Verbal Fluency Test Scores Research Articles

Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial

Background: Recent evidence has indicated that flavanol consumption may have many health benefits in humans, including improved cognitive activities.Objective: The aim was to evaluate the effect of flavanol consumption on cognitive performance in cognitively intact elderly subjects.Design: This was a double-blind, controlled, parallel-arm study conducted in 90 elderly individuals without clinical evidence of cognitive dysfunction who were randomly assigned to consume daily for 8 wk a drink containing 993 mg [high flavanol (HF)], 520 mg [intermediate flavanol (IF)], or 48 mg [low flavanol (LF)] cocoa flavanols (CFs). Cognitive function was assessed at baseline and after 8 wk by using the Mini-Mental State Examination (MMSE), the Trail Making Test (TMT) A and B, and the Verbal Fluency Test (VFT).Results: The changes in MMSE score in response to the 3 different treatments were not different. In contrast, there was a positive impact of the intervention on specific aspects of cognitive function. Mean changes (±SEs) in the time required to complete the TMT A and B after consumption of the HF (−8.6 ± 0.4 and −16.5 ± 0.8 s, respectively) and IF (−6.7 ± 0.5 and −14.2 ± 0.5 s, respectively) drinks significantly (P < 0.0001) differed from that after consumption of the LF drinks (−0.8 ± 1.6 and −1.1 ± 0.7 s, respectively). Similarly, VFT scores significantly improved among all treatment groups, but the magnitude of improvement in the VFT score was significantly (P < 0.0001) greater in the HF group (7.7 ± 1.1 words/60 s) than in the IF (3.6 ± 1.2 words/60 s) and LF (1.3 ± 0.5 words/60 s) groups. Significantly different improvements in insulin resistance (P < 0.0001), blood pressure (P < 0.0001), and lipid peroxidation (P = 0.001) were also observed for the HF and IF groups in comparison with the LF group. Changes in insulin resistance explained ∼17% of changes in composite z score (partial r2 = 0.1703, P < 0.0001).Conclusions: This dietary intervention study provides evidence that regular CF consumption can reduce some measures of age-related cognitive dysfunction, possibly through an improvement in insulin sensitivity. These data suggest that the habitual intake of flavanols can support healthy cognitive function with age. This trial was registered at www.controlled-trials.com as ISRCTN68970511.

Abnormalities of the uncinate fasciculus correlate with executive dysfunction in patients with left temporal lobe epilepsy

ObjectiveTo evaluate executive deficits in patients with left temporal lobe epilepsy (TLE) and to analyze the association of executive deficits and diffusion tensor imaging (DTI) parameters of the uncinate fasciculus. MethodsThis study included 14 adult left TLE patients and 15 healthy controls. Executive function was examined using neuropsychological tests, including the Stroop color–word, digit span, digit symbol, trail-making test, and verbal fluency tests. All subjects underwent brain DTI. ResultsCompared with controls, TLE patients needed significantly more time (P=0.036) and had more wrong answers (P<0.001) in the Stroop test, and exhibited significantly lower scores in the digit span (P=0.017), digit symbol (P=0.009), and verbal fluency (P=0.001) tests. Additionally, TLE patients took significantly longer to accomplish the trail-making test (P=0.042). Fractional anisotropy (FA) of the left uncinate fasciculus in TLE patients was significantly lower compared to controls (P<0.001). FA of the left uncinate fasciculus in TLE patients and controls positively correlated with verbal fluency (r=0.565, P=0.035; r=0.561, P=0.031) and digit span (r=0.556, P=0.039; r=0.559, P=0.030) test scores. ConclusionsPatients with left TLE exhibit wide ranges of executive deficits. Abnormal FA values in the left UF ipsilateral to the epileptogenic zone suggest that disrupted integrity in the left uncinate fasciculus is related to executive deficits in patients with left TLE.

Graph analysis of verbal fluency test discriminate between patients with Alzheimer's disease, mild cognitive impairment and normal elderly controls.

Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment—subtypes amnestic (aMCI) and amnestic multiple domain (a+mdMCI)—and patients with Alzheimer's disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGA). The individuals were compared when divided in three (NC—MCI—AD) and four (NC—aMCI—a+mdMCI—AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.

Neuropsychological and psychiatric assessments following bilateral deep brain stimulation of the subthalamic nucleus in Japanese patients with Parkinson’s disease

The physical benefits of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) patients are well documented, but the mental benefits are uncertain, particularly in Japanese patients. This study evaluated the clinical and neuropsychological characteristics before and after STN-DBS surgery in Japanese PD patients. PD patients (n=13, age 67.0±7.8years) were evaluated pre-surgery (baseline) and at 1 and 6months post-surgery by two trained psychiatrists. The motor symptoms were assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. The neuropsychological and psychiatric tests performed were the Mini-Mental State Examination, the Wisconsin Card Sorting Test (WCST), the Verbal Fluency Test (VFT), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HAM-A). The UPDRS motor score (p<0.001) and HAM-A score (p=0.004) showed significant improvement at 1month post-surgery, but a significant decline was observed in the WCST total error (p=0.005) and the semantic VFT score (p<0.001). The phonetic VFT also showed a substantial decline (p=0.015) at 1month post-surgery. At 6months post-surgery, the improvement in the UPDRS motor score was maintained, and the scores on the neuropsychological and psychiatric tests had returned to baseline. Although bilateral STN-DBS did not appear to have long-term effects on neuropsychological and psychiatric outcomes, the microlesion effects associated with STN-DBS appear to increase the risk of transient cognitive and psychiatric complications. These complications should be monitored by careful observation of neurological and psychiatric symptoms.

Effects of fluoxetine on brain-derived neurotrophic factor serum concentration and cognition in patients with vascular dementia

BackgroundSelective serotonin reuptake inhibitors improve cognition in patients with stroke and increase the expression of brain-derived neurotrophic factor (BDNF) in the rat hippocampus. However, the effects of selective serotonin reuptake inhibitors on cognition and serum BDNF levels in patients with vascular dementia are largely unknown. We performed an open-label study to investigate the effects of fluoxetine, a selective serotonin reuptake inhibitor, on cognition and serum BDNF levels in patients with vascular dementia.MethodsFifty patients with vascular dementia were randomly allocated to receive fluoxetine (20 mg/day; n=25) or no fluoxetine (control group; n=25) for 12 weeks. Both groups received secondary prevention of stroke. Serum BDNF level, Mini-Mental State Examination (MMSE) score, Ten-Point Clock Drawing score, and Digit Span Test and Verbal Fluency Test scores were measured at baseline and at week 12 in the both groups.ResultsThe baseline serum BDNF level correlated significantly with the MMSE score. MMSE score, Ten-Point Clock Drawing score, and serum BDNF level increased significantly in the fluoxetine group but not in the control group. The increase in serum BDNF level correlated with the increase in MMSE score in the fluoxetine group.ConclusionFluoxetine may potentially improve cognition in patients with vascular dementia and requires further investigation. BDNF may play an important role in cognitive recovery.

Administering Design Fluency Tests in School-aged Children: Analyses of Design Productivity over Time, Clustering, and Switching

This study investigated the effects of child-related factors (age, sex, and intellectual abilities) upon design fluency (DF) test scores. A DF test, a semantic verbal fluency (VF) test, and a Block Design test, as a proxy of intelligence, were administered to N = 80 healthy native Dutch-speaking children aged 8.45–12.82 years. Three components of DF performance were examined, i.e., design productivity over time, clustering (i.e., generating designs that share visual-spatial similarities, such as addition, deletion, or rotation), and switching (i.e., shifting between strategies that children use to draw the designs). The relation between DF design productivity over time and age was curvilinear, that is, improvements in test scores were much more pronounced for younger children than for older children. No (curvi)linear age effects were found in DF productivity scores, clustering, and switching. Also, our results did not reveal a relation between intellectual abilities and DF test scores. Furthermore, DF test scores and VF test scores were only partially significant, i.e., only significant positive correlations were found between the productivity scores of the VF test and the DF test. Finally, higher order sex by age interactions were found in all DF test scores, i.e., girls <10.5 years produced more designs, made longer clusters, and switched less than boys. Opposite sex differences were found for children >10.5 years. This illustrates the utility of combining quantitative scoring procedures with in-depth clustering and switching to understand interactions between age and sex during DF tests.

Cognitive predictors for five-year conversion to dementia in community-dwelling Chinese older adults

This study evaluates which cognitive measure is best for predicting incident dementia in a population-based random sample of Chinese older adults without dementia over a five-year period. A total of 787 community-dwelling Chinese older adults without dementia in Hong Kong were assessed at baseline (T0), at two years (T1), and at five years (T2). The annual conversion rate to dementia was 1.6% and 6.3% for baseline normal participants and baseline mild cognitive impairment (MCI) participants, respectively. The Cantonese version of Mini-mental State Examination (CMMSE) scores declined significantly over time. In participants who progressed to dementia, Category Verbal Fluency Test (CVFT) scores dropped significantly from T0 to T1. A 1-SD drop of either CMMSE or CVFT in two years predicted dementia at five years with 91.5% sensitivity and 62.0% specificity. A stable CMMSE and CVFT at two years predicted a 91% chance of not progressing to clinical dementia at five years. In this community sample of Chinese older adults, a decline in cognitive screening tests in short term (two years) offered useful information in predicting dementia conversion over a longer period.

Atrophy of the left dorsolateral prefrontal cortex is associated with poor performance in verbal fluency in elderly poststroke women.

This study aimed to investigate the association between atrophy in the prefrontal cortex with executive function and verbal fluency in elderly male and female patients poststroke. Thirty elderly female patients with non-aphasic ischemic stroke aged ≥ 60 years and 30 age-matched non-aphasic male patients with ischemic stroke were recruited. Automatic magnetic resonance imaging segmentation was used to assess the volume of the whole prefrontal cortex, along with its subdivisions: anterior cingulate cortex, orbitofrontal cortex and dorsolateral prefrontal cortex. The Semantic Verbal Fluency Test was administered at 3 and 15 months poststroke. At 3 months poststroke, left dorsolateral prefrontal cortex volume was significantly correlated with Verbal Fluency Test score in female patients only (partial coefficient = 0.453, P = 0.045), after controlling for age, education, diabetes, neurological deficit, white matter lesions volume, as well as the location and volume of infarcts. At 15 months poststroke, there remained a significant association between the left dorsolateral prefrontal cortex volume and Verbal Fluency Test (partial coefficient = 0.661, P = 0.001) and between the left prefrontal cortex volume and Verbal Fluency Test (partial coefficient = 0.573, P = 0.004) in female patients after the same adjustments. These findings indicate that atrophy of the left dorsolateral prefrontal cortex contributes to the impairment of verbal fluency in elderly female patients with stroke. Sex differences may be present in the neuropsychological mechanisms of verbal fluency impairment in patients with stroke.

Clustering and switching during a semantic verbal fluency test contribute to differential diagnosis of cognitive impairment

The verbal fluency test (VFT) can be dissociated into "clustering" (generating words within subcategories) and "switching" (shifting between clusters), which may be valuable in differential diagnosis. In the current study, we investigated the validity of VFT in the differential diagnosis of Alzheimer's disease (AD, n = 65), vascular dementia (VaD, n = 65), mild cognitive impairment (MCI, n = 92), and vascular cognitive impairment without dementia (VCIND, n = 76) relative to cognitively normal senior controls (NC, n = 374). We found that in the NC group, the total correct score was significantly correlated with age and education; males generated more subcategories; cluster size increased with education, and subcategory and switching decreased with age. A significantly progressive advantage was observed in VFT scores in the sequence NC > MCI/VCIND > AD/VaD, and this significantly discriminated dementia patients from the other groups. AD patients performed better in all four VFT scores than VaD patients. Subcategory and switching scores significantly distinguished AD from VaD patients (AD > VaD; mean difference, 0.50 for subcategory, P <0.05; 0.71 for switching, P <0.05). MCI patients scored higher than VCIND patients, but the difference did not reach statistical significance. These results suggest that semantic VFT is useful for the detection of MCI and VCIND, and in the differential diagnosis of cognitive impairment.

Spanish normative studies in young adults (NEURONORMA young adults project): Norms for verbal fluency tests

IntroductionLexical fluency tests are frequently used in clinical practice to assess language and executive function. ObjectiveAs part of the Spanish normative studies project in young adults (NEURONORMA young adults), we provide age- and education-adjusted normative data for 3 semantic fluency tasks (animals, fruits and vegetables, and kitchen tools), three formal lexical fluency tasks (words beginning with P, M and R), three excluded-letter fluency tasks (words excluding A, E and S) and a verb fluency task. Material and methodsThe sample consisted of 179 participants who are cognitively normal and range in age from 18 to 49 years. Tables are provided to convert raw scores to scaled scores. Age- and education-adjusted scores are provided by applying linear regression techniques. ResultsThe results show that education impacted most of the verbal fluency test scores, with no effect related to age and only minimal effects related to sex. ConclusionsThe norms obtained will be extremely useful in the clinical evaluation of young Spanish adults.

The characteristics of cognitive impairment in neuromyelitis optica patients

Objective To investigate the characteristics of cognitive impairment in neuromyelitis optica(NMO) patients. Methods 12 NMO patients, 15 multiple sclerosis(MS) patients and 15 healthy people were collected and grouped as NMO group, MS group and normal control group. The five cognitive domains including working memory and information processing speed, verbal memory ability, semantic fluency, visual spatial structure and visuospatial recall ability, and executive function were evaluated respectively by the five tests, which are the 3/2 second edition of Chinese Version Auditory Continuous Addition test (PASAT3/2), the Chinese Rey Auditory Verbal Learning test (CRAVLT), Verbal Fluency test (VFT), the Rey Complex Figure test (RCFT) and the Chinese Version of the Stroop Colour-Word test (Stroop). The severity of somatic dysfunction and disability, depression, anxiety, fatigue and the sleep quality were evaluated both in NMO and MS patients by the Expanded Disability Status Scale Rating Scale (EDSS), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA), Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). Analysis of variance, Mann-Whitney and Kruskal-Wallis H test were performed to determine significant differences among three groups. Results The PASAT3 accomplishments were (33.3±9.6), (38.9±14.3), (45.5±8.6) respectively, the VFT scores were (24.8±8.7), (26.4±8.4), (31.7±4.7) respectively in NMO group, MS group and control group, and the differences of PASAT3 and VFT among three groups were significant (P 0.05). Conclusion NMO patients exist obstacle in working memory and information processing speed, semantic fluency, but still retain other aspects of the verbal memory capacity, executive function, visual-spatial structures and visual memory ability. The characteristics of cognitive impairment in NMO patients are not exactly the same as in MS patients. Key words: Neuromyelitis optica; Cognitive impairment; Multiple sclerosis

Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment

Flavanol consumption is favorably associated with cognitive function. We tested the hypothesis that dietary flavanols might improve cognitive function in subjects with mild cognitive impairment. We conducted a double-blind, parallel arm study in 90 elderly individuals with mild cognitive impairment randomized to consume once daily for 8 weeks a drink containing ≈990 mg (high flavanols), ≈520 mg (intermediate flavanols), or ≈45 mg (low flavanols) of cocoa flavanols per day. Cognitive function was assessed by Mini Mental State Examination, Trail Making Test A and B, and verbal fluency test. At the end of the follow-up period, Mini Mental State Examination was similar in the 3 treatment groups ( P =0.13). The time required to complete Trail Making Test A and Trail Making Test B was significantly ( P &lt;0.05) lower in subjects assigned to high flavanols (38.10±10.94 and 104.10±28.73 seconds, respectively) and intermediate flavanols (40.20±11.35 and 115.97±28.35 seconds, respectively) in comparison with those assigned to low flavanols (52.60±17.97 and 139.23±43.02 seconds, respectively). Similarly, verbal fluency test score was significantly ( P &lt;0.05) better in subjects assigned to high flavanols in comparison with those assigned to low flavanols (27.50±6.75 versus 22.30±8.09 words per 60 seconds). Insulin resistance, blood pressure, and lipid peroxidation also decreased among subjects in the high-flavanol and intermediate-flavanol groups. Changes of insulin resistance explained ≈40% of composite z score variability through the study period (partial r 2 =0.4013; P &lt;0.0001). To the best of our knowledge, this is the first dietary intervention study demonstrating that the regular consumption of cocoa flavanols might be effective in improving cognitive function in elderly subjects with mild cognitive impairment. This effect appears mediated in part by an improvement in insulin sensitivity.

No association between gain in body mass index across the life course and midlife cognitive function and cognitive reserve—The 1946 British birth cohort study

BackgroundThe association between lifelong body mass index (BMI) and cognitive function has not been comprehensively studied.MethodsIn more than 2000 men and women born in 1946, we tested associations between BMI gain at 15, 20, 26, 36, 43, and 53 years with respect to the previous measure (gain at age 15 years with respect to BMI at age 11 years), and semantic fluency (animal naming) and cognitive reserve (the National Adult Reading Test) at age 53 years, and verbal memory (word list recall) and speed/concentration (letter cancellation) at ages 43 and 53 years. Measures of BMI gain were adjusted in stages for childhood intelligence, education, socioeconomic position (SEP), lifestyle, and vascular risk factors.ResultsIndependent of childhood intelligence, BMI gain between ages 26 and 36 years was associated with lower memory scores (β per SD increase in BMI in men = −0.11; 95% confidence interval [CI]: −0.19, −0.02), verbal fluency (β in women = −0.11; 95% CI: −0.20, −0.02), and lower National Adult Reading Test score (β in women = −0.08; 95% CI: −0.15, −0.01), but not with speed/concentration (β in men = 0.02; 95% CI: −0.11, 0.07). Associations were largely explained by educational attainment and SEP (P ≥ .10). However, BMI gain at 53 years in men was independently associated with better memory (β = 0.12; 95% CI: 0.03, 0.22), and both underweight (β = −1.54; 95% CI: −2.52, −0.57) and obese (β = −0.30; 95% CI: −2.52, −0.57) women at 53 years had significantly lower memory scores.ConclusionThe adverse effect of higher BMI gain on midlife cognitive function and cognitive reserve is independent of childhood intelligence but not of education and SEP. The independent association between greater BMI gain in midlife and better cognitive function deserves further investigation.

Automated semantic indices related to cognitive function and rate of cognitive decline

The objective of our study is to introduce a fully automated, computational linguistic technique to quantify semantic relations between words generated on a standard semantic verbal fluency test and to determine its cognitive and clinical correlates. Cognitive differences between patients with Alzheimer’s disease and mild cognitive impairment are evident in their performance on the semantic verbal fluency test. In addition to the semantic verbal fluency test score, several other performance characteristics sensitive to disease status and predictive of future cognitive decline have been defined in terms of words generated from semantically related categories (clustering) and shifting between categories (switching). However, the traditional assessment of clustering and switching has been performed manually in a qualitative fashion resulting in subjective scoring with limited reproducibility and scalability. Our approach uses word definitions and hierarchical relations between the words in WordNet®, a large electronic lexical database, to quantify the degree of semantic similarity and relatedness between words. We investigated the novel semantic fluency indices of mean cumulative similarity and relatedness between all pairs of words regardless of their order, and mean sequential similarity and relatedness between pairs of adjacent words in a sample of patients with clinically diagnosed probable (n=55) or possible (n=27) Alzheimer’s disease or mild cognitive impairment (n=31). The semantic fluency indices differed significantly between the diagnostic groups, and were strongly associated with neuropsychological tests of executive function, as well as the rate of global cognitive decline. Our results suggest that word meanings and relations between words shared across individuals and computationally modeled via WordNet and large text corpora provide the necessary context to account for the variability in language-based behavior and relate it to cognitive dysfunction observed in mild cognitive impairment and Alzheimer’s disease.

Estudios normativos españoles en población adulta joven (proyecto NEURONORMA jóvenes): normas para los test de fluencia verbal

IntroductionLexical fluency tests are frequently used in clinical practice to assess language and executive function. ObjectiveAs part of the Spanish normative studies project in young adults (NEURONORMA young adults project), we provide age- and education-adjusted normative data for 3 semantic fluency tasks (animals, fruits and vegetables, and kitchen tools), three formal lexical fluency tasks (words beginning with P, M and R), three excluded-letter fluency tasks (words excluding A, E and S) and a verb fluency task. Material and methodsThe sample consisted of 179 participants who are cognitively normal and range in age from 18 to 49 years. Tables are provided to convert raw scores to scaled scores. Age- and education-adjusted scores are provided by applying linear regression techniques. ResultsThe results show that education impacted most of the verbal fluency test scores, with no effects related to age and only minimal effects related to sex. ConclusionsThe norms obtained will be extremely useful in the clinical evaluation of young Spanish adults.

FOTOTRANS Study. Multicentre study on the validity of Fototest under clinical practice conditions

ObjectiveFototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. Material and methodsA cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity. ResultsNineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94±0.02) than for CI (0.86±0.02). For DEM the best cut-off point was 26/27 (Sn=0.88 [95% CI, 0.93-0.97], Sp=0.87 [95% CI, 0.84–0.90]); and for CI, 28/29 (Sn=0.71 [95% CI, 0.65–0.77], Sp=0.84 [95% CI, 0.80–0.88]). Fototest showed a high and significant correlation with Eurotest (r=0.70±0.02), VFT (r=0.68±0.02) and the GDS score (r=−0.77±0.02). ConclusionThe Fototest showed adequate validity for CI and DEM in general neurology clinics in an extensive and wide geographical area.

Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica

ObjectiveFototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. Material and methodsA cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were, over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity. ResultsNineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94±0.02) than for CI (0.86±0.02). For DEM the best cut-off point was 26/27 (Sn=0.88 [95% CI, 0.93-0.97], Sp=0.87 [95% CI, 0.84-0.90]); and for CI, 28/29 (Sn=0.71 [95% CI, 0.65-0.77], Sp=0.84 [95% CI, 0.80-0.88]). Fototest showed a high and significant correlation with Eurotest (r=0.70±0.02), VFT (r=0.68±0.02) and the GDS score (r=-0.77±0.02). ConclusionThe Fototest showed adequate validity for CI and DEM in general Neurology clinics in an extensive and wide geographical area.

PATH61 Structural plasticity of white matter networks following anterior temporal lobe resection

Anterior temporal lobe resection (ATLR) is an effective treatment for temporal lobe epilepsy (TLE). The structural consequences of ATLR and how these relate to language function after surgery remain unknown....

The structural plasticity of white matter networks following anterior temporal lobe resection

Anterior temporal lobe resection is an effective treatment for refractory temporal lobe epilepsy. The structural consequences of such surgery in the white matter, and how these relate to language function after surgery remain unknown. We carried out a longitudinal study with diffusion tensor imaging in 26 left and 20 right temporal lobe epilepsy patients before and a mean of 4.5 months after anterior temporal lobe resection. The whole-brain analysis technique tract-based spatial statistics was used to compare pre- and postoperative data in the left and right temporal lobe epilepsy groups separately. We observed widespread, significant, mean 7%, decreases in fractional anisotropy in white matter networks connected to the area of resection, following both left and right temporal lobe resections. However, we also observed a widespread, mean 8%, increase in fractional anisotropy after left anterior temporal lobe resection in the ipsilateral external capsule and posterior limb of the internal capsule, and corona radiata. These findings were confirmed on analysis of the native clusters and hand drawn regions of interest. Postoperative tractography seeded from this area suggests that this cluster is part of the ventro-medial language network. The mean pre- and postoperative fractional anisotropy and parallel diffusivity in this cluster were significantly correlated with postoperative verbal fluency and naming test scores. In addition, the percentage change in parallel diffusivity in this cluster was correlated with the percentage change in verbal fluency after anterior temporal lobe resection, such that the bigger the increase in parallel diffusivity, the smaller the fall in language proficiency after surgery. We suggest that the findings of increased fractional anisotropy in this ventro-medial language network represent structural reorganization in response to the anterior temporal lobe resection, which may damage the more susceptible dorso-lateral language pathway. These findings have important implications for our understanding of brain injury and rehabilitation, and may also prove useful in the prediction and minimization of postoperative language deficits.

A control study of execute function about unipolar depression and bipolar depression patient

Objective To explore the execute function and the influential factors in unipolar depression and bipolar depression.Methods 27 unipolar depression patients and 30 bipolar depression patients were taken the drug treatment for 12 weeks,and 26 healthy people were involved as controls.The depression severity was assessed with the 24-item Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale (HAMA),Global Assessment Function(GAF) and execute function with a series of neuropsychological tests including Wisconsin cards sorting test(WCST),Stroop, Verbal Fluency Test.Results In comparison with the controls,before and after treatment, unipolar depression patients and bipolar depression patients had lower scores of the Verbal Fluency Test.Before and after treatment, unipolar depression patients had lower scores of the Stroop-C and after treatment,bipolar depression patients had higher scores of the Stroop-C than unipolar depression patients. Before treatment,bipolar depression patients had higher scores of the Stroop-CW. In comparison with the controls, before and after treatment,unipolar depression patients had higher scores of the completion of the first request for the number of respondents in WCST and bipolar depression patients had higher scores after treatment. Before treatment,unipolar depression patients had higher scores of the random errors in WCST. Linger regression analysis showed that before treatment of unipolar depression patients ,the scores of Verbal Fluency Test and Stroop-CW were negatively correlated to the retardation factor score, categories completes in the WCST was negatively correlated to recognizing obstacles factor score, completion of the first request for the number of respondents in WCST was negatively correlated to weight factor score. To bipolar depression patients before treatment, the scores of Verbal Fluency Test were negatively correlated to recognizing obstacles factor score,total test in the WCST was positively correlated to recognizing obstacles factor score, categories completes in the WCST was positively correlated to sleeping disturbance factor score, the completion of the first request for the number of respondents and random errors in the WCST were negatively correlated to sleeping disturbance factor score.Conclusions It is common that unipolar depression patients and bipolar depression patients have execute disfunction, bipolar depression execute impairment is slightly lighter than unipolar depression and the depression symptom severity of unipolar depression and bipolar depression has clear impact on the execute function. Key words: Bipolar depression; Unipolar depression; Execute function; Neuropsychological tests