Specific Areas Of Cognitive Functioning Research Articles

Cognitive training interventions for dementia and mild cognitive impairment in Parkinson's disease.

Approximately 60% to 80% of people with Parkinson's disease (PD) experience cognitive impairment that impacts on their quality of life. Cognitive decline is a core feature of the disease and can often present before the onset of motor symptoms. Cognitive training may be a useful non-pharmacological intervention that could help to maintain or improve cognition and quality of life for people with PD dementia (PDD) or PD-related mild cognitive impairment (PD-MCI). To determine whether cognitive training (targeting single or multiple domains) improves cognition in people with PDD and PD-MCI or other clearly defined forms of cognitive impairment in people with PD. We searched the Cochrane Dementia and Cognitive Improvement Group Trials Register (8 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO. We searched reference lists and trial registers, searched relevant reviews in the area and conference proceedings. We also contacted experts for clarifications on data and ongoing trials. We included randomised controlled trials where the participants had PDD or PD-MCI, and where the intervention was intended to train general or specific areas of cognitive function, targeting either a single domain or multiple domains of cognition, and was compared to a control condition. Multicomponent interventions that also included motor or other elements were considered eligible. Two review authors independently screened titles, abstracts, and full-text articles for inclusion in the review. Two review authors also independently undertook extraction of data and assessment of methodological quality. We used GRADE methods to assess the overall quality of the evidence. Seven studies with a total of 225 participants met the inclusion criteria for this review. All seven studies compared the effects of a cognitive training intervention to a control intervention at the end of treatment periods lasting four to eight weeks. Six studies included people with PD living in the community. These six studies recruited people with single-domain (executive) or multiple-domain mild cognitive impairment in PD. Four of these studies identified participants with MCI using established diagnostic criteria, and two included both people with PD-MCI and people with PD who were not cognitively impaired. One study recruited people with a diagnosis of PD dementia who were living in long-term care settings. The cognitive training intervention in three studies targeted a single cognitive domain, whilst in four studies multiple domains of cognitive function were targeted. The comparison groups either received no intervention or took part in recreational activities (sports, music, arts), speech or language exercises, computerised motor therapy, or motor rehabilitation combined with recreational activity. We found no clear evidence that cognitive training improved global cognition. Although cognitive training was associated with higher scores on global cognition at the end of treatment, the result was imprecise and not statistically significant (6 trials, 178 participants, standardised mean difference (SMD) 0.28, 95% confidence interval (CI) -0.03 to 0.59; low-certainty evidence). There was no evidence of a difference at the end of treatment between cognitive training and control interventions on executive function (5 trials, 112 participants; SMD 0.10, 95% CI -0.28 to 0.48; low-certainty evidence) or visual processing (3 trials, 64 participants; SMD 0.30, 95% CI -0.21 to 0.81; low-certainty evidence). The evidence favoured the cognitive training group on attention (5 trials, 160 participants; SMD 0.36, 95% CI 0.03 to 0.68; low-certainty evidence) and verbal memory (5 trials, 160 participants; SMD 0.37, 95% CI 0.04 to 0.69; low-certainty evidence), but these effects were less certain in sensitivity analyses that excluded a study in which only a minority of the sample were cognitively impaired. There was no evidence of differences between treatment and control groups in activities of daily living (3 trials, 67 participants; SMD 0.03, 95% CI -0.47 to 0.53; low-certainty evidence) or quality of life (5 trials, 147 participants; SMD -0.01, 95% CI -0.35 to 0.33; low-certainty evidence). There was very little information on adverse events. We considered the certainty of the evidence for all outcomes to be low due to risk of bias in the included studies and imprecision of the results. We identified six ongoing trials recruiting participants with PD-MCI, but no ongoing trials of cognitive training for people with PDD. This review found no evidence that people with PD-MCI or PDD who receive cognitive training for four to eight weeks experience any important cognitive improvements at the end of training. However, this conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results. There is a need for more robust, adequately powered studies of cognitive training before conclusions can be drawn about the effectiveness of cognitive training for people with PDD and PD-MCI. Studies should use formal criteria to diagnose cognitive impairments, and there is a particular need for more studies testing the efficacy of cognitive training in people with PDD.

Caregiver perceptions of environment moderate relationship between neighborhood characteristics and language skills among youth living with perinatal HIV and uninfected youth exposed to HIV in New York City

ABSTRACTDespite the increased recognition of how neighborhood conditions bear on cognitive and academic outcomes, no studies have examined the influences of objective and subjective neighborhood indices on specific areas of cognitive functioning among youth living with perinatal HIV (PHIV). In the United States (US), this is of particular concern as HIV has disproportionately affected African American youth living in economically disadvantaged and racially segregated communities. Thus, based on a longitudinal cohort study of psychosocial and behavioral health outcomes in 340 perinatally HIV-exposed but uninfected (PHEU) and PHIV youth residing in New York City, ages 9–16 years at enrollment, we analyzed data from baseline and multiple follow-up (FU) quantitative interviews with youth and their primary caregivers, from when they were at least 13-years-old (approximately 4–6 years post enrollment). We examined the association between baseline neighborhood indices (2000 US census data and caregiver’s perception of neighborhood stressors) and youth receptive language skills (PPVT; Peabody Picture Vocabulary Test) at FU2 and FU3. Census data (percentage of families in neighborhood living below the national poverty rate, median neighborhood household income, and percentage of residents professionally employed) were not independently associated with PPVT scores at both follow-ups. However, in the logistic regression model, the more caregivers perceived their neighborhood as stressful and subjected to violence, the stronger the relationship between census data indicators of low resource neighborhoods and lower PPVT scores for both groups. Findings support “place-based” policies and practices that alleviate caregiver experiences of neighborhood stressors which may contribute to improved cognitive outcomes for youth living with and affected by PHIV.

Mediating Age-related Cognitive Decline through Lifestyle Activities: A Brief Review of the Effects of Physical Exercise and Sports-playing on Older Adult Cognition.

Normal aging is associated with variable declines in perception and cognition, which may be mediated through active engagement in certain lifestyle activities. The aim of this review was to discuss the relationship between cognitive functioning in older adulthood and participation in various types of physical exercise and sports-playing activities. Most studies have focused on the beneficial effects of relatively nonspecific forms of aerobic physical activity, although some emerging evidence has suggested that more specific forms of sports-playing activities may confer greater cognitive benefit in specific areas of cognitive functioning. The evidence reviewed suggests the potential for simple lifestyle-related behaviors to mediate the cognitive decline often found in older adults, and to enhance the aging brain's cognitive reserve. However, more work is needed in order to ascertain the variable outcomes of exercise type, duration, and frequency, and the cognitive effects of various sports activities.

THU0017 Cognitive Dysfunction in Active and Remitted Egyptian Non-Neuropsychiatric Systemic Lupus Erythematosus Patients

BackgroundFew studies reported mild cognitive deficits in patients with Non-Neuropsychiatric Systemic Lupus Erythematosus (Non-NPSLE) with no consistent pattern of cognitive deficits with suggest of the presence of a subtle CNS...

Neuropsychological functioning in inpatients with major depression or schizophrenia.

BackgroundStudies that compare neuropsychological functioning in inpatients with mood disorder or schizophrenia come to heterogeneous results. This study aims at investigating the question whether there are different neuropsychological test profiles in stabilised post-acute inpatients with affective disorders or schizophrenia.MethodWe were interested in evaluating impairment in specific areas of cognitive functioning in patients with schizophrenia or depression. In clinical reality, patients with depression and schizophrenia are often treated together with little attention to their specific needs. 74 patients with major depression and 38 patients with schizophrenia were assessed in a comprehensive neuropsychological battery. All patients were in a post-acute stage of their illness, i.e. remission of acute symptoms.ResultsIn spite of a comparable mean score of psychopathological symptoms in the Brief Psychiatric Rating Scale-Expanded (BPRS-E) as well as in the Global Assessment Functioning Scale (GAF), patients with depressive disorder showed significantly better results in verbal and visual short-term memory, verbal fluency, visual-motor coordination, information processing in visual-verbal functioning and selective attention compared to patients with schizophrenia. No significant differences between both samples were found in practical reasoning, general verbal abstraction, spatial-figural functioning, speed of cognitive processing.ConclusionsThese results show that there are differences in scores in psychopathology (BPRS-E, GAF) in patients with affective disorders or schizophrenia and different neuropsychological test profiles in the post-acute stage of their illness.

The validity of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) in acute stroke

Purpose: The purpose was to examine the validity of the Addenbrooke’s Cognitive Examination Revised (ACE-R) as a screening measure to detect cognitive impairment after stroke. Methods: Stroke patients in hospital were recruited and the ACE-R, which includes the Mini-Mental Status Examination (MMSE), was administered, followed by a battery of neuropsychological tests, which served as the ‘gold standard’ for classification of cognitive impairment. The diagnostic validity of the ACE-R was determined by ROC analysis. Results: Of the 101 patients who completed the ACE-R, 61 also completed the neuropsychological assessment. Both the MMSE and the ACE-R were found to have inadequate diagnostic validity for the detection of overall cognitive impairment (MMSE AUC = 0.53, p > 0.05; ACE-R AUC = 0.53, p > 0.05). The ACE-R subscales predicted impairment in specific cognitive domains significantly better than chance; Visuospatial (AUC = 0.71, p < 0.05), Fluency (AUC = 0.72, p< 0.05) and Attention and Orientation (AUC = 0.80, p < 0.05). However, no cut-off score for any subscale gave both adequate levels of sensitivity and specificity for the detection of impairment in specific areas of cognitive functioning. Conclusions: The ACE-R was not a suitable measure to screen for overall cognitive impairment in acute stroke patients, but was able to detect impairment in visuospatial, attention and executive domains.Implications for RehabilitationCognitive impairments are common after stroke.Brief screening measures are needed to detect cognitive problems.The Addenbrooke’s cognitive examination–revised (ACE-R) was more accurate for detecting cognitive impairment after stroke than the Mini-Mental State Examination (MMSE), but neither was a satisfactory measure.Stroke specific screening measures need to be developed.

Candesartan and cognitive decline in older patients with hypertension

Hypertension is associated with impaired cognitive function but the effect of antihypertensive treatment on cognitive function is unclear. We investigated the effect of treatment of hypertension on cognition with the angiotensin-receptor-blocker, candesartan, in a placebo-controlled, double-blind, randomized controlled trial at one center participating in the Study on Cognition and Prognosis in the Elderly. A total of 257 older adults with hypertension (mean age 76 years, blood pressure 165 +/- 8/88 +/- 7 mm Hg) were recruited from general practice and treated with 8-16 mg candesartan or placebo once daily, for a mean follow-up period of 44 months. Additional antihypertensive therapy was permitted in both groups to achieve treatment targets. Cognitive function was measured using the Cognitive Drug Research computerized assessment battery, trail-making tests, and verbal fluency. Data from annual assessments were used to calculate individual coefficients of decline by regressing composite test scores over time for five cognitive domains. The blood pressure difference between groups at study close was 8/3 mm Hg. The candesartan group showed less decline in attention (0.004 vs -0.036, p = 0.04) and episodic memory (0.14 vs -0.22, p = 0.04) compared to placebo, a similar trend for speed of cognition (-2.3 vs -17.4, p = 0.15), but no differences in working memory (0.0014 vs 0.0010, p = 0.90) or executive function (-0.0031 vs -0.0023, p = 0.95). Effect sizes were in the small-to-moderate range. The potential for blood pressure-lowering with angiotensin-receptor-blockers to reduce the rate of decline of specific areas of cognitive function in older patients with hypertension warrants further investigation to determine clinical efficacy.

Effects of Exercise Training on Cognitive Functioning among Depressed Older Men and Women

The effects of a structured exercise program on the cognitive functioning of 84 clinically depressed middle-aged and older adults (mean age = 57 years) were examined. Participants were randomized to either 4 months of aerobic exercise (n = 42) or antidepressant medication (n = 42). Assessments of cognitive functioning (memory, psychomotor speed, executive functioning, and attention/concentration), depression, and physical fitness (aerobic capacity and exercise endurance) were conducted before and after the intervention. Exercise-related changes (accounting for baseline levels of cognitive functioning and depression) were observed for memory (p = .01) and executive functioning (p = .03). There were no treatment-group differences on tasks measuring either attention/concentration or psychomotor speed. Results indicate that exercise can exert influence on specific areas of cognitive functioning among depressed older adults. Further research is necessary to clarify the kinds of cognitive processes that are affected by exercise and the mechanisms by which exercise affects cognitive functioning.

Association between Prenatal Exposure to Methylmercury and Cognitive Functioning in Seychellois Children: A Reanalysis of the McCarthy Scales of Children's Ability from the Main Cohort Study

Methylmercury (MeHg) is a neurotoxicant whose high-dose effects first became known following a number of poisoning outbreaks that occurred worldwide. The primary human exposure is low dosage from fish consumption. Studies of fish-eating populations have not found a consistent pattern of association between exposures and outcomes. Therefore, examining specific areas of cognitive functioning has been suggested as an important approach to determine whether more subtle effects of MeHg exposure are present. In the Seychelles longitudinal study of prenatal and postnatal MeHg exposure from fish consumption and development, the McCarthy Scales of Children's Abilities (MSCA) were administered to children at age 66 months. No association between MeHg exposure and performance on the MSCA General Cognitive Index was identified. We analyzed these data further to determine whether associations were present on specific subscales of the MSCA. The standard MSCA subscales were analyzed. Then, more specific subscales of the MSCA were defined and analyzed utilizing a neuropsychological approach. The subscales were recombined to approximate the domains of cognitive functioning evaluated in the Faroes and New Zealand studies. Analyses of both the standard and the recombined MSCA subscales showed no adverse associations with MeHg exposure and neuropsychological endpoints. A positive association between postnatal MeHg exposure and performance on the MSCA Memory subscale was found. These findings are consistent with previous reports from the Seychelles study in that no adverse effects of MeHg exposure from fish consumption can be detected in this cohort.

Cognitive correlates of 1H MRSI-detected hippocampal abnormalities in temporal lobe epilepsy.

To examine associations between 1H magnetic resonance spectroscopic imaging (1H MRSI)-detected hippocampal creatine to N-acetylaspartate (Cr/NAA) ratios and neuropsychological measures sensitive to mesial temporal lobe function. The measurement of 1H MRSI-detected hippocampal metabolites has proved effective in determining extent and lateralization of neuronal damage. However, relationships between 1H MRSI-detected hippocampal metabolic abnormalities and specific areas of cognitive functioning have received limited attention compared to other studies using MRI volumetry or cerebral blood flow techniques. We analyzed right and left hippocampal Cr/NAA ratios in 46 adult mesial temporal lobe epilepsy patients (32 left, 14 right) by 1H MRSI at high magnetic field (4.1 T). We examined the relationship between the right and left Cr/NAA hippocampal ratios to measures of verbal and visual memory, intelligence, attention, visuoperception, and confrontation naming. Measures of episodic verbal memory (n = 33) and visual confrontation naming (n = 46) were selectively associated with left hippocampal metabolic function (p<0.004), whereas neuronal function of the right hippocampal region was strongly associated with performance on a measure of facial recognition (n = 46; p<0.02). This study shows that specific areas of cognitive function are related to hippocampal neuronal metabolic abnormalities as detected by spectroscopic imaging. The current study indicates that 1H MRSI offers a complimentary technique to structural imaging studies in the study of mesial temporal lobe epilepsy and may enhance understanding of the role of hippocampal function in complex cognitive systems.

Do memory complaints indicate the presence of cognitive impairment? Results of a field study.

In the context of suspected cognitive disorders, the validity of memory complaints is subject to considerable debate. This investigation documents the prevalence of memory complaints and assesses the validity of memory complaints for detecting cognitive impairment. The sample comprises 349 randomly selected non-institutionalized individuals, aged 75 and over living in the city of Leipzig. Twenty individuals who suffer from moderate and severe dementia according to DSM-III-R were excluded. Memory complaints were measured by means of a single item question. The Mini-Mental State Examination (MMSE) and a wider range of cognitive tests which constitute the short neuropsychological battery of the SIDAM (Structured Interview for the Diagnosis of dementia of Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-III-R) were used to test cognitive performance. One in three individuals aged 75 and over complained about memory deficits. The MMSE is not significantly related to memory complaints, whereas poorer performance on 2 out of 8 tests regarding specific areas of cognitive function (immediate recall, short-term memory) were found to be significantly associated with memory complaints. Despite these statistically significant associations, it is shown that memory complaints do not have diagnostic validity in detecting cognitive impairment on the individual level. Memory self-assessment should not be used as a substitute measure of cognitive performance. Initiation of further diagnostic and therapeutic steps should be based on cognitive performance testing. Relaying solely on memory complaints would miss individuals in need and allocate resources to worried but cognitively healthy persons.

IMPROVEMENT IN SPECIFIC ASPECTS OF NEUROCOGNITIVE PERFORMANCE IN CHILDREN AFTER RENAL TRANSPLANTATION

691 Uremia diminishes neurocognitive function in children, limiting development and educational attainment. We utilized an extensive battery of neuropsychological tests to measure mental processing speed, working memory, attention, verbal learning, visuospatial ability, motor dexterity and visual motor speed to determine which would be most sensitive to uremia and would improve after renal transplantation (Tx). Nine subjects (8-21 yrs) with full scale IQ of 92 ± 15 (mean±SD) were studied on chronic PD (n=6, Kt/V 2.3±.5), chronic HD (n=2, Kt/V 1.8±.9) or with advanced CRI, and restudied 1 year after successful renal Tx (Cr 1.3±.6 mg/dl) on stable doses of cyclosporine, prednisone and azathioprine. Comparisons were made within subjects, pre and post Tx, by paired t-test and Wilcoxon signed ranks test with p < .05 significant. Mental processing speed indices from the Cognitive Abilities Tests and the Conners Continuous Performance Test improved post-Tx. Working memory, measured by the Paced Auditory Serial Addition Test also improved post-Tx. In contrast, indices which depended upon motor speed, attention, visual motor speed, visuospatial ability and verbal learning did not change post-Tx. Increased renal function post-Tx resulted in enhanced performance on tests of mental processing speed and working memory. Intensive assessment and within subject comparisons allowed us to detect subtle, reversible effects on specific areas of cognitive function. These observations may provide insights into mechanisms of neuropsychological impairment in uremia and justify early Tx in children to permit cognitive development.

Psychometric characteristics of the mini-mental state examination in patients with Alzheimer?s disease? a grade of membership analysis of cerad data: part II

In order to determine whether the Mini-Mental State Examination (MMSE) assesses multiple areas of cognitive functioning, a grade of membership analysis, carried out initially on data from a representative sample of community residents (see Part I), was repeated on data from 718 carefully characterized Alzheimer’s disease (AD) cases. The findings from both normal and demented samples differed little. In AD cases three pure types were identified which varied in level of cognitive impairment rather than by aspect of cognitive functioning. The presence of the originally proposed five aspects of cognitive functioning was not confirmed, although subsets (selected orientation items; three recall items; the two naming items) were identified. Nevertheless, since problems with learning and recall are a function of AD, and may underlie ability to respond to the items of the MMSE, summary MMSE score may be a sound indicator of severity of cognitive impairment, even if specific areas of cognitive functioning cannot be identified.