Neuropsychological Test Results Research Articles

Demographic and Clinical Profile of Patients with Mild Cognitive Impairment Seen at St. Luke’s Medical Center-Global City Memory Service

Introduction: Mild cognitive impairment (MCI) is a dynamic state, which has evolved into a highly defined condition due to its association with dementia syndromes. There are no published data on the demographic and clinical characteristics of MCI in the Philippines. These data will help in defining the population at risk for the condition and in modifying the factors for its prevention. Methods: From 2010 to 2019, 434 subjects were diagnosed with MCI based on the criteria published by the International Working Group on MCI last 2004. The demographic profile, vascular risk factors, and levels of Vitamin B12, Vitamin D, and homocysteine were reviewed. Results of neuropsychological tests, such as Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Mini-Mental State Exam (MMSE), and Montreal Cognitive Assessment (MoCA), were collected. The Fazekas score of the cranial magnetic resonance imaging of patients was also considered. Results: The median age was 72 years [34–97] with 58.3% females. The median years of education were 14 [4–28]. Median ADAS-Cog, MMSE, and MoCA scores were 11.3 [0–27.67], 27 [13–30], and 21 [7–30], respectively. Hypertension and dyslipidemia were present in 66.8% and 64.1%, respectively. Normal homocysteine, Vitamin B12, and Vitamin D levels were found in 64.2%, 59.8%, and 48.8%, respectively. The median Fazekas score was 1 (59.4%). Conclusion: This is the first study to document the demographic and clinical profile of Filipinos with MCI in a clinical setting. This review serves as a foundation for increased understanding of MCI with the ultimate goal of controlling the factors which may impact its prevention.

Thyroid Dysfunction, Vitamin B12, and Folic Acid Deficiencies Are Not Associated With Cognitive Impairment in Older Adults in Lima, Peru.

Background: Reversible etiologies of cognitive impairment are common and treatable, yet the majority of mild cognitive impairment (MCI) and dementia research in Latin America has focused on irreversible, neurodegenerative etiologies.Objective: We sought to determine if thyroid dysfunction and vitamin B12 and folate deficiencies are associated with cognitive disorders among older adults with memory complaints in Lima, Peru.Methods: This was a retrospective review of patients who presented for cognitive evaluations to a multidisciplinary neurology clinic in Lima, Peru from January 2014 to February 2020. We included individuals aged ≥60 years, native Spanish-speakers, with at least a primary school educational level and a complete clinical assessment. Patients had either subjective cognitive decline (SCD), MCI, or dementia. One-way ANOVA and multiple logistic regression analyses were performed.Results: We included 720 patients (330 SCD, 154 MCI, and 236 dementia); the dementia group was significantly older [mean age SCD 69.7 ± 4.1, dementia 72.4 ± 3.7 (p = 0.000)] and had lower folate levels than SCD patients. The MCI group had higher free T3 levels compared with SCD patients. Those with lower TSH had greater dementia risk (OR = 2.91, 95%CI: 1.15–6.86) but not MCI risk in unadjusted models. B12 deficiency or borderline B12 deficiency was present in 34% of the dementia group, yet no clear correlation was seen between neuropsychological test results and B12 levels in our study. There was no association between MCI or dementia and thyroid hormone, B12 nor folate levels in adjusted models.Conclusion: Our findings do not support an association between metabolic and endocrine disorders and cognitive impairment in older Peruvians from Lima despite a high prevalence of B12 deficiency. Future work may determine if cognitive decline is associated with metabolic or endocrine changes in Latin America.

Exploring Neurocognitive Performance Differences in Military Aviation Personnel.

INTRODUCTION: Military aeromedical evaluations are common, but specialized neuropsychological norms for aviation personnel are sparse, resulting in a need to rely on norms from the general population. Little has been published regarding aviation subpopulations and how their neuropsychological profiles may differ from general population normative data. This study investigated neuropsychological test results of aeromedical service members to evaluate consistency with general population norms, and to delineate differences between aviation subpopulations.METHODS: Analyses were conducted on demographic variables and test scores of military aviators (N 26) and nonaviator crewmembers (N 36) referred for evaluation due to a clinical problem requiring a waiver for flight status. Performance differences between subsamples were investigated with general linear modeling. Base rates for low scores were described.RESULTS: Mean test scores in both subsamples were 0 to 1 standard deviation (SD) above the general populations means, with the largest discrepancies being found on measures of visuospatial ability (crewmembers) and verbal learning (aviators). Modeling revealed a significant difference between aviators and crewmembers on Trail Making Test Part B, after accounting for education. Aviators produced fewer low scores than crewmembers, even when using education adjusted normative data.DISCUSSION: Results suggest the cognitive profile of aviators is uniquely strong in specific domains, with fewer low scores. The development of aviator-specific norms may enhance sensitivity to cognitive decrements in this population. Future studies might separately assess crewmember roles to further assess cognitive performance standards across specialties.Maltez-Laurienti A, Minniear A, Moore R, McGovern T, Newman P, Brearly T. Exploring neurocognitive performance differences in military aviation personnel. Aerosp Med Hum Perform. 2021; 92(9):702709.

A-108 Psychological and Sociodemographic Challenges, but Not History of Mild Traumatic Brain Injury, Is Associated with Criminal Justice Involvement among Veterans and Service Members

Abstract Objective Examine factors associated with history of arrests and felony incarceration among Veterans and Service Members (V/SM) with combat exposure. Method Participants were V/SM who completed a baseline assessment for the multicenter Chronic Effects of Neurotrauma Consortium study (N = 1555). Most were male (87%), white (72%), with a mean age of 40 years (SD = 9.71). The majority (83%) reported a history of ≥1 mild traumatic brain injury (mTBI), with thirty-five present of those experiencing 3+ mTBIs. Results Three groups were composed based on self-reported level of involvement with the criminal justice system: 1.) No history of arrests or incarcerations (65%), 2.) A lifetime history of arrest but no felony incarceration (32%), and 3.) A lifetime history of felony incarceration (3%). Chi-square and Kruskal-Wallis H tests revealed statistically significant differences between the groups in demographic factors including the incarcerated group having younger age, greater percentage of men, lower education, and greater percentage of never being married, followed by the arrest group and then the no arrest group (all p < 0.05). The incarcerated group also had the highest level of posttraumatic stress disorder (PTSD) symptoms, lowest social support, and greatest percentage of hazardous alcohol consumption, followed by the arrest and then the no arrest groups (all p < 0.05). No differences were found between groups for mTBI history or neuropsychological testing results. Conclusions Correlates of legal involvement among V/SM span demographic and psychological dimensions. Some correlates are modifiable, including social support, PTSD symptoms, and alcohol consumption. Addressing these modifiable risk factors is critical to lower the risk of future criminal justice involvement.

A-51 The Effect of Acculturation on Neuropsychological Test Performance; a Systematic Review

Abstract Objective While neuropsychological testing is often seen as an unbiased form of measuring brain function, recent literature has emerged detailing possible effects of cultural competence on test performance (Fernandez, 2018). This systematic review examined the effects of acculturation on neuropsychological tests across domains and populations in existing literature. We anticipated that “verbal” tests would be more affected by acculturation, and we were unsure if specific patient populations or ethnic groups would be more affected. Data Selection A preliminary search for articles of acculturation and neuropsychological performance was conducted; Search terms included acculturat* (acculturation, acculturate), cultural assimilation* (assimilate, assimilation), neuropsychological test (test performance), and cognitive domains (cognition, intelligence, learning, memory). Over 10,000 studies were screened; the 39 studies included in analysis had quantitative data only, adult populations (18+), an acculturation measure or proxy (place of birth, length of time in the US, and English language use/proficiency), and relational data between neuropsychological test performance and acculturation. Data synthesis A narrative synthesis of included articles was performed prior to data extraction; data extracted from these articles include unadjusted correlation coefficients, partial correlation, regression model outputs, and descriptive statistics. Results are still being compiled but initial findings suggest that generally, increased acculturation leads to better performance. Conclusion Initial results show that increased acculturation to “white America,” leads to better neuropsychological test performances. This effect is more noticeable on verbal tests. Results of this review will be beneficial in understanding how cultural bias may negatively influence the accuracy of neuropsychological test results.

Inflammatory Biomarkers Aid in Diagnosis of Dementia.

Dual pathology of Alzheimer's disease (AD) and vascular cognitive impairment and dementia (VCID) commonly are found together at autopsy, but mixed dementia (MX) is difficult to diagnose during life. Biological criteria to diagnose AD have been defined, but are not available for vascular disease. We used the biological criteria for AD and white matter injury based on MRI to diagnose MX. Then we measured multiple biomarkers in CSF and blood with multiplex biomarker kits for proteases, angiogenic factors, and cytokines to explore pathophysiology in each group. Finally, we used machine learning with the Random forest algorithm to select the biomarkers of maximal importance; that analysis identified three proteases, matrix metalloproteinase-10 (MMP-10), MMP-3 and MMP-1; three angiogenic factors, VEGF-C, Tie-2 and PLGF, and three cytokines interleukin-2 (IL-2), IL-6, IL-13. To confirm the clinical importance of the variables, we showed that they correlated with results of neuropsychological testing.

Oxygen Enrichment Mitigates High-Altitude Hypoxia-Induced Hippocampal Neurodegeneration and Memory Dysfunction Associated with Attenuated Tau Phosphorylation.

Cai, Jing, Junyong Ruan, Xi Shao, Yuanjun Ding, Kangning Xie, Chi Tang, Zedong Yan, Erping Luo, and Da Jing. Oxygen enrichment mitigates high-altitude hypoxia-induced hippocampal neurodegeneration and memory dysfunction associated with attenuated tau phosphorylation. High Alt Med Biol. 22:274-284, 2021. Background: Brain is predominantly vulnerable to high-altitude hypoxia (HAH), resulting in neurodegeneration and cognitive impairment. The technology of oxygen enrichment has proven effective to decrease the heart rate and improve the arterial oxygen saturation by reducing the equivalent altitude. However, the efficacy of oxygen enrichment on HAH-induced cognitive impairments remains controversial based on the results of neuropsychological tests, and its role in HAH-induced hippocampal morphological and molecular changes remains unknown. Therefore, this study aims to systematically investigate the effects of oxygen enrichment on the memory dysfunction and hippocampal neurodegeneration caused by HAH. Materials and Methods: Fifty-one male Sprague-Dawley rats were equally assigned to three groups: normal control, HAH, and HAH with oxygen enrichment (HAHO). Rats in the HAH and HAHO groups were exposed to hypoxia for 3 days in a hypobaric hypoxia chamber at a simulated altitude of 6,000 m. Rats in the HAHO group were supplemented with oxygen-enriched air, with 12 hours/day in the hypobaric hypoxia chamber. Results: Our results showed that oxygen enrichment improved the locomotor activity of HAH-exposed rats. The Morris water maze test revealed that oxygen enrichment significantly ameliorated HAH-induced spatial memory deficits. Oxygen enrichment also improved morphological alterations of pyramidal cells and the ultrastructure of neurons in the hippocampal CA1 region in rats exposed to acute HAH. Tau hyperphosphorylation at Ser396, Ser262, Thr231, and Thr181 was also significantly attenuated by oxygen enrichment in HAH-exposed rats. Conclusions: Together, our study reveals that oxygen enrichment can ameliorate HAH-induced cognitive impairments associated with improved hippocampal morphology and molecular expression, and highlights that oxygen enrichment may become a promising alternative treatment against neurodegeneration for humans ascending to the plateau.

Brain-responsive corticothalamic stimulation in the pulvinar nucleus for the treatment of regional neocortical epilepsy: A case series.

Drug‐resistant focal epilepsy with regional neocortical seizure onsets originating from the posterior quadrant can be particularly difficult to treat with resective surgery due to the overlap with eloquent cortex. Published reports indicate that corticothalamic treatment targeting the anterior or centromedian nucleus of the thalamus with direct brain‐responsive stimulation may be an effective approach to treat regional neocortical epilepsy. The pulvinar has remained largely unstudied as a neurostimulation target to treat refractory epilepsy. Because the pulvinar has connections with the posterior quadrant, neurostimulation may be effective if applied to seizures originating in this area. We performed a retrospective chart review of patients with regional neocortical seizure onsets in the posterior quadrant treated with the RNS System. Demographics, epilepsy history, clinical seizure frequencies, and neuropsychological testing results were obtained from the chart. Electrocorticogram (ECoG) records stored by the RNS System were reviewed to evaluate electrographic seizure onset patterns. Our patients were followed for 10, 12.5, and 15 months. All patients were responders (≥50% seizure reduction), and two of the three patients experienced a ≥90% reduction in seizures at the last follow‐up. Pre‐ and postsurgical neuropsychological evaluations were compared for two of the patients, and there was no evidence of cognitive decline found in either patient. Interestingly, mild cognitive improvements were reported. The third patient had only postimplant neuropsychological testing data available. Findings for this patient suggested executive dysfunction that was present prior to the RNS System which did not worsen with surgery. A visual inspection of ECoGs revealed near‐simultaneous seizure onsets in neocortical and pulvinar leads in two patients. Seizure onsets in the third patient were more variable. This is the first published report of brain‐responsive neurostimulation targeting the pulvinar to treat refractory regional onset epilepsy of posterior quadrant origin.

Effects of Combined and General Anesthesia on Cognitive Functions for Patients Undergoing Cardiac Surgery Under CPB.

Patients may experience a variety of neurological complications after heart surgery. The most common complication observed in clinical practice is delayed neurocognitive recovery (dNCR). The role of the anesthesiologist is very important, as the risk of dNCR may be reduced, depending on the anesthesia tactic chosen. Although the possibility that neuropsychological complications are less common in patients undergoing combined anesthesia (general + epidural) than in patients undergoing general anesthesia is not yet confirmed, the results are being discussed. The aim of this study was to determine impact of combined anesthesia (general + epidural) on cognitive functions of patients after cardiac surgery. The prospective, case-controlled study included 80 patients undergoing cardiac surgery from 2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. After approval from the local bioethics center, informed consent was obtained from all study participants. Inclusion criteria were age 51 to 80 years, elective cardiac surgery, left ventricular ejection fraction > 35%, anamnesis of not using agents affecting the central nervous system, absence of neuropathology, and sufficient renal function. Exclusion criteria were patients suffering from diseases causing cognitive function or using agents affecting the central nervous system, emergency or re-surgery, carotid artery atherosclerosis with artery diameter 50 or more percent reduction, and a patient's disagreement. MMSE test and 6-CIT test were used for a cognitive function assessment, Trail making test and WAIS Digital Symbol Substitution test were used for psychomotor function assessment. All tests were used a day before surgery and seven days after surgery. According to the planned anesthesia, patients were assigned into two groups: 1 - combined general + epidural anesthesia and 2 - general anesthesia. Standardized protocol of anesthesia was followed for all patients. Preoperative patients and surgery factors, preoperative and postoperative neuropsychological test results were recorded. Eighty patients were enrolled in the study. Both groups did not differ in demographic, perioperative values, and baseline (preoperative) test results. Postoperative (7th day) WAIS (P = .042) and 6-item cognitive impairment (P = .016) test results were statistically different when comparing the GA and CA groups. Comparing preoperative and postoperative test results, there was a significant decline in the WAIS test score in the GA group (P = .013).

Drinking coffee enhances neurocognitive function by reorganizing brain functional connectivity

The purpose of this study was to identify the mechanisms underlying effects of coffee on cognition in the context of brain networks. Here we investigated functional connectivity before and after drinking coffee using graph-theoretic analysis of electroencephalography (EEG). Twenty-one healthy adults voluntarily participated in this study. The resting-state EEG data and results of neuropsychological tests were consecutively acquired before and 30 min after coffee consumption. Graph analyses were performed and compared before and after coffee consumption. Correlation analyses were conducted to assess the relationship between changes in graph measures and those in cognitive function tests. Functional connectivity (FC) was reorganized toward more efficient network properties after coffee consumption. Performance in Digit Span tests and Trail Making Test Part B improved after coffee consumption, and the improved performance in executive function was correlated with changes in graph measures, reflecting a shift toward efficient network properties. The beneficial effects of coffee on cognitive function might be attributed to the reorganization of FC toward more efficient network properties. Based on our findings, the patterns of network reorganization could be used as quantitative markers to elucidate the mechanisms underlying the beneficial effects of coffee on cognition, especially executive function.

Allogenic hematopoietic stem cell transplantation in two siblings with adult metachromatic leukodystrophy and a systematic literature review.

Two siblings were diagnosed with adult metachromatic leukodystrophy (MLD) and treated with hematopoietic stem cell transplantation (HSCT). While the older sibling was symptomatic at the time of diagnosis, her younger brother was diagnosed and transplanted at the presymptomatic state. We describe patients' clinical, biochemical, and genetic features, as well as neuropsychological and neurophysiological test results, and brain magnetic resonance imaging from pretransplantation and posttransplantation assessments. Both patients converted to complete donor chimerism and arylsulfatase A levels normalized 3 months posttransplantation. Twelve months posttransplantation, neurological and neuropsychological assessment for both patients showed stabilization, and they remained stable for the 38 months long observation period. To assess the effect of HSCT used as treatment for the rare, adult MLD subtype on survival and stabilization, we performed a systematic literature review and included 7 studies with a total of 26 cases. Of these 26 cases, 6 patients died of HSCT‐related complications and 2 patients had graft rejection. Of the remaining 18 patients, 2 patients improved after HSCT, 13 patients stabilized, and 3 patients progressed, suggesting that HSCT potentially benefits adult MLD patients. Larger studies focusing on this subtype are needed and recommendations on criteria for HSCT in adult MLD need to be evolved.

The Role of Self- and Informant-Reports on Symptoms and Impairments in the Clinical Evaluation of Adult ADHD

Little is known about which clinical features may aid the differentiation between attention deficit hyperactivity disorder (ADHD) and other clinical conditions. This study seeks to determine the role of self- and informant reports on symptoms and impairments in the clinical evaluation of adult ADHD and explore their association with objective neuropsychological test performance by examining data of 169 outpatients referred for a diagnostic evaluation of adult ADHD. Participants were assigned either to an ADHD group (ADHD, n = 73) or one of two clinical comparison groups, depending on whether they show indications (Clinical Comparison Group, CCG, n = 53) or no indications (Clinical Comparison Group—Not Diagnosed, CCG-ND, n = 43) of psychiatric disorders other than ADHD. All participants and their informants completed a set of questionnaires. Compared to the CCG-ND, the ADHD group obtained significantly higher scores on ADHD symptoms, impulsivity, cognitive deficits, and anxiety. Compared to the CCG, the ADHD group scored significantly higher on ADHD symptoms but lower on depression. Further regression analyses revealed that self- and informant reports failed to predict neuropsychological test performance. Self- and informant reported information may be distinct features and do not correspond to results of objective neuropsychological testing.

American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term ‘malingering.’ Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.

Psychiatric rehabilitation: An innovative program of integrative neurocognitive remediation therapy for patients with cognitive dysfunction

IntroductionNeurocognitive dysfunction is associated with important socio-professional consequences and diminished quality of life. In the Neurocognitive Remediation Clinic of the Centre Hospitalier Universitaire Brugmann (Brussels, Belgium), patients suffering from neurocognitive dysfunctions related to common mental disorders (e.g. psychotic, mood, adjustment disorders) are considered for Neurocognitive Remediation Therapy (NCRT), combining personalized computerized cognitive training and strategy training, with group sessions of physical rehabilitation and cognitive behavior therapy.ObjectivesThis cross-sectional study aims to assess the efficacy of a 12 week (1day/week) NCRT program organized within the day clinic.MethodsPatients who completed the NCRT between March 2018 and June 2019 were eligible to participate. Efficacy was assessed using the cognitive failure questionnaire (CFQ) and a 17-item questionnaire assessing daily functioning. Current scores on the CFQ were compared to the scores before and after NCRT. Additionally NCF was retrospectively assessed through the neuropsychological test results before and after NCRT.ResultsOf the eligible 38 patients, 27 consented to participate (18 women/9 men); median age was 52 years, range (29-61); median time since stop NCRT was 7 months, range (4-17). Twenty patients (80%) reported improvement in daily function. Subjective neurocognitive function improved significantly immediately after NCRT (t=2.681, df=23, p=0.013) and remained stable at time of assessment (t=2.775, df=24, p=0.011). After NCRT at least 1 neuropsychological subtest normalized in 25 patients (96.15%). Divided attention, long-term visual memory and planning improved in respectively 80%, 75% and 75% of the patients.ConclusionsOur innovative integrative program improves neuropsychological performances and sustainably ameliorate subjective neurocognitive and daily function.DisclosureNo significant relationships.

A mixed-methods study of cognitive performance in persons with multiple sclerosis: Association between neuropsychological test performance and interviews about daily cognitive functioning

BackgroundCognitive difficulties are commonly reported in persons with multiple sclerosis (MS), however, self-reports of cognition often do not correspond well to objective neuropsychological test performance. The use of qualitative interviews can allow for persons with MS to describe in more detail how their cognitive function is impacted in daily life while also taking into consideration personal and environmental influences. No study to our knowledge has examined the association between objective neuropsychological test performance and qualitative interview reports of daily cognitive function. Such information could help explain the reported lack of correspondence between these two methods of evaluating cognitive function in MS. ObjectiveTo investigate the relationship between objective neuropsychological test performance and qualitative interview reported daily cognitive function in persons with MS . MethodsConvergent parallel mixed-methods design whereby 12 persons with MS (mean age= 47, 9 female, 7 relapsing-remitting MS) took part in a 2-hour neuropsychological assessment [including the Brief International Cognitive Assessment for MS (BICAMS)] followed by a semi-structured qualitative interview probing daily cognitive functioning. Interview data were analysed using thematic analysis. Interview codes and themes were compared with neuropsychological performance on respective cognitive domains and between those with and without cognitive impairment on the BICAMS. ResultsBased on the qualitative interview data, the most commonly reported difficulties were related to memory, word finding, and processing speed but only 43%, 0%, and 33% of the individuals reporting these deficits actually demonstrated impairment on the respective/ corresponding neuropsychological measures. Eleven of the twelve participants reported the use of strategies to manage cognitive difficulties. The most frequently reported strategies used were related to fatigue management. Personal (age, fatigue) and environmental factors (pressure of daily responsibilities, availability of support) were reported as influencers of daily cognitive function. Three of the 12 participants were classified as cognitively impaired on the BICAMS but they did not differ from those who were non-impaired with respect to use of strategies, and influence of personal and environmental factors on daily cognitive functioning. ConclusionsInterview-reported daily cognitive difficulties did not correspond well to objective neuropsychological performance. Greater emphasis should be placed on utilizing and developing objective neuropsychological measures that have greater sensitivity, particularly to word finding difficulties in MS, and to the incorporation of personal and environmental factors into the interpretation of neuropsychological test results. As almost all participants reported the use of cognitive strategies, we feel greater emphasis needs to be placed on patient education of evidence-based strategies, particularly focused on highly reported impacted word finding and processing speed abilities.

Thalamocortical Functional Connectivity in Patients With White Matter Hyperintensities.

Background: White matter hyperintensities (WMH)s is a very common neuroradiological manifestation in the elderly and is an increased risk of dementia and cognitive decline. As we all know, the thalamocortical circuit plays an important part in cognition regulation. However, the role of this circuit in WMHs and its related cognitive deficits is still unclear.Method: Eighty WMH patients and 37 healthy controls (HCs) were enrolled in the current study. WMH patients were divided into a mild WMH group (n = 33) and moderate-severe WMH group (n = 47) according to Fazekas scores. Resting-state functional magnetic resonance imaging (rs-fMRI) data of all participants were collected for thalamocortical functional connectivity (FC) analysis. The analysis was performed in two steps. First, the whole cerebral cortex was divided into six regions of interest (ROIs), which were used as seeds to investigate the changes of FC with the thalamus. Then, the subregion of the thalamus generated in the previous step was used as the seed for FC analysis with the whole brain.Results: In the first step of FC analysis, it was found that precentral gyrus (PrCG)-interthalamic adhesion (ITA) FC values in moderate-severe WMH group were higher than those in HC and mild WMH groups. However, when compared with the HC group, the increase of PrCG-ITA FC values in mild WMH group was not statistically significant. In the second step of FC analysis, the ITA was set as the seed, and compared with the HC group, the results showed that the FC values of the ITA-medial frontal gyrus (MFG) in mild group and moderate-severe WMH groups were significantly increased. In addition, the FC values in moderate-severe group were significantly higher than those in mild group. Finally, it was also found that FC values (PrCG-ITA and ITA-MFG) were significantly correlated with neuropsychological test results for multiple cognitive functions such as memory, execution and attention in WMH patients.Conclusion: Abnormal thalamocortical FC was closely related with cognitive impairments in WMH patients.

Neurocognitive Effects of Chemotherapy for Colorectal Cancer: A Systematic Review and a Meta-Analysis of 11 Studies.

PurposeChemotherapy-related cognitive impairment (CRCI) is a controversial concept not much explored on colorectal cancer patients.Materials and MethodsWe identified 11 prospective studies: eight studies on 696 colorectal cancer patients who received chemotherapy and three studies on 346 rectal cancer patients who received neoadjuvant chemoradiotherapy. Standardized mean differences (SMDs) of neuropsychological test results and the cognitive quality-of-life scale were calculated using random effect models. A meta-regression was conducted to investigate the association between mean study population age and effect sizes.ResultsThe association between chemotherapy and cognitive impairment was not clear in colorectal cancer patients (SMD, 0.003; 95% confidence interval, −0.080 to 0.086). However, a meta-regression showed that older patients are more vulnerable to CRCI than younger patients (β=–0.016, p < 0.001).ConclusionChemotherapy has an overall positive negligible effect size on the cognitive function of colorectal patients. Age is a significant moderator of CRCI.

Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age

ABSTRACT Objective To investigate demographic and pre-injury factors in Finnish school-aged children admitted to pediatric neurology services after mild traumatic brain injury (mTBI). The relation of these factors to prolonged injury symptoms and later visits into psychiatric care was assessed. Methods Demographic information, pre-injury learning status, and neuropsychological test results of 120 patients aged 7–16 years were retrospectively collected from the hospital medical records. Data were compared with self- or parent-reported injury symptoms at 1–3 months post-injury and later visits to psychiatric care. Results According to medical records, 14.2% of the children with mTBI had a diagnosed neurobehavioral or psychiatric condition pre-injury. Additionally, 53.3% of the children had some neurobehavioral or psychiatric concerns or traits prior to the injury. Over half (56.7%) of the children studied were symptomatic at 1–3 months following the injury. Female gender and presence of prolonged symptoms were predictive for later visit into psychiatric care. Conclusions Pre-injury neurobehavioral or psychiatric problems may predict prolonged injury symptoms following pediatric mTBI. In this retrospective patient series, prolonged symptoms and female gender seem to predict the need for later psychiatric care. Monitoring the recovery of children with mTBI and pre-injury risk factors is important for timely interventions.

Specific Cognitive Changes due to Hippocalcin Alterations? A Novel Familial Homozygous Hippocalcin Variant Associated with Inherited Dystonia and Altered Cognition.

Recent research suggested an hippocalcin (HPCA)-related form of DYT2-like autosomal recessive dystonia. Two reports highlight a broad spectrum of the clinical phenotype. Here, we describe a novel HPCA gene variant in a pediatric patient and two affected relatives. Whole exome sequencing was applied after a thorough clinical and neurological examination of the index patient and her family members. Results of neuropsychological testing were analyzed. Whole exome sequencing revealed a novel homozygous missense variant in the HPCA gene [c.182C>T p.(Ala61Val)] in our pediatric patient and the two affected family members. Clinically, the cases presented with dystonia, dysarthria, and jerky movements. We observed a particular cognitive profile with executive dysfunctions in our patient, which corresponds to the cognitive deficits that have been observed in the patients previously described. We present a novel genetic variant of the HPCA gene associated with autosomal recessive dystonia in a child with childhood-onset dystonia supporting its clinical features. Furthermore, we propose specific HPCA-related cognitive changes in homozygous carriers, underlining the importance of undertaking a systematic assessment of cognition in HPCA-related dystonia.

Reproducibility and replicability of high-frequency, in-home digital biomarkers in reducing sample sizes for clinical trials.

IntroductionReproducibility and replicability of results are rarely achieved for digital biomarkers analyses. We reproduced and replicated previously reported sample size estimates based on digital biomarker and neuropsychological test outcomes in a hypothetical 4‐year early‐phase Alzheimer's disease trial.MethodsOriginal data and newly collected data (using a different motion sensor) came from the Oregon Center for Aging & Technology (ORCATECH). Given trajectories of those with incident mild cognitive impairment and normal cognition would represent trajectories of the control and experimental groups in a hypothetical trial, sample sizes to provide 80% power to detect effect sizes ranging from 20% to 50% were calculated.ResultsFor the reproducibility, identical P‐values and slope estimates were found with both digital biomarkers and neuropsychological test measures between the previous and current studies. As for the replicability, a greater correlation was found between original and replicated sample size estimates for digital biomarkers (r = 0.87, P < .001) than neuropsychological test outcomes (r = 0.75, P < .001).DiscussionReproducibility and replicability of digital biomarker analyses are feasible and encouraged to establish the reliability of findings.