwide trend of demographic aging highlights the progress made in healthcare, albeit with health challenges like Alzheimer’s Disease (AD), prevalent in individuals aged 65 and above. Its early detection at the mild cognitive impairment (MCI) stage is crucial. Event-related potentials (ERPs) obtained by averaging EEG segments responded to repeated events are vital for cognitive impairment research. Consequently, examining intra-trial ERP variability is vital for comprehending fluctuations within psychophysiological processes of interest. This study aimed to investigate cognitive deficiencies and instability in MCI using ERP variability and its asymmetry from a prefrontal two-channel EEG device.MethodsIn this study, ERP variability for both target and non-target responses was examined using the response variance curve (RVC) in a sample comprising 481 participants with MCI and 1,043 age-matched healthy individuals. The participants engaged in auditory selective attention tasks. Cognitive decline was assessed using the Seoul Neuropsychological Screening Battery (SNSB) and the Mini-Mental State Examination (MMSE). The research employed various statistical methods, including independent t-tests, and univariate and multiple logistic regression analyses. These analyses were conducted to investigate group differences and explore the relationships between neuropsychological test results, ERP variability and its asymmetry measures, and the prevalence of MCI.ResultsOur results showed that patients with MCI exhibited unstable cognitive processing, characterized by increased ERP variability compared to cognitively normal (CN) adults. Multiple logistic regression analyses confirmed the association between ERP variability in the target and non-target responses with MCI prevalence, independent of demographic and neuropsychological factors.DiscussionThe unstable cognitive processing in the MCI group compared to the CN individuals implies abnormal neurological changes and reduced and (or) unstable attentional maintenance during cognitive processing. Consequently, utilizing ERP variability measures from a portable EEG device could serve as a valuable addition to the conventional ERP measures of latency and amplitude. This approach holds significant promise for identifying mild cognitive deficits and neural alterations in individuals with MCI.

Neurometabolic activity in the thalamic and frontal cortex and cognitive functions in adolescents with generalized epileptic syndromes

The study aimed to analyse the mutual correlations between the metabolic activity of the brain evaluated by the magnetic resonance spectroscopy method (MRS) and intelligence and cognitive functions in adolescents with idiopathic generalised epilepsies (IGE). The focus of the study was placed on the activity of the thalamus and frontal cortex.Twenty newly diagnosed patients with juvenile absence epilepsy (JAE) and juvenile myoclonic epilepsy (JME) were included in the study. Adolescents underwent primary structural neuroimaging (1.5T) and advanced evaluation of the frontal cortex and thalamus by MRS. Concentrations of N-acetyl aspartate (NAA), creatine plus phosphocreatine (Cr) and choline (Cho) were measured and were expressed as ratios of NAA/Cr, NAA/Ch and NAA/Cr+Ch. Patients also completed a panel of IQ and cognitive tests (e.g., FePsy Battery – classification test, verbal fluency test, RAVLT memory test). The correlation between the level of metabolites and the results of intellectual and cognitive tests was examined.Strong correlations were found between IQ and some cognitive functions and metabolic ratios in the IGEs group. Overall the patients whose NAA/Cr, NAA/Ch, NAA/Cr+Ch ratios were lower, obtained worse results in IQ and in some of the neuropsychological tests.The metabolite activity in the thalamus and frontal cortex impacts the results of neuropsychological tests in the group of patients with IGE.

Quantitative analysis of visually normal EEG reveals spectral power abnormalities in temporal lobe epilepsy

ObjectiveTo compare quantitative spectral parameters of visually-normal EEG between Mesial Temporal Lobe Epilepsy (MTLE) patients and healthy controls (HC). MethodWe enrolled 26 MTLE patients and 26 HC. From each recording we calculated total power of all frequency bands and determined alpha-theta (ATR) and alpha-delta (ADR) power ratios in different brain regions. Group-wise differences between spectral parameters were investigated (p < 0.05). To test for associations between spectral-power and cognitive status, we evaluated correlations between neuropsychological tests and quantitative EEG (qEEG) metrics. ResultsIn all comparisons, ATR and ADR were significantly decreased in MTLE patients compared to HC, particularly over the hemisphere ipsilateral to epileptic activity. A positive correlation was seen in MTLE patients between ATR in ipsilateral temporal lobe, and results of neuropsychological tests of auditory verbal learning (RAVLT and RAVLT-D), short term verbal memory (Digit span backwards), and executive function (Weigl's sorting test). ADR values in the contralateral posterior region correlated positively with RAVLT-D and Digit span backwards tests. DiscussionResults confirmed that the power spectrum of qEEG is shifted towards lower frequencies in MTLE patients compared to HC. ConclusionOf note, our results were found in visually-normal recordings, providing further evidence of the value of qEEG for longitudinal monitoring of MTLE patients over time. Exploratory analysis of associations between qEEG and neuropsychological data suggest this could be useful for investigating effects of antiseizure medications on cognitive integrity in patients.

Association between mammillary body atrophy and memory impairment in retired athletes with a history of repetitive mild traumatic brain injury

Cognitive dysfunction, especially memory impairment, is a typical clinical feature of long-term symptoms caused by repetitive mild traumatic brain injury (rmTBI). The current study aims to investigate the relationship between regional brain atrophy and cognitive impairments in retired athletes with a long history of rmTBI. Overall, 27 retired athletes with a history of rmTBI (18 boxers, 3 kickboxers, 2 wrestlers, and 4 others; rmTBI group) and 23 age/sex-matched healthy participants (control group) were enrolled. MPRAGE on 3 T MRI was acquired and segmented. The TBV and TBV–adjusted regional brain volumes were compared between groups, and the relationship between the neuropsychological test scores and the regional brain volumes were evaluated. Total brain volume (TBV) and regional brain volumes of the mammillary bodies (MBs), hippocampi, amygdalae, thalami, caudate nuclei, and corpus callosum (CC) were estimated using the SPM12 and ITK–SNAP tools. In the rmTBI group, the regional brain volume/TBV ratio (rmTBI vs. control group, Mann–Whitney U test, p < 0.05) underwent partial correlation analysis, adjusting for age and sex, to assess its connection with neuropsychological test results. Compared with the control group, the rmTBI group showed significantly lower the MBs volume/TBV ratio (0.13 ± 0.05 vs. 0.19 ± 0.03 × 10−3, p < 0.001). The MBs volume/TBV ratio correlated with visual memory, as assessed, respectively, by the Rey–Osterrieth Complex Figure test delayed recall (ρ = 0.62, p < 0.001). In conclusion, retired athletes with rmTBI have MB atrophy, potentially contributing to memory impairment linked to the Papez circuit disconnection.

Peculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disordersPeculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to reveal the dependence of changes in the cognitive sphere on the peculiarities of the daily profile of blood pressure (BP) and heart activity in patients with arrhythmias. Materials and methods. We examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing, a study of the daily BP profile and heart activity. Hemodynamic status was assessed by daily BP and ECG monitoring. Average daily, average daytime and nighttime systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) were evaluated. The analysis of spectral indicators of heart rate variability was performed to assess the state of the autonomic nervous system. Correlations of hemodynamic indicators with the results of neuropsychological testing were determined. Results. In patients with cognitive disorders (CD), there was an increase in SBP in all periods of the day, most pronounced in patients with moderate CD (p = 0.049). In patients with mild CD and without CD, there were no significant intergroup differences in the level of average daily, daytime and night SBP, DBP and pulse pressure (p &gt; 0.05). Patients with moderate CD had significantly higher SBP and time index of SBP at the expense of average daytime and average night values of these indicators compared to those without CD (p &lt; 0.05). During the active period of the day, time index of DBP was significantly higher in patients with moderate CD (p = 0.002) who also had an increase in average daily, daytime and night SBP variability compared to participants without CD (p = 0.041). The differences between the groups were not significant in terms of DBP variability (р = 0.07). In 61 (54 %) patients with CD, non-dipper SBP prevailed in the structure of disorders of the daily BP profile, with the highest indicators in moderate CD (55.6 %). The presence of adverse daily DBP profiles — night-peaker (6.2 %) and over-dipper (8.8 %), which prevailed in patients with moderate CD, is hidden behind normal indicators of the daily BP index. Increased average SBP24 (odds ratio (OR) = 3.26, 95% confidence interval (CI): 1.45–5.35, p &lt; 0.001), DBP24 (OR = 3.06, 95% CI: 1.41–4.79, p &lt; 0.001), average HR24 (OR = 2.67, 95% CI: 1.32–4.14, p &lt; 0.001), average SBP24 variability (OR = 2.13, 95% CI: 1.11–3.32, p &lt; 0.001) are the main factors of central hemodynamic disorders that increase the risk of developing CD in patients with arrhythmias. Conclusions. The identified associations between cognitive dysfunction, indicators of daily BP monitoring and heart activity are important in the context of their comprehensive accounting for optimizing an individualized approach to patient management and predicting the development of CD.

Abstract P271: Greater Long-Term Non-High Density Lipoprotein Cholesterol Variability From Childhood is Associated With Poorer Midlife Cognitive Function: The Bogalusa Heart Study

Background: Exposure to elevated plasma non-high density lipoprotein cholesterol (non-HDL-C) levels during adulthood has been associated with higher risk of cardiovascular events. However, whether long term non-HDL-C variability from childhood impacts midlife cognitive function (CF) is unclear. Hypothesis: We hypothesized that higher long-term non-HDL-C variability from childhood would be associated with worse midlife CF measures. Aim: We aimed to identify the effect of long term lipid variability from childhood on midlife CF. Methods: We studied 1,249 midlife participants of the Bogalusa Heart Study (age at baseline: mean 9.5 years+/- standard deviation(SD)3.5 years; age at midlife: mean 48.2 years+/- SD 5.2 years; 59.8 % women(747 of 1249), 34.3% Black(428 of 1249)) with ≥3 lipid measurements across follow up. Non-HDL-C levels were obtained as total cholesterol - HDL cholesterol. Visit-to visit non-HDL-C variability from childhood was estimated by the deviation from age predicted values (DEV), and residual SD (RSD). Non-HDL-C measurements were fitted in random-effects models stratified by race and sex, to produce individual growth curves. DEV and RSD were measured as the mean and SD of the residuals of observed and predicted non-HDL levels. Midlife CF was measured by 10 neuropsychological (NP) tests. NP test results were categorized into 3 distinct NP profiles (optimal, average, and mixed-low) using cluster analysis. Associations between non-HDL-C and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status and the mean of non-HDL-C measurements from childhood to midlife. DEV and RSD were standardized to z-scores before conducting regression analysis. Interactions according to race and sex were performed. Results: The odds of having a mixed-low CF compared to optimal increased by 31.1% (95% CI 1.075, 1.599) for every 1 SD increase in DEV, and by 30.5% (95% CI 1.069, 1.591) for every 1 SD increase in RSD, respectively, adjusted for education status and mean non-HDL-C levels. Neither race or sex were found to modify the associations of DEV nor RSD on CF. Conclusions: Higher long-term non-HDL-C variability was linked to poorer midlife CF. Further studies are needed to identify the impact of long-term non-HDL-C variability in the association of cardiometabolic risk factors and midlife CF.

Neuropsychological characteristics of drug resistant epilepsy patients with and without comorbid functional seizures

IntroductionNeuropsychological testing is a mandatory component in the evaluation of drug resistant epilepsy. The results of testing may assist with both the localization of an epilepsy as well as assessment of surgical risk. Previous studies have demonstrated differences in the neuropsychological performance of patients with epilepsy and functional seizures. We hypothesized that comorbid functional seizures could potentially influence neuropsychological test performance. Therefore, we evaluated whether there is a difference in the neuropsychological test results between drug resistant epilepsy patients with and without comorbid functional seizures. MethodNeuropsychological test results were compared between 25 patients with drug resistant focal epilepsy and 25 patients that also had documented functional seizures. Univariate analyses and multiple logistic regression models were used to both assess performance differences between the groups and to assess whether test results could be used to accurately identify which patients had comorbid functional seizures. ResultsEpilepsy patients with comorbid functional seizures performed significantly worse on the FAS Verbal Fluency Test compared to ES patients (p = 0.047). Digit Span Backwards (p = 0.10), Digit Span Forwards (p = 0.14) and Working Memory Index (p = 0.10) tended to be lower in the epilepsy and functional seizures group but was not statistically significant. A multiple logistic regression model using the results of four neuropsychological tests was able to identify patients with comorbid functional seizures with 83.33% accuracy. ConclusionsThere are appeared to be some differences in the neuropsychological performance among drug resistant epilepsy patients based on whether they have comorbid functional seizures. These findings may have relevant implications for the interpretation of neuropsychological test results.

Glucose Metabolism of Hippocampal Subfields in Medial Temporal Lobe Epilepsy.

Reduced glucose metabolism in the hippocampus is commonly observed in cases of medial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS). Glucose metabolism among the various hippocampal subfields has not been thoroughly investigated. This study examined 29 patients (18 females; 15-58 years) diagnosed with HS who underwent surgery for drug-resistant epilepsy. FreeSurfer 7.1.1 was used in the processing of MRI data and 18 F-FDG PET scans to derive volumetric data and the FDG SUVr in the whole hippocampus and hippocampal subfields, including the CA1, CA2-4, granule cell and molecular layer of the dentate gyrus (GC-ML-DG), and subiculum. Asymmetries in the volume and SUVr between the 2 sides from the subfields of the hippocampus were defined in terms of an asymmetry index. Comparisons of the asymmetry index among these regions were performed. The correlations between asymmetry index values and postoperative outcomes and presurgical neuropsychological test results were also evaluated. The CA1, CA2-4, subiculum, GC-ML-DG, and whole hippocampus presented reductions in volume and hypometabolism ipsilateral to MTLE. Asymmetries in volume and SUVr were significantly less pronounced in the CA1 and subiculum than in the CA2-4 or GC-ML-DG. Postoperative seizure outcomes were not correlated with the asymmetry index for volume or SUVr in any hippocampal subfield. In cases of left MTLE, scores of immediate logical memory and delayed logical memory were positively correlated with the asymmetry index for SUVr in the following subfields: CA1 ( R = 0.829, P = 0.021; R = 0.770, P = 0.043), CA2-4 ( R = 0.825, P = 0.022; R = 0.894, P = 0.007), subiculum ( R = 0.882, P = 0.009; R = 0.853, P = 0.015), GC-ML-DG ( R = 0.850, P = 0.015; R = 0.796, P = 0.032), and whole hippocampus ( R = 0.841, P = 0.018; R = 0.822, P = 0.023). In cases of right MTLE, the scores for delayed face memory were positively correlated with the asymmetry index for SUVr in the subiculum ( R = 0.935, P = 0.006). In cases of HS, changes in glucose metabolism levels varied among the hippocampal subfields. Asymmetries in glucose metabolism among the CA-1, CA2-4, subiculum, and GC-ML-DG subregions were correlated with scores for verbal memory among patients with left MTLE. Asymmetric glucose metabolism in the subiculum was also correlated with visual memory scores among patients with right MTLE.

Marker associations of chronic heart failure severity and cognitive dysfunction in elderly patients

Introduction. Next to neurodegenerative disorders, cardiovascular diseases are now the most common cause of cognitive impairment. The combination of factors such as older age and chronic heart failure is a corner-stone of a greater risk for developing vascular cognitive impairment.Aim. To study the relationship between the parameters of the left ventricular ejection fraction and the concentration of NT-proBNP with the results of neuropsychological testing in patients with chronic heart failure in old age.Materials and methods. The study included 200 elderly patients with CHF II–III FC. The neuropsychological examination included tests: tracking, Schulte tables, verbal associations, the Montreal Cognitive Function Assessment Scale (МоСА test). Laboratory tests included determination of the concentration of NT-proBNP in serum.Results. During neuropsychological testing, reduced indicators were obtained: during the MOS test in patients with left ventricular ejection fraction (LVEF) values &lt; 40% and ≥ 40% and &lt; 50% and with a concentration of NT-proBNP 7230 [3325; 8830] pg/ml; in the Schulte test, an increase in execution time was noted in patients with LVEF values &lt; 40% and ≥ 40% and &lt; 50% and with a concentration of NT-proBNP 2900 [700; 7500] pg/ml; in the tracking test – an increase in time in part A in patients with LVEF values &lt; 40% and ≥ 40% and &lt; 50% and with a concentration of NT-proBNP 5385 [2125; 8675] pg/ml and part B in patients with LVEF values &lt; 40% and ≥ 40% and &lt; 50% and with a concentration of NT-proBNP 6947 [3325; 9310] pg/ml, in the verbal association test – in patients with LVEF values &lt; 40% and ≥ 40% and &lt; 50% and with a concentration of NT-proBNP 2090 [608; 7126] pg/ml. Correlation analysis showed the presence of a significant relationship between LVEF indicators, the concentration of NT-proBNP and the results of neuropsychological testing (p &lt; 0.001), while, according to the Rea&amp;Parker classification, the connection was assessed as relatively strong and medium strength.Conclusion. The cognitive impairments identified in this study in elderly patients with chronic heart failure were characterized by a decrease in concentration, memory, executive functions and the overall integrative index of cognitive functions. These disorders were significantly associated with a decrease in the left ventricular ejection fraction and a high concentration of NT-proBNP.

Alterations of Structural Network Efficiency in Early-Onset and Late-Onset Alzheimer's Disease.

Early- and late-onset Alzheimer's disease (EOAD and LOAD, respectively) share the same neuropathological hallmarks of amyloid and neurofibrillary tangles but have distinct cognitive features. We compared structural brain connectivity between the EOAD and LOAD groups using structural network efficiency and evaluated the association of structural network efficiency with the cognitive profile and pathological markers of Alzheimer's disease (AD). The structural brain connectivity networks of 80 AD patients (47 with EOAD and 33 with LOAD) and 57 healthy controls were reconstructed using diffusion-tensor imaging. Graph-theoretic indices were calculated and intergroup differences were evaluated. Correlations between network parameters and neuropsychological test results were analyzed. The correlations of the amyloid and tau burdens with network parameters were evaluated for the patients and controls. Compared with the age-matched control group, the EOAD patients had increased global path length and decreased global efficiency, averaged local efficiency, and averaged clustering coefficient. In contrast, no significant differences were found in the LOAD patients. Locally, the EOAD patients showed decreases in local efficiency and the clustering coefficient over a wide area compared with the control group, whereas LOAD patients showed such decreases only within a limited area. Changes in network parameters were significantly correlated with multiple cognitive domains in EOAD patients, but only with Clinical Dementia Rating Sum-of-Boxes scores in LOAD patients. Finally, the tau burden was correlated with changes in network parameters in AD signature areas in both patient groups, while there was no correlation with the amyloid burden. The impairment of structural network efficiency and its effects on cognition may differ between EOAD and LOAD.

Influence of rehabilitation with the use of sulphide and hydrogen sulphide baths on the concentration of the brain-derived neurotrophic factor (BDNF) and selected parameters of cognitive, executive and affect functions in multiple sclerosis patients

Aim: To compare the blood serum BDNF concentration in MS patients before and after a standard three-week rehabilitation offered by the NHF. The study compared the expected growth of the BDNF concentration in a group of patients rehabilitated with the help of standard kinesiotherapy and a group of patients rehabilitated with kinesiotherapy plus sulphide and hydro sulphide baths as well as the results of the assessment of the cognitive and executive functions of MS patients in the two groups. Materials and methods: Participants in the study were divided into 3 groups of 20 people each. Group 1. MS patients rehabilitated for 3 weeks in the Day Ward of the Rehabilitation Clinic – standard kinesiotherapy. Group 2. MS patients rehabilitated for 3 weeks in the Day Ward of the Rehabilitation Clinic – kinesiotherapy with sulphide baths. Group 3. Healthy volunteers – occasional BDNF determination. In the group of MS patients the BDNF concentration was determined prior to and after the rehabilitation. Group 3 was monitored for BDNF levels initially lower than in MS patients. Results: Rehabilitation of MS patients with kinesiotherapy and sulphide baths causes a statistically higher growth of BDNF concentration than rehabilitation alone in this group of patients (p&lt;0.001). Results of neuropsychological tests of MS patients rehabilitated with kinesiotherapy and balneotherapy elements are statistically better than of patients rehabilitated with kinesiotherapy (p&lt;0.033). Conclusions: Research findings show that sulphide and hydro sulphuric baths seem to be a valuable supplement to MS patients’ rehabilitation.

Forensic neuropsychiatric evaluation of a personal injury case.

Civil litigation involving the forensic neuropsychiatric evaluation of a personal injury case requires an assessment of damages and causation. The expert witness is obliged to integrate data from three critical sources of information: the review of records; the results of neuropsychological testing; and the findings from the clinical examination. In civil litigation involving a personal injury claim, the expert witness can be expected to address causation and prognosis of any neuropsychiatric damages. We discuss the undertaking of a forensic neuropsychiatric evaluation, psychiatric disorders often encountered in personal injury litigation, provide case vignettes and describe a number of special types of forensic neuropsychiatric evaluations, for example, Workers' Compensation, VA Disability and Social Security Disability.