Phonemic Fluency Test Research Articles

Diagnostic accuracy of the UDS 3.0 neuropsychological battery in a cohort with Alzheimer’s disease in Colombia

Background Alzheimer’s disease (AD) is a neurodegenerative disease that causes a gradual loss of cognitive functions and limits daily activities performance. Early diagnosis of AD is essential to start timely treatment. This study aimed to validate the Uniform Data Set neuropsychological battery version 3.0 (UDS 3.0) in a Colombian cohort. Methods This study is a cross-sectional type, consecutive, incidental, with 143 persons, divided into two groups: 48 diagnosed AD cases and 95 healthy controls, between the ages of 50 and 80+, and between 1 and 19+ years of education. Results The results indicate differences between the control group and the AD group in most battery tests. A significant correlation was found between the Montreal Cognitive Assessment (MoCA), Multilingual Naming Test (MINT), Craft Story, Benson Figure Test, P-word and F-word Phonemic Fluency Test, and their respective reference tests. Cutoff points were found based on the Youden index for each sub-test. The results indicate that all sub-tests are above the reference line of the ROC curve. Conclusion The use of the UDS 3.0 in Colombia would help improving clinical diagnostic routes because of its high accuracy and high correlation with tests that measure general impairment; it has good sensitivity and specificity, and it can be a useful tool for AD.

Psychomotor processing and functional decline in Parkinson's disease predicted by the Purdue Pegboard test.

The Purdue Pegboard test (PPT) assesses upper-extremity dexterity and motor skills. We hypothesized that PPT skill would predict functional and cognitive decline in Parkinson's disease (PD), independent of observer-rated measures of motor impairment. We utilized data from 399 PD participants enrolled in the deprenyl and tocopherol antioxidative therapy of Parkinsonism trial. Unified Parkinson Disease Rating Scale (UPDRS) metrics, neuropsychological assessments, and clinical rating scales were extracted for analysis with multivariate linear mixed-effects and generalized estimating equation regression models. In multivariate logistic regression, higher baseline and time-varying PPT scores predicted better visual processing speed and attention throughout longitudinal follow-up. No similarly strong associations were found for tests of memory, nonvisual attention, phonemic fluency, or set-shifting. Independently of observer-rated motor impairment (UPDRS part III), PPT performance was significantly associated with changes in activities of daily living (ADL) function measured with UPDRS part II. Low baseline PPT score (≤10th percentile) doubled the relative risk of later ADL dysfunction (≥90th percentile). PPT impairment selectively predicted declining psychomotor processing speed in PD. The domain-specificity of this association may reflect correlated pathophysiological changes in top-down visual and motor control pathways. PPT also predicted increasing ADL dysfunction after adjusting for objective measures of motor impairment. We suggest that PPT scores may be prognostically useful for predicting cognitive changes and ADL dysfunction, which have dramatic impacts on both patient and caregiver quality of life. Furthermore, simple task-based assessments like the PPT could be investigated for remote assessment in PD.

Association Between Greater Cerebellar Network Connectivity and Improved Phonemic Fluency Performance After Exercise Training in Older Adults.

Little is known about the effects of exercise training (ET) on lexical characteristics during fluency task and its association with cerebellum functional connectivity. The purposes of this study were (1) to investigate whether ET alters response patterns during phonemic and semantic fluency tasks and (2) to assess the association between ET-related changes in cerebellum functional connectivity (FC) and lexical characteristics during fluency tasks. Thirty-five older adults (78.0 ± 7.1years; 17 mild cognitive impairment (MCI) and 18 healthy cognition (HC)) underwent a 12-week treadmill ET. Before and after ET, cardiorespiratory fitness tests, phonemic and semantic fluency tests, and resting-state fMRI scans were administered. We utilized a seed-based correlation analysis to measure cerebellum FC and linear regression to assess the association of residualized ET-induced Δcerebellum FC with Δtask performance. Improved mean switches and frequency during the phonemic fluency task were observed following ET in all participants. There were significant associations between ET-induced increases in cerebellum FC and greater phonemic fluency task log frequency, increases in mean switches, and a reduction in the number of syllables in HC. Lastly, there was a significant interaction between group and cerebellar connectivity on phonemic fluency mean log frequency and number of syllables. A 12-week walking ET is related to enhanced phonemic fluency lexical characteristics in older adults with MCI and HC. The association between ET-induced increases in cerebellum FC and enhanced response patterns after ET suggests that the cerebellum may play an important role in ET-related improvement in phonemic fluency performance in cognitively healthy older adults.

Relationship among the quality of cognitive abilities, depression symptoms, and various aspects of handgrip strength in the elderly

Background/Aim. Both the cognitive and physical functioning changes occur within the normal aging, suggesting possible common biological processes. The aging process is often characterized by a reduction of adaptive responses, an increasing vulnerability and functional limitations. The aim of this study was to determine if there were correlations between particular cognitive abilities (verbal ability, spatial ability, processing speed, memory, verbal fluency, divergent thinking, memory, attention, executive functions, conceptualization, orientation, computation), depression symptoms and different dynamometric parameters of muscle contraction, during handgrip (HG) of both hands, in the elderly population. Methods. The sample consisted of 98 participants, 16 males and 82 females, aged from 65 to 85. Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Frontal Function Test (Go/No-Go), Categorical and Phonemic fluency tests and Geriatric Depression Scale Short Form (GDS-SF). Physical measures were assessed by Handgrip Dynamometry Tests (HG), and included: the maximum force (Fmax), maximal rate of force development (RFDmax), static endurance HG time realized at 50% of maximal HG force (tFmax50%) of dominant (Do) and non-dominant (NDo) hand. Results. Higher MoCA score was followed by higher values of muscle endurance of dominant hands. Higher values of F max of dominant hand were associated with higher values of Alternating Trail Making that is by visuoconstructive abilities (MoCA). The variable Categorical fluency was in a small, positive correlation with Fmax. No correlation of depressive symptoms with HG parameters was found except in the subgroup of female subjects. Conclusion. Better cognitive performance was associated with better HG muscle strength. Therefore, HG strength can be a useful tool in geriatric practice in monitoring not only physical, but also cognitive function status and de-cline. The link between lower cognitive functioning and lower values of HG variables, emphasize the need for in-creased awareness about it in clinical practice.

A-096 Reliable Change Indices as a Measure of Neurocognitive Change following Deep Brain Stimulation for Essential Tremor

Abstract Objective Deep brain stimulation (DBS) is a widely used treatment for essential tremor (ET). To assess for neurocognitive decline following DBS, most studies use statistical methods that directly compare changes in test scores between pre- and post-surgical evaluations. By contrast, reliable change scores are calculated using regression-based models that account for practice effect and systematic error that can occur between repeat test administrations. We sought to determine the utility of reliable change scores in monitoring neuropsychological function following DBS. Method Twenty-eight ET patients (M age = 70.2 ± 6.3, 57% female) completed neuropsychological evaluations at an outpatient clinic 6.4 ± 3.6 months before and 6.7 ± 1.9 months after DBS placement within the ventral intermediate nucleus of the thalamus (71% left-sided). Wilcoxon signed rank tests were used to identify differences in performance using absolute change versus reliable change scores. Results There were no significant absolute differences between pre- and post-surgery scores on tests of attention, processing speed, executive function, object naming, verbal fluency, or learning and memory. By contrast, significant differences in reliable change scores from zero were identified on tests of phonemic fluency (p < .001), semantic fluency (p = .05), and verbal learning (p = .005). Conclusions Analyses that used reliable change scores identified post-surgical declines that were not evident in traditional statistical comparisons. Results suggest that reliable change indices are useful tools for monitoring changes in neurocognitive functions that can occur following DBS and related neuromodulation treatments.

Parietal Perfusion Alterations in Parkinson's Disease Patients Without Dementia.

Fronto-parietal regions are involved in cognitive processes that are commonly affected in Parkinson's disease (PD). The aims of this study were to investigate cerebral blood flow (CBF) and gray matter (GM) volume within the regions belonging to the fronto-parietal circuit in people with PD (pwPD) without dementia, and to assess their association with cognitive performance. Twenty-seven pwPD without dementia (mean [SD] age = 67.4 [8.1] years, 20 males, mean [SD] Montreal Cognitive Assessment, MoCA score = 24.2 [2.9], median [IQR] Hoehn and Yahr scale = 1.5 [1–2]) and twenty-six age- and sex-matched healthy controls (HC) were scanned with arterial spin labeling (ASL) and T1-weighted magnetic resonance imaging (MRI) sequences to investigate CBF and GM volume, respectively. The cognitive performance of the enrolled pwPD was assessed with MoCA, Trail Making Test (TMT, part A, B, B-A), phonemic fluency and semantic fluency tests. The scores were adjusted for age and education. After standard preprocessing, CBF differences between pwPD and HC were tested with a voxel-wise approach. Voxel-based morphometry was used to compare pwPD and HC in terms of GM volume. Both voxel-wise comparisons between pwPD and HC were restricted to regions of the fronto-parietal circuit. The following additional voxel-wise analyses were performed within regions showing either perfusion or GM volume alterations: (1) correlation with neuropsychological test scores; (2) subgroup comparison after median split on each neuropsychological test score. Family-wise error-corrected (FWE) p-values lower than 0.05 were considered significant. Significant hypoperfusion was identified in the left inferior parietal lobule (IPL, ppeak = 0.037) and in the bilateral superior parietal lobule (SPL, left hemisphere: ppeak = 0.037; right hemisphere: ppeak = 0.049) of pwPD when compared to HC. No significant GM atrophy was observed. Local hypoperfusion did not correlate with any neuropsychological test scores. However, significantly lower CBF was observed in the left SPL and IPL of the pwPD subgroup who performed poorer on TMT part A in comparison with the pwPD subgroup that performed better. Perfusion alterations may occur in parietal regions of pwPD without dementia, and may be associated with lower visuomotor skills. Parietal CBF may be considered as a suitable early biomarker for longitudinal studies investigating cognitive decline in PD.

1144 Actigraphy-defined Sleep And Neurocognitive Decline In Middle-age Hispanic/Latino Adults

Abstract Introduction Few studies have evaluated objective sleep measures and longitudinal neurocognitive decline, particularly in middle-age or Hispanic/Latino adults. We evaluated prospective associations between actigraphy-defined sleep and 7-year neurocognitive change among Hispanic/Latino adults. We hypothesized that sleep duration would be associated with neurocognitive decline. Methods We analyzed data from 1,036 adults 45-64 years of age from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center prospective cohort study of diverse community-dwelling Hispanic/Latino adults. At Visit 1 (2008-2011), participants underwent neurocognitive assessments, 7-days of actigraphy, home sleep testing, and sleep questionnaires (including the Insomnia Severity Index). Seven years later, participants repeated neurocognitive assessments. The neurocognitive battery included the Six-Item Screener, Brief Spanish-English Verbal Learning Test, phonemic word fluency test, and Digit Symbol Subtest. Survey linear regression was used to evaluate prospective associations between actigraphy-defined or self-reported sleep variables and neurocognitive change. Final models adjusted for objectively-defined variables (age, body-mass index, Field Center, and time between neurocognitive assessments), and self-reported variables (sex, education, Hispanic/Latino background, alcohol consumption, physical activity, heart failure, cerebrovascular events, depression and anxiety symptoms, and antidepressant use). Results At Visit 1, the sample was 55% female and mean age was 54.9±2.2 years. The mean sleep duration was 402.6±27.6 minutes, mean sleep-onset latency was 11.3±9.7 minutes, mean number of days with naps of ≥ 15 minutes duration was 1.1±0.7, and mean sleep-time per nap was 51±14.1 minutes. Increased sleep-onset latency was associated with 7-year declines in global neurocognitive function (β=-0.0026, p<0.01), verbal learning (β=-0.0028, p<0.001) and verbal memory (β=-0.036, p<0.05). Increased sleep-time per nap predicted better verbal memory (β=0.0038, p<0.05). In contrast, sleep duration, sleep fragmentation, and self-reported sleep measures were not associated with neurocognitive change. Conclusion Among middle-age adults, sleep-onset latency and nap duration were associated with neurocognitive change. These findings may serve as targets for intervention of neurocognitive decline. Support This work is supported by the National Institute on Aging: R01AG048642, RF1AG054548, R01AG061022, R21AG056952, and R21HL140437 (AR).

Effects of robot-assisted gait training combined with virtual reality on motor and cognitive functions in patients with multiple sclerosis: A pilot, single-blind, randomized controlled trial.

Studies on robot-assisted gait training rehabilitation in multiple sclerosis have reported positive effects on mobility and quality of life. However, their effects on cognitive functions are difficult to determine because not all trials have included cognition assessments. Virtual reality-based training provides enhanced opportunity for stimulating cognitive abilities by repetitive practice, feedback information, and motivation for endurance practice. To compare the effects of innovative robot-assisted gait training combined with virtual reality versus standard robot-assisted gait training on information processing speed, sustained attention, working memory, and walking endurance in patients with multiple sclerosis. Seventeen outpatients were randomly assigned to receive robot-assisted gait training either with or without virtual reality. The robot assisted gait training + virtual reality group underwent end-effector system training engendered by virtual reality. The standard training group underwent end-effector system training. A blinded rater evaluated patients before and after treatment and at one month follow-up. The outcome measures were the Paced Auditory Serial Addition Test, Phonemic Fluency Test, Novel Task, Digit Symbol, Multiple Sclerosis Quality of Life-54, 2-Minutes Walk Test, 10-Meter Walking Test, Berg Balance Scale, gait analysis, and stabilometric assessment. Between-group comparisons showed a significant change on the 2-Minutes Walk Test (p = 0.023) after treatment in the robot-assisted gait training + virtual reality group. Significant improvement were obtained also in executive functions (p = 0.012). Both gains were maintained at the 1-month follow-up evaluation (p = 0.012, p = 0.012) in the robot-assisted gait training + virtual reality group. Both group improved quality of life after treatment (Multiple Sclerosis Quality of Life-54: Mental Health p = 0.018, Physical Health p = 0.017). Both training lead to positive influenced on executive functions. However larger positive effects on gait ability were noted after robot-assisted gait training engendered by virtual reality with multiple sclerosis. Robot-assisted gait training provides a therapeutic alternative and motivational of traditional motor rehabilitation.

Dissociation in Age-Related Developmental Trajectories Between Phonetic Fluency and Semantic Fluency Tests: Analysis of Longitudinal Data From the Yakumo Study

Abstract Possible age-related differences in Phonemic Fluency Test (PFT) and Semantic Fluency Test (SFT) performance were examined by using longitudinal data of healthy older adults. The performance trajectories of 81 older adults in the 2 tests were analyzed for 11 years, from 65 to 75 years of age, via individually calculated linear regression coefficients. The results indicated that the PFT and SFT performance showed an age-related decline. However, the declining slope of the SFT was steeper than that of the PFT performance. These findings correspond with those of previous cross-sectional studies and suggest a future need to examine neurobiological substrates underlying the two domains of verbal fluency abilities.

Normative Data of the Phonemic Fluency Test in Korean Middle-Aged and Elderly Population

Objective：The available normative data for the phonemic fluency test in Korean older adults have concerns for its utility. The aim of the currently study is to provide the normative data that overcome the issues of the previous norms. Methods：Total of 443 middle- and old-aged non-demented adults participated in this study. All participants underwent comprehensive assessments conducted by trained psychiatrists and psychologists. Diagnosis was made based on formal guidelines prior to administering the phonemic fluency test. Results：The norms on two age groups (50-59 and 60-90 years) with different strata of the education levels for the age groups are provided. Conclusion：The goal of the current study, which was to overcome the shortcomings of the previously published normative data and establish an updated reference for the Korean version of the phonemic fluency test, is achieved.

Executive Dysfunction Related to Binge Drinking in Ischemic Stroke.

Recent evidence has shown that cognitive dysfunction is associated with a history of binge drinking in adolescents who do not have an alcohol use disorder. Most previous studies with adults, however, have failed to show a link between cognitive dysfunction and subdiagnostic binge drinking, nor have any studies investigated the additive cognitive effect of binge drinking to ischemic stroke. To examine whether a pattern of cognitive dysfunction, especially executive and memory dysfunction, in patients with a first-ever ischemic stroke is associated with a history of subdiagnostic binge drinking. We studied 206 first-ever ischemic stroke patients (18-65 years) and 50 healthy, demographically comparable adults-both groups with no alcohol use disorder. After exclusion by matching, 189 patients and 39 healthy participants were included in our study (228 participants). The binge-drinking group included 76 participants; the non-binge-drinking group included 152. A multivariate analysis of covariance was used to compare nine cognitive functions between the two groups, with age, education, and stroke severity used as covariates. Binge drinking had a significant negative effect on executive functions (P<0.001). The non-binge-drinking group outperformed the binge-drinking group on the Stroop Test (P=0.001), Trail Making Test (P=0.002), and a phonemic fluency test (P=0.005). The Binge×Stroke Severity interaction (P=0.037) indicated that a history of binge drinking increased the negative effect of stroke on executive functions. Subdiagnostic binge drinking may exacerbate the adverse effects of ischemic stroke on executive dysfunction.

Altered speech-related cortical network in frontotemporal dementia

BackgroundIn healthy subjects (HS), transcranial magnetic stimulation (TMS) demonstrated an increase in motor-evoked potential (MEP) amplitudes during specific linguistic tasks. This finding indicates functional connections between speech-related cortical areas and the dominant primary motor cortex (M1). ObjectiveTo investigate M1 function with TMS and the speech-related cortical network with neuroimaging measures in frontotemporal dementia (FTD), including the non-fluent variant of primary progressive aphasia (nfv-PPA) and the behavioral variant of FTD (bv-FTD). MethodsM1 excitability changes during specific linguistc tasks were examined using TMS in 24 patients (15 with nfv-PPA and 9 with bv-FTD) and in 18 age-matched HS. In the same patients neuroimaging was used to assess changes in specific white matter (WM) bundles and grey matter (GM) regions involved in language processing, with diffusion tensor imaging (DTI) and voxel-based morphometry (VBM). ResultsDuring the linguistic task, M1 excitability increased in HS, whereas in FTD patients it did not. M1 excitability changes were comparable in nfv-PPA and bv-FTD. DTI revealed decreased fractional anisotropy in the superior and inferior longitudinal and uncinate fasciculi. Moreover, VBM disclosed GM volume loss in the left frontal operculum though not in the parietal operculum or precentral gyrus. Furthermore, WM and GM changes were comparable in nfv-PPA and bv-FTD. There was no correlation between neurophysiological and neuroimaging changes in FTD. Atrophy in the left frontal operculum correlated with linguistic dysfunction, assessed by semantic and phonemic fluency tests. ConclusionWe provide converging neurophysiological and neuroimaging evidence of abnormal speech-related cortical network activation in FTD.

Fluency and rule breaking behaviour in the frontal cortex

Design (DF) and phonemic fluency tests (FAS; D-KEFS, 2001) are commonly used to investigate voluntary generation. Despite this, several important issues remain poorly investigated. In a sizeable sample of patients with focal left or right frontal lesion we established that voluntary generation performance cannot be accounted for by fluid intelligence. For DF we found patients performed significantly worse than healthy controls (HC) only on the switch condition. However, no significant difference between left and right frontal patients was found. In contrast, left frontal patients were significantly impaired when compared with HC and right frontal patients on FAS. These lateralization findings were complemented, for the first time, by three neuroimaging; investigations. A traditional frontal subgrouping method found significant differences on FAS between patients with or without Left Inferior Frontal Gyrus lesions involving BA 44 and/or 45. Parcel Based Lesion Symptom Mapping (PLSM) found lower scores on FAS were significantly associated with damage to posterior Left Middle Frontal Gyrus. An increase in rule break errors, so far only anecdotally reported, was associated with damage to the left dorsal anterior cingulate and left body of the corpus callosum, supporting the idea that conflict resolution and monitoring impairments may play a role. Tractwise statistical analysis (TSA) revealed that patients with disconnection; in the left anterior thalamic projections, frontal aslant tract, frontal; orbitopolar tract, pons, superior longitudinal fasciculus I and II performed significantly worse than patients without disconnection in these tracts on FAS. In contrast, PLSM and TSA analyses did not reveal any significant relationship between lesion location and performance on the DF switch condition. Overall, these findings suggest DF may have limited utility as a tool in detecting lateralized frontal executive dysfunction, whereas FAS and rule break behavior appears to be linked to a set of well localized left frontal grey matter regions and white matter tracts.

COWAT Performance of Persons with Alzheimer Dementia, Vascular Dementia, and Parkinson Disease Dementia According to Stage of Cognitive Impairment.

The Controlled Oral Word Association Test (COWAT) evaluates frontal lobe and executive function. Therefore, it can be helpful in differentiating cognitive deficits. However, there are no studies comparing the COWAT performance according to the type and stage of cognitive impairment. To compare performance among persons with Alzheimer dementia (AD), vascular dementia (VaD), and Parkinson disease dementia (PDD) on the COWAT according to stage of cognitive impairment. Retrospective chart review. University hospital rehabilitation psychology center. We reviewed the medical records of 246 persons diagnosed with mild cognitive impairment (MCI) or dementia using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Korean-Instrumental Activities of Daily Living (K-IADL). Patients were divided into a control group, Alzheimer groups (amnestic mild cognitive impairment [aMCI] + AD), Vascular groups (vascular mild cognitive impairment [VaMCI] + VaD), and Parkinson groups (Parkinson disease-mild cognitive impairment [PD-MCI] + PDD). Total scores (ie, total number of words produced in 60 seconds on the semantic and phonemic fluency tests of the COWAT) were analyzed. Secondary analysis included calculating percentage scores of words produced during each of the four, 15-second segments from the total number of words produced in each trial. All MCI groups scored significantly lower than the control group on both semantic and phonemic fluency tests. Among the dementia groups, the VaD (mean ± SD, 5.6 ± 5.1) and PDD (5.5 ± 5.5) groups' scores were significantly lower and worse than that of the AD (11.0 ± 8.8) group on the phonemic test (P < .001). The difference in percentage scores was most marked between the PD-MCI (17.0 ± 2.2) and PDD (1.2 ± 3.1) groups, followed by the VaMCI (13.3 ± 1.9) and VaD (5.6 ± 1.8) groups on the latter phonemic test (P = .007). The COWAT is a sensitive test of frontal-lobe and executive function impairment in persons with MCI. Decreased verbal output in the last 15 seconds of phonemic fluency test is significantly decreased and impaired in persons with VaMCI and PD-MCI compared to persons with aMCI as they progress to dementia. III.

REM-Sleep Behavior Disorder in Patients With Essential Tremor: What Is Its Clinical Significance?

Objective: REM sleep behavior disorder (RBD) is an important risk factor for the dementia development and for the deterioration of autonomic functions in patients with Parkinson's Disease. RBD has also been reported in patients with Essential Tremor (ET). However, its clinical significance in ET remains still unknown. We aimed to investigate clinical, neuropsychological and cardiac autonomic scintigraphic differences between ET patients with and without RBD.Methods: To assess RBD symptoms, RBD Single-Question has been administered in a cohort of 55 patients with a clinical diagnosis of ET. Patients with clinical RBD underwent polysomnography (PSG) confirmation. All patients completed a battery of neuropsychological assessment of memory, executive function, attention, language, and visuospatial function. Cardiac MIBG scintigraphy was performed in order to measure the cardiac autonomic innervation.Results: Ten ET patients (18%) had a PSG-confirmed RBD (ETRBD+). Compared to ET patients without RBD (ETRBD−), significantly reduced scores on memory domain tests such as Rey auditory verbal learning test immediate recall (p = 0.015) and Rey auditory verbal learning test delayed recall (p = 0.004) and phonemic fluency test (p = 0.028) were present in ETRBD+. By contrast, no other significant clinical difference has emerged from the comparison between two ET groups. Similarly, ETRBD+ patients have cardiac MIBG tracer uptake in the normal value range as occurred in those with ETRBD−.Conclusions: This study improves the knowledge on clinical significance of RBD symptoms in ET patients. Our preliminary findings demonstrate that presence of RBD in ET is associated with neurocognitive impairment, but not with cardiac autonomic dysfunction. Further longitudinal studies are needed to investigate whether ET patients with RBD will develop a frank dementia over the time.

Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement.

Intrinsic imperfections of thyroid hormone replacement therapy may affect long-term general well-being. In patients with Hashimoto thyroiditis (HT), cognitive functioning may be affected via altered thyroid hormones action as well as by the autoimmune process. The aim of this study was to evaluate cognitive function and quality of life (QoL) in patients on long-term levothyroxine replacement for HT in relation to thyroid function tests and TPO (thyroid-peroxidase) antibody (TPOAb) status. Retrospective cross-sectional study. One-hundred-and thirty patients with HT on long-term levothyroxine replacement and 111 euthyroid control subjects. Both groups were divided into two age subgroups, 20-49 years (N = 59 vs N = 79) and > 50 years (N = 71 vs N = 32). Evaluation included biochemical and neuropsychological tests, evaluating attention, global cognitive status, verbal and working memory, executive function, depression and anxiety, and quality of life. We used ANOVA and partial correlations to test for significant associations. FT4 (free-thyroxine), FT3 (free-triiodothyronine) levels and FT3/FT4 ratio were not different between patients and controls. Mean TSH (thyroid-stimulating hormone) was normal in all subjects but significantly higher in the patients (20-49 yrs:3.64 ± 2.74 vs 1.93 ± 1.10, >50 yrs:3.93 ± 2.84 vs 1.91 ± 0.90). Antibodies (TgAb,TPOAb) were higher in patients. Global cognitive function (MMSE-Mini mental state examination), conceptual tracking (TMT-Trail Making Test:A/B), verbal divergent thinking (like Phonemic fluency test), and anxiety and depression scores were significantly worse in patients vs controls. QoL was impaired in patients. there was a significant negative correlation between antibodies (TPOAb, TgAb) and quality in life (total SF36 score). Patients on long-term levothyroxine replacement show persistent impairments in both cognitive functioning and general well-being.

Executive function in patients with schizophrenia based on socio-occupational impairment: A cross-sectional study.

Background:Executive dysfunction deficit is the functionally most important cognitive deficit noted in schizophrenia. There is a dearth of Indian literature on the subject. The current study aimed at studying these executive functions in patients with schizophrenia in remission.Methodology:Sixty outpatients with a diagnosis of schizophrenia as per international classification of diseases-10 criteria; in remission as measured by Positive and Negative Syndrome Scale scores were divided into two groups using the personal and social performance scale. The patients with and without socio-occupational impairment formed the two groups. All patients were administered the Wisconsin Card Sorting Test (WCST), Stroop test, Color Trails Test 1 and 2, Phonemic Fluency (Controlled Oral Word Association Test), and category fluency (animal names test) tests and the tower of London test to ascertain deficits in executive functions. The data obtained were subjected to statistical analysis.Results:The two groups were well matched. The group with socio-occupational impairment showed a lesser number of categories completed (P = 0.001), more perseverative errors (P = 0.001), and greater percentage of the same (P = 0.001) on the WCST. Statistically significant differences between both groups were observed for scores on phonemic fluency (P = 0.012) and category fluency (P = 0.049) tests as well as the Tower of London test (P = 0.021). They also showed differences on the Stroop test and Color Trail tests, but this was not statistically significant.Conclusions:Performance on executive function tests is significantly correlated with functional outcome. It is important that future studies explore the role of these tests as a marker of socio-occupational impairment in schizophrenia.

Apathy, not depressive symptoms, as a predictor of semantic and phonemic fluency task performance in stroke and transient ischemic attack

ABSTRACTObjectives: This study examined the relationship between apathy and cognition in patients with cerebrovascular disease. Apathy may result from damage to frontal subcortical circuits causing dysexecutive syndromes, but apathy is also related to depression. We assessed the ability of apathy to predict phonemic fluency and semantic fluency performance after controlling for depressive symptoms in 282 individuals with stroke and/or transient ischemic attack. Method: Participants (N = 282) completed the Phonemic Fluency Test, Semantic Fluency Test, Center for Epidemiologic Studies Depression Scale, and Apathy Evaluation Scale. A cross-sectional correlational design was utilized. Results: Using hierarchical linear regressions, apathy scores significantly predicted semantic fluency performance (β = –.159, p = .020), but not phonemic fluency performance (β = –.112, p = .129) after scaling scores by age and years of education and controlling for depressive symptoms. Depressive symptoms entered into the first step of both hierarchical linear regressions did not predict semantic fluency (β = –.035, p = .554) or phonemic fluency (β = –.081, p = .173). Apathy and depressive symptoms were moderately correlated, r(280) = .58, p < .001. Conclusions: The results of this study are consistent with research supporting a differentiation between phonemic and semantic fluency tasks, whereby phonemic fluency tasks primarily involve frontal regions, and semantic fluency tasks involve recruitment of more extended networks. The results also highlight a distinction between apathy and depressive symptoms and suggest that apathy may be a more reliable predictor of cognitive deficits than measures of mood in individuals with cerebrovascular disease. Apathy may also be more related to cognition due to overlapping motivational and cognitive frontal subcortical circuitry. Future research should explore whether treatments for apathy could be a novel target for improving cognitive outcomes after stroke.

Screening for dementia in Arabic: normative data from an elderly Lebanese sample

Objective: Prevention and treatment of dementia is a global concern that requires involvement of international samples. The purpose of this study is to develop culturally sensitive norms based on normal older Lebanese adults using multiple cognitive screening measures translated into Arabic for regional use. Methods: Participants were 164 community dwelling older Lebanese adults without cognitive complaints. They were administered the following cognitive measures in Arabic: Alzheimer’s Disease 8-item questionnaire, Montreal Cognitive Assessment, Mini Mental Status Exam, Modified Mini Mental Status, Brief Visuospatial Memory Test-Revised, Lebanese Digit Span, Cross-Linguistic Naming Test, and phonemic and semantic fluency tests. Results: Sample characteristics and descriptive statistics for the demographically unadjusted raw scores are first presented (N = 164). Same-form test-retest reliability for each test were computed for 24 participants retested over 2–5 weeks, with reliabilities ranging from .55 to .90; Cronbach alpha coefficients ranged from .34 to .93. Two sets of normative data were constructed. First, base-rates for demographically unadjusted raw scores for the 5th, 10th and 15th percentiles are presented to identify relatively rare occurring performances. Second, using standardized regression-based procedures demographically corrected normative information adjusted for age, education and sex were generated for normative interpretation. Conclusions: Adapting cognitive tests for use in culturally and linguistically diverse regions of the world not only requires careful translation of test instructions and materials, but construction of culturally sensitive local norms. Our normative data should allow for more accurate identification of cognitive impairment and dementia in Arabic-speaking patients, especially those living in Lebanon.

Association of neurobehavioral performance with R2* in the caudate nucleus of asymptomatic welders

ObjectivesWelding fumes contain several metals including manganese (Mn) and iron (Fe) that may affect the nervous system. Previous studies of potential welding-related neurotoxicity have focused primarily on Mn exposure. The current study examined neurobehavioral and brain imaging changes in asymptomatic welders and their associations with both Mn and Fe exposure measurements. MethodsData were obtained from subjects with (n=46) and without (controls; n=31) a history of welding exposure. Occupational questionnaires estimated recent (HrsW; welding hours and E90; cumulative exposure, past 90days) and lifetime (YrsW; total welding years and ELT; cumulative exposure, lifetime) exposure. Brain MRI pallidal index (PI), R1 (1/T1), and R2* (1/T2*) were measured to estimate Mn and Fe concentrations in the basal ganglia [caudate nucleus (CN), putamen, and globus pallidus], amygdala, and hippocampus. Comprehensive neuropsychological tests were conducted to examine behavioral differences between welders and controls. Correlation analyses were conducted between neuropsychological tests and those exposure measurements that showed significant group differences. ResultsCompared to controls, welders had significantly higher R2* in the CN and lower performance on the Phonemic Fluency test. Correlation analyses revealed that welders’ Phonemic Fluency scores were inversely associated with R2* in the CN, but not with the PI or R1 in any brain region of interest studied. DiscussionThe results showed that neurobehavioral performance for the asymptomatic welders in our study was worse than individuals who had not welded, and suggest the differences may be associated with higher Fe accumulation in the CN.