Tests Of Psychomotor Function Research Articles

Evaluating possible ‘next day’ impairment in insomnia patients administered an oral medicinal cannabis product by night: a pilot randomized controlled trial

Cannabis and its major constituents, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are being widely used to treat sleep disturbances. However, THC can cause acute cognitive and psychomotor impairment and there are concerns that driving and workplace safety might be compromised the day after evening use. Here, we examined possible ‘next day’ impairment following evening administration of a typical medicinal cannabis oil in adults with insomnia disorder, compared to matched placebo. This paper describes the secondary outcomes of a larger study investigating the effects of THC/CBD on insomnia disorder. Twenty adults [16 female; mean (SD) age, 46.1 (8.6) y] with physician-diagnosed insomnia who infrequently use cannabis completed two 24 h in-laboratory visits involving acute oral administration of combined 10 mg THC and 200 mg CBD (‘THC/CBD’) or placebo in a randomised, double-blind, crossover trial design. Outcome measures included ‘next day’ (≥9 h post-treatment) performance on cognitive and psychomotor function tasks, simulated driving performance, subjective drug effects, and mood. We found no differences in ‘next day’ performance on 27 out of 28 tests of cognitive and psychomotor function and simulated driving performance relative to placebo. THC/CBD produced a small decrease (-1.4%, p=.016, d=-0.6) in accuracy on the Stroop-Colour Task (easy/congruent) but not the Stroop-Word Task (hard/incongruent). THC/CBD also produced a small increase (+8.6, p=.042, d=0.3) in self-ratings of Sedated at 10 h post-treatment, but with no accompanying changes in subjective ratings of Alert or Sleepy (p’s>0.05). In conclusion, we found a lack of notable ‘next day’ impairment to cognitive and psychomotor function and simulated driving performance following evening use of 10 mg oral THC, in combination with 200 mg CBD, in an insomnia population who infrequently use cannabis.

Association between arterial health and cognition in adolescents: The PANIC study.

We investigated the associations of the measures of arterial health with cognition in adolescents and whether physical activity (PA) or sedentary time (ST) confounds these associations. One hundred sixteen adolescents (71 boys) aged 15.9 ± 0.4 participated in the study. PA and ST were assessed using a combined accelerometer/heart rate monitor. Overall cognition was computed from the results of psychomotor function, attention, working memory, and paired-associate learning tests. Pulse wave velocity was measured by impedance cardiography, carotid intima-media thickness, and carotid artery distensibility by carotid ultrasonography. Systolic and diastolic blood pressure (SBP and DBP) were measured using an aneroid sphygmomanometer. SBP was inversely associated with overall cognition (standardized regression coefficient [β] = -0.216, 95% confidence interval (CI) -0.406 to -0.027, p = 0.025). Pulse wave velocity (β = -0.199, 95% CI -0.382 to -0.017, p = 0.033) was inversely associated with working memory task accuracy. SBP was directly associated with reaction time in the attention (β = 0.256, 95% CI 0.069 to 0.443, p = 0.008) and errors in the paired-associate learning tasks (β = 0.308, 95% CI 0.126 to 0.489, p = 0.001). Blood pressure was inversely associated with overall cognition. PA or ST did not confound the associations. Results suggest that preventing high blood pressure is important for promoting cognition in adolescents.

Evolocumab in paediatric heterozygous familial hypercholesterolaemia: cognitive function during 80 weeks of open-label extension treatment.

PCSK9 inhibition intensively lowers low density lipoprotein cholesterol and is well tolerated in adults and paediatric patients with familial hypercholesterolaemia (FH). HAUSER-RCT showed that 24 weeks of treatment with evolocumab in paediatric patients did not affect cognitive function. This study determined the effects of 80 additional weeks of evolocumab treatment on cognitive function in paediatric patients with heterozygous FH. HAUSER-OLE was an 80-week open-label extension of HAUSER-RCT, a randomized, double-blind, 24-week trial evaluating the efficacy and safety of evolocumab in paediatric patients (ages 10-17 years) with FH. During the OLE, all patients received monthly 420 mg subcutaneous evolocumab injections. Tests of psychomotor function, attention, visual learning, and executive function were administered at baseline and Weeks 24 and 80 of the OLE. Changes over time were analysed descriptively and using analysis of covariance. Cohen's d statistic was used to evaluate the magnitude of treatment effects. Analysis of covariance results indicated no decrease in performance across visits during 80 weeks of evolocumab treatment for Groton Maze Learning, One Card Learning accuracy, Identification speed, or Detection speed (all P > 0.05). Performance on all tasks was similar for those who received placebo or evolocumab in the RCT (all P > 0.05). For all tests, the least square mean differences between patients who received placebo vs. evolocumab in the parent study were trivial (all Cohen's d magnitude < 0.2). In paediatric patients with FH, 80 weeks of open-label evolocumab treatment had no negative impact on cognitive function. ClinicalTrials.gov identifier: NCT02624869.

Cognitive Impairment Among Patients with Chronic Immune Thrombocytopenia

Introduction: Immune thrombocytopenia (ITP) is an autoimmune disease associated with autoantibody-mediated platelet destruction and impaired platelet production, resulting in thrombocytopenia and high bleeding risk. Fatigue and impairment of both memory and concentration are also common in ITP, theoretically due to acute neural inflammation, microbleeding, and thrombotic occlusions of small blood vessels in the brain. However, little is known about the nature and severity of cognitive impairment in patients with chronic ITP. Tests from the Cogstate Brief Battery (CBB) and composite scores computed from these have a high sensitivity to cognitive dysfunction in clinical and clinical trial contexts. The aim of this analysis was to assess cognitive impairment among difficult-to-treat patients with ITP. Methods: Participants (N=60) in the ongoing, global phase 1/2 study (NCT03395210) assessing the safety and efficacy of the Bruton tyrosine kinase inhibitor rilzabrutinib in ITP, were eligible for cognitive testing at baseline. In the CBB, the Detection test (DET) measured psychomotor function, the Identification test (IDN) measured attention, the One Card Learning test (OCL) measured visual learning, and the One Back test (ONB) measured working memory. For each participant, prior to rilzabrutinib treatment, the score on each test was compared with age-matched normative data to produce a standardized score (Z-score). Z-scores measure the distance between an observed value and a reference mean using standard deviation units and can be positive or negative, indicating that the observed value lies above or below the mean, respectively. Z-scores ≤-1 denoted impairment. Descriptive summary statistics, including mean Z-scores for individual tests and composite cognitive scores (Psychomotor/Attention, Learning/Memory), and level of impairment are presented. Relationships between cognitive impairment and demographics, concomitant medication, and medical history were also explored. Results: At baseline, the 49 patients with CBB assessments had a mean age of 50 years, 57% were females, and 71% had an ITP duration of ≥3 years; 14 patients each had concomitant corticosteroids or thrombopoietin receptor agonists (TPO-RA) and 7 patients had both concomitant therapies. Medical history included hypertension (n=17), depression/anxiety (n=8), diabetes (n=7), and stroke/CNS bleeding (n=1). Mean Z-scores for the psychomotor function, attention, and working memory tests were below age-matched healthy norms (Table 1). The degree of impairment was substantial for the psychomotor function and attention tests and composite scores. Impairment was also large for the working memory test, whereas performance on the visual learning test was close to normal. The level of impairment followed the same pattern, with top rates for the attention (67% of patients), followed by psychomotor function (53% of patients), working memory (39% of patients), and visual learning (16% of patients) tests. Psychomotor/Attention impairment was greater (69% of patients) than Learning/Memory (43% of patients; Table 1) and occurred irrespective of biological/clinical characteristics (Figure 1). More than half of patients aged <65 years, with no concomitant ITP medication, and those with no medical history had a "Clinically Important Cognitive Impairment". Conclusion: This report provides evidence of cognitive impairment in patients with ITP. The cognitive impairment was moderate in magnitude for Psychomotor/Attention, and mild for Learning/Memory. Further, the observed impairment appeared to be irrespective of biological/clinical characteristics and unrelated to concomitant use of corticosteroids or TPO-RA. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Attributable risk factors for asymptomatic malaria and anaemia and their association with cognitive and psychomotor functions in schoolchildren of north-eastern Tanzania.

In Africa, children aged 5 to 15 years (school age) comprises more than 50% (>339 million) of the under 19 years population, and are highly burdened by malaria and anaemia that impair cognitive development. For the prospects of improving health in African citizens, understanding malaria and its relation to anaemia in school-aged children, it is crucial to inform targeted interventions for malaria control and accelerate elimination efforts as part of improved school health policy. We conducted a study to determine the risk factors for asymptomatic malaria and their association to anaemia. We explored the prevalence of antimalarial drug resistance as well as the association of asymptomatic malaria infection and anaemia on cognitive and psychomotor functions in school-aged children living in high endemic areas. This study was a comprehensive baseline survey, within the scope of a randomised, controlled trial on the effectiveness and safety of antimalarial drugs in preventing malaria and its related morbidity in schoolchildren. We enrolled 1,587 schoolchildren from 7 primary schools located in Muheza, north-eastern Tanzania. Finger-pricked blood samples were collected for estimation of malaria parasitaemia using a microscope, haemoglobin concentration using a haemoglobinometer, and markers of drug resistance processed from dried blood spots (DBS). Psychomotor and Cognitive functions were assessed using a ‘20 metre Shuttle run’ and a test of everyday attention for children (TEA-Ch), respectively. The prevalence of asymptomatic malaria parasitaemia, anaemia and stunting was 26.4%, 49.8%, and 21.0%, respectively with marked variation across schools. In multivariate models, asymptomatic malaria parasitaemia attributed to 61% of anaemia with a respective population attribution fraction of 16%. Stunting, not sleeping under a bednet and illiterate parent or guardian were other factors attributing to 7%, 9%, and 5% of anaemia in the study population, respectively. Factors such as age group (10–15 years), not sleeping under a bednet, low socioeconomic status, parents’ or guardians’ with a low level of education, children overcrowding in a household, and fewer rooms in a household were significantly attributed to higher malaria infection. There was no significant association between malaria infection or anaemia and performance on tests of cognitive function (sustained attention) or psychomotor function (VO2 max). However, a history of malaria in the past one month was significantly associated with decreased cognitive scores (aOR = -4.1, 95% CI -7.7–0.6, p = 0.02). Furthermore, stunted children had significantly lower VO2max scores (aOR = -1.9, 95% CI -3.0–0.8, p = 0.001). Regarding the antimalarial drug resistance markers, the most prevalent Pfmdr1 86-184-1034-1042-1246 haplotypes were the NFSND in 47% (n = 88) and the NYSND in 52% (n = 98). The wild type Pfcrt haplotypes (codons 72–76, CVMNK) were found in 99.1% (n = 219) of the samples. Malaria, stunting and parents’ or guardians’ illiteracy were the key attributable factors for anaemia in schoolchildren. Given malaria infection in schoolchildren is mostly asymptomatic; an addition of interventional programmes such as intermittent preventive treatment of malaria in schoolchildren (IPTsc) would probably act as a potential solution while calling for an improvement in the current tools such as bednet use, school food programme, and community-based (customised) health education with an emphasis on nutrition and malaria control.

Psychomotor function in children with epilepsy seen at a tertiary hospital in southern Nigeria: does treatment with anti-epileptic drugs have any effect?

BackgroundPsychomotor slowing is more commonly reported in children with epilepsy (CWE) compared to healthy controls. The effect of anti-epileptic drug (AED) treatment on psychomotor abilities of CWE remains controversial. In Nigeria, psychomotor abilities of CWE are scarcely investigated and the impact of AEDs is not known. The present study sought to assess psychomotor performance of CWE compared to healthy controls and to determine any association with seizure characteristics and treatment.MethodA comparative cross-sectional study involving 160 children with idiopathic epilepsy and 80 controls aged 6–16 years. Psychomotor function was assessed using reaction times and tapping task of the Iron psychology computerised test battery. The criterion for impairment was fixed at two standard deviations (SD) worse than the mean of age-matched controls. The relationship between seizure variables and psychomotor function was assess with the one-way analysis of variance (ANOVA).ResultFifty-nine (36.9%) CWE had impaired auditory reaction, 50 (31.3%) with impaired visual reaction and 11 (6.9%) had fine motor control impairment. There was no significant difference in psychomotor performance between CWE on AED and the newly diagnosed counterparts yet to start AED treatment (auditory reaction time—p = 0.226; visual reaction time—p = 0.349; tapping task—p = 0.818). AED treatment duration over 5 years was associated with better auditory reaction time (F = 4.631, p = 0.034) in CWE. Also, seizure onset before 5 years of age was associated with slower auditory reaction (F = 4.912, p = 0.028) and verbal reaction (F = 14.560, p < 0.001).ConclusionNigerian CWE perform less favourably on tests of psychomotor function than healthy controls. The performance of children on AED is not significantly different from those not on AED. Longer duration of AED treatment may result in psychomotor improvement in CWE. CWE should be closely monitored for psychomotor slowness so that deficits can be identified and appropriate interventions instituted.

Usefulness of a psychomotor function test as a cognitive function scale for patients with schizophrenia: A pilot study

As cognitive dysfunction due to schizophrenia is strongly associated with patients' social rehabilitation, cognitive functions have been examined as a therapeutic target. Although the Brief Assessment of Cognition in Schizophrenia (BACS) has been used to evaluate cognitive function, it is difficult to administer in routine clinical practice due to its time-consuming nature. Therefore, a novel tool is needed to facilitate the assessment of cognitive function. In the present study, we examined whether cognitive function can be assessed effectively by testing psychomotor function in patients with schizophrenia. Test batteries consisting of choice reaction time (CRT) and compensatory tracking task (CTT) and the BACS were examined in 20 schizophrenic patients to evaluate the correlation between the scales by Pearson correlation coefficient. Of the test batteries, the CRT was significantly correlated with attention functions, a subtest of the BACS (r = -0.506, p = 0.023), and the CTT was strongly correlated with attention functions (r = -0.716, p < 0.001) and working memory (r = -0.633, p = 0.003). A multiple regression analysis was performed to clarify the association between psychomotor function tests and the total BACS score, and peripheral awareness task, a component of CTT, was independently associated with the total BACS score (β = -0.59, p = 0.004) with an R2 of 0.37. Thus, of the psychomotor function tests, the CRT and the CTT are highly useful in assessing cognitive functions in schizophrenic patients. However, no having large sample size in this study is a limitation.

A Randomized Open-label Study to Evaluate the Effects of Escitalopram and Mirtazapine on Psychomotor Functions and Memory in Patients with Depression

Objective: To compare the effects of escitalopram and mirtazapine on psychomotor functions and memory and also to correlate the antidepressant efficacy of these drugs with psychomotor functions. Materials and Methods: This study was carried out at a tertiary care teaching hospital on 104 newly diagnosed literate patients with endogenous depression as per the inclusion and exclusion criteria. Patients were prescribed either escitalopram (20 mg OD) or mirtazapine (15 mg OD) or amitriptyline (75 mg BD). Psychomotor functions were assessed by digit-letter substitution, six-letter cancellation, choice reaction time, hand steadiness, and flicker fusion tests, and memory was assessed by PGI memory scale at the baseline and at the end of the 1st week, 1st month, and 4th month. Efficacy of drugs was measured by the Hamilton Depression Rating Scale (HDRS) at the baseline and each follow-up. The antidepressant efficacy of these drugs with various psychomotor function tests was correlated using Pearson's correlation test. P 0.05). A strong correlation was observed between psychomotor functions and HDRS score in patients treated with escitalopram (positive correlation), mirtazapine (positive correlation), and amitriptyline (negative correlation). Conclusion: Escitalopram and mirtazapine improve psychomotor function in patients with endogenous depression while amitriptyline deteriorates it. Thus, escitalopram and mirtazapine may be preferred to amitriptyline in clinical practice.

Effect of agomelatine on psychomotor function tests in healthy human volunteers

Background: Agomelatine is a melatonergic agonist that acts specifically on MT1/MT2 melatonergic receptors and 5-HT2C antagonism. The present study was taken up to evaluate the effect of Agomelatine 25mg on psychomotor function in healthy human volunteers.Methods: The effect of Agomelatine was studied in 12 healthy volunteers of either gender. The study was a randomised, cross over, placebo controlled study, done after obtaining permission from NIMS Institutional Ethics Committee and informed consent taken from all the subjects, after briefly explaining the study procedure and training them adequately. Psychomotor function was assessed using Choice reaction time (CRT), Critical Flicker fusion test (CFFT), Digit letter substitution test (DLST), Six letter cancellation test (SLCT), Card sorting test (CST) and Visual analog scale (VAS). Psychomotor function tests were performed, 90 minutes after administering Agomelatine 25 mg or placebo. Washout period of seven days was allowed between the cross over. Statistical analysis was done by comparing groups using unpaired t test.Results: There was significant decrease in the mean percentage of time (p&lt;0.01) in CRT in Agomelatine group (20.09±9.47%) when compared to placebo (10.48±3.68%). Improved mean percentage of performance was seen in CFFT with Agomelatine (6.2±2.1%) compared to placebo (9.11±2.99%). No significant difference was noted in the performance of DLST, SLCT and CST. Drug was subjectively rated as sedative on VAS.Conclusions: There is no significant effect of Agomelatine on psychomotor performance. CNS processing of information also improved. Agomelatine can thus be safely administered to depressed patients.

Using Robust Normative Data to Investigate the Neuropsychology of Cognitive Aging.

The extent to which increasing age is associated with impairment in cognitive function, termed cognitive aging, may have been overestimated in prior studies. The inclusion of individuals with severe or uncontrolled systemic medical illness or prodromal neurodegenerative disease in normal aging samples is likely to bias estimates toward lower cognitive performance and inflate estimates of variability. Unbiased estimates of cognitive aging in 658 adults aged 60-84, who underwent rigorous screening to ensure their general and cognitive health, were computed. The first study screened the psychometric properties of a battery of neuropsychological tests in order to identify those with optimal properties to evaluate cognitive aging. The second study used the selected tests to compare baseline performance within 5-year age bands from 60 to 84. The first study identified a battery of 12 tests that provided reliable measures of memory, psychomotor speed, attention, and executive function and were appropriate for investigating age-related cognitive changes. The second study observed moderate to large age-related impairment for performance on tests of complex psychomotor function, category fluency, verbal learning, and verbal and visual memory. No, or only small, age effects were observed for working memory, phonemic fluency, learning of visual information, and reaction time. These data suggested that while increasing age is associated with impairment in cognitive function, this impairment is less severe and is evident only on more complex neuropsychological tests than estimated previously in samples selected using less rigorous criteria to ensure cognitive health.

Effects of blueberry supplementation on measures of functional mobility in older adults.

Limited functional mobility in older adults has been associated with declines in tests of motor, psychomotor, and executive function. Animal studies have demonstrated reversals in indices of motor and psychomotor function via supplementation with polyphenolic-rich foods such as blueberries. The purpose of this study was to examine whether 6 weeks of daily consumption of 2 cups of frozen blueberries affects functional mobility in older adults. Pre- and post-intervention assessments of grip strength, simple reaction time, adaptive gait, and executive function were completed for older adults (age >60 years) partially randomly assigned to a blueberry (BB) supplementation or a carrot juice drink control (CAR) group. Paired t tests were used to assess within-group effects for outcome variables in each supplementation group, and a mixed-model analysis of covariance (ANCOVA) was used to determine group (CAR vs. BB) differences. Mixed-model analysis indicated that the BB group demonstrated significant improvements relative to the CAR group in performance (i.e., number of step errors) of a challenging dual-task adaptive gait test that were independent of differences in gait speed. Within only the BB group, significant improvements were also seen in 3 other measures (i.e., usual gait speed; number of step errors during single-task adaptive gait; and gait speed during dual-task adaptive gait). These preliminary findings support the hypothesis that blueberry supplementation may provide an effective countermeasure to age-related declines in functional mobility and serve as justification for an expansion to larger trials to more fully assess this nonpharmacologic approach to maintaining optimal mobility and independence.

Odor identification and cognitive function in the Beaver Dam Offspring Study

Olfactory impairment is associated with cognitive impairment in older adults but less is known about the association of olfactory impairment and cognitive function in middle-aged adults. The association between olfactory impairment and cognitive function tests of attention, processing speed, and executive and psychomotor function was explored in 2837 participants (21–84 years; mean age 49 years) in the Beaver Dam Offspring Study. Among middle-aged participants (aged 35–64 years), those with impairment on an odor identification test took significantly longer to complete the Trail Making Test (TMT-A and TMT-B) and the Grooved Peg Board (GPB) test, than those without olfactory impairment in regression models adjusted for multiple factors. Similar results were found for the TMT-A and TMT-B, but not the GPB, in the whole cohort. Olfactory impairment was associated with poorer performance on cognitive function tests in a primarily middle-aged cohort.

Placebo- and Amitriptyline-Controlled Evaluation of Central Nervous System Effects of the NK1Receptor Antagonist Aprepitant and Intravenous Alcohol Infusion at Pseudo-Steady State

Recent interest in NK1 receptor antagonists has focused on a potential role in the treatment of drug addiction and substance abuse. In the present study, the potential for interactions between the NK1 receptor antagonist aprepitant and alcohol, given as an infusion at a target level of 0.65 g/L, was evaluated. Amitriptyline was included as positive control to provide an impression of the profile of central nervous system (CNS) effects. In a double-blind, randomized, placebo- and amitriptyline-controlled study, the pharmacokinetics and CNS effects of aprepitant and alcohol were investigated in 16 healthy volunteers. Cognitive and psychomotor function tests included the visual verbal learning test (VVLT), Bond and Lader visual analogue scales (VAS), digit symbol substitution test (DSST), visual pattern recognition, binary choice reaction time, critical flicker fusion (CFF), body sway, finger tapping, and adaptive tracking. Alcohol impaired finger tapping and body sway. Amitriptyline impaired DSST performance, VAS alertness, CFF, body sway, finger tapping, and adaptive tracking. No impairments were found after administration of aprepitant. Co-administration of aprepitant with alcohol was generally well tolerated and did not cause significant additive CNS effects, compared with alcohol alone. Therefore, our study found no indications for clinically relevant interactions between aprepitant and alcohol.

Does Sleep Deprivation Impair Orthopaedic Surgeons’ Cognitive and Psychomotor Performance?

Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained. We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center. Testing sessions used handheld computers to administer validated cognitive and psychomotor function tests. We conducted a multivariate analysis to examine the independent association between test performance and multiple covariates, including the amount of sleep the night before testing. Our analysis demonstrated that orthopaedic surgeons who had slept four hours or less the night before the test had 1.43 times the odds (95% confidence interval, 1.04 to 1.95; p = 0.03) of committing at least one error on an individual test compared with orthopaedic surgeons who had slept more than four hours the previous night. The Running Memory test, which assesses sustained attention, concentration, and working memory, was most sensitive to deterioration in performance in participants who had had four hours of sleep or less; when controlling for other covariates, the test demonstrated a 72% increase in the odds of making at least one error (odds ratio, 1.72 [95% confidence interval, 1.02 to 2.90]; p = 0.04). No significant decrease in performance with sleep deprivation was shown with the other three tests. Orthopaedic trauma surgeons showed deterioration in performance on a validated cognitive task when they had slept four hours or less the previous night. It is unknown how performance on this test relates to surgical performance.

P.6.a.010 Cognitive disorders among alcoholics: relevance of the Montreal Cognitive Assessment

Acetaldehyde, the first product of ethanol metabolization, is a biologically active compound, but the behavioral properties of acetaldehyde in humans are largely undefined. We investigated the acute effects of both alcohol and acetaldehyde on psychomotor functions related to automobile driving skills.Twenty-four men were selected through genotyping; one-half had the ALDH2*1/*1 (active form) genotype and one-half had the ALDH2*1/*2 (inactive form) genotype. In a double-blind placebo-controlled crossover design, each subject was administered one of the following doses of alcohol: .25 g/kg, .5 g/kg, or .75 g/kg or a placebo in four trials that took place at 1-week intervals. Blood ethanol concentration (BEC) and blood acetaldehyde concentration (BAAC) were measured nine times, and psychomotor function tests (critical flicker fusion threshold, choice reaction time, compensatory tracking task, and digit symbol substitution test) were assessed seven times in total over 4 hours after study drug ingestion.After the consumption of alcohol, BEC was comparable in the two subject groups, whereas BAAC was significantly higher in subjects with ALDH2 *1/*2 than in those with ALDH2 *1/*1. The psychomotor performance of subjects with ALDH2*1/*2 was significantly poorer than that of subjects with ALDH2*1/*1. Significant correlations between psychomotor performance and both BEC and BAAC were observed. However, in the linear regression analysis, BAAC significantly predicted poorer psychomotor performance, whereas BEC was not associated with any measure of psychomotor function.Acetaldehyde might be more important than alcohol in determining the effects on human psychomotor function and skills.

Parent-reported cognition and its clinical applications in pediatric oncology.

9532 Background: Parent-reported cognitive function (PCF) of their child's cognitive abilities is often used to trigger referral for comprehensive neuropsychological evaluation. The purpose of this study was to evaluate the clinical utility of PCF to predict impairment as measured by neuropsychological assessment and to identify factors associated with PCF. Methods: 565 patients (53% brain tumor, BT; 47% other types of cancer, non-BT) aged 7-21 (mean=14 yrs; 56% males) and their parents were recruited. 34% received radiation therapy, 72% chemotherapy and 71% surgery. Mean years since diagnosis= 5.7 yrs. PCF was measured using a 43-item pediatric perceived cognitive function item bank (pedsPCF). Parents completed the pedsPCF and a single item to rate their child's quality of life (QOL). Patients completed NINDS-NeuroQOL Depression, PedsQL Fatigue scales and neuropsychological tests (NPT) of psychomotor function, attention, learning and working memory using the CogState. K-Means clustering was used to group patients based on scores of depression, fatigue and pedsPCF. Results: PedsPCF significantly differentiated BT from non-BT, t=5.65, p&lt;.01. Correlations between pedsPCF and NPT ranged from 0-0.66 (BT, &lt; 1 yr diagnosis, psychomotor), depending on BT (vs non-BT), yrs since diagnosis and treatment, and NPT. Three clusters were identified with its own unique characteristics. Specifically, pedsPCF was significantly correlated w/ depression &amp; fatigue for cluster 1; correlated w/ NPT scores for non-BT for cluster 2; and correlated w/ NPT for BT for cluster 3. Cluster membership of patients were significantly differentiated by Karnofsky rating, surgery (yes/no), QOL, parent education, child age, and child gender, but not types of treatment, and grade repetition (yes/no). Conclusions: This is one of the first studies to report an association between perceived cognitive function, using parent ratings, and neuropsychological performance. PedsPCF demonstrated clinical utility in differentiating between children with a brain tumor from children with other cancer types. PedsPCF has the potential to serve as a screening tool to facilitate efficient referral for comprehensive neurocognitive assessment.

Passiflora incarnata Linneaus as an anxiolytic before spinal anesthesia

Patients who undergo regional anesthesia experience anxiety in the preoperative period. Passiflora incarnata Linneaus is a plant that has traditionally been used as an anxiolytic and sedative. We aimed to investigate the effect of preoperative oral administration of Passiflora incarnata Linneaus on anxiety, psychomotor functions, sedation, and hemodynamics in patients undergoing spinal anesthesia. Under local ethics committee approval, 60 patients who were aged 25-55 years and ASAI-II and who were scheduled for spinal anesthesia were enrolled in this prospective, randomized, double-blind and placebo-controlled study. Thirty minutes before spinal anesthesia, baseline hemodynamic parameters, State-Trait Anxiety Inventory (STAI) score, sedation score, and psychomotor function test results were measured, then patients were randomly assigned to two groups: oral Passiflora incarnata Linneaus extract or placebo was given to the patients. Tests were repeated just before spinal anesthesia. Hemodynamics, sedation score, sensory-motor block and side effects were assessed during the operation. Psychomotor function tests were repeated at the end of the operation and 60 min after the operation. There was a statistically significant difference between the two groups for the increase in State Anxiety Inventory (STAI-S) score obtained just before spinal anesthesia when compared to the baseline. There was no statistically significant difference in psychomotor function from the baseline for either group. A significant difference was not found between the two groups in demographics, psychomotor function, sedation score, hemodynamics, and side effects. Oral preoperative administration of Passiflora incarnata Linneaus suppresses the increase in anxiety before spinal anesthesia without changing psychomotor function test results, sedation level, or hemodynamics.

Estrogen treatment impairs cognitive performance after psychosocial stress and monoamine depletion in postmenopausal women

Recent studies have shown that women experience an acceleration of cognitive problems after menopause and that estrogen treatment can improve or at least maintain current levels of cognitive functioning in postmenopausal women. However, we have previously shown that the negative emotional effects of psychosocial stress are magnified in normal postmenopausal women after estrogen treatment. This study examined whether estradiol (E2) administration can modify cognitive performance after exposure to psychological stress and monoamine depletion. Participants consisted of 22 postmenopausal women placed on either oral placebo or 17beta-E2 (1 mg/d for 1 mo, then 2 mg/d for 2 mo). At the end of the 3-month treatment phase, participants underwent three depletion challenges in which they ingested one of three amino acid mixtures: deficient in tryptophan, deficient in phenylalanine/tyrosine, or balanced. Five hours later, participants performed the Trier Social Stress Test (TSST), followed by mood and anxiety ratings and cognitive testing. Cognitive measures included tests of attention, psychomotor function, and verbal episodic memory. E2-treated compared with placebo-treated participants exhibited significant worsening of cognitive performance on tasks measuring attentional performance and psychomotor speed. Similar trends for impairment were seen in measures of long-term episodic memory compared with placebo-treated postmenopausal women. E2-treated participants also showed a significant increase in negative mood and anxiety compared with placebo-treated women after, but not before, the TSST, although the worsening of both cognitive and behavioral functioning was not correlated. These effects were independent of tryptophan or tyrosine/phenylalanine depletion and were not manifested before the TSST or at baseline. These data suggest that the relationship between estrogen administration and cognitive/behavioral performance in postmenopausal women may be more complex than initially appreciated and that the effects of psychosocial stress may influence whether hormone effects are beneficial.

Effects of ramelteon on insomnia symptoms induced by rapid, eastward travel

Objective Ramelteon, an MT 1/MT 2 melatonin receptor agonist, was evaluated for its ability to reduce sleep-onset difficulties associated with eastward jet travel. Methods Healthy adults ( n = 110) with a history of jet lag sleep disturbances were flown eastward across five time zones from Hawaii to the east coast of the US. Ramelteon 1, 4, or 8 mg or placebo was administered 5 min before bedtime (local time) for four nights. Sleep parameters were measured using polysomnography (PSG) on Nights 2, 3, and 4. Next-day residual effects were assessed using psychomotor and memory function tests. Results Compared to placebo, there was a significant decrease in mean latency to persistent sleep (LPS) on Nights 2–4 with ramelteon 1 mg (−10.64 min, P = 0.030). No consistent significant differences were observed with ramelteon vs. placebo on measures of next-day residual effects except on Day 4 where participants in all ramelteon groups performed significantly worse on the immediate memory recall test compared with placebo ( P ⩽ 0.05). The incidence of adverse events was similar for ramelteon and placebo. Conclusion After a 5-h phase advance due to eastward jet travel, ramelteon 1 mg taken before bedtime for four nights reduced mean LPS relative to placebo in healthy adults.

Factor Analysis of Proton MR Spectroscopic Imaging Data in HIV Infection: Metabolite-derived Factors Help Identify Infection and Dementia

To develop a relevant pathophysiologic model of human immunodeficiency virus (HIV)-associated dementia by studying regional variations in metabolite levels measured with magnetic resonance (MR) spectroscopic imaging and their relationship to immunologic measures and cognitive dysfunction. This was a HIPAA-compliant, institutional review board-approved study involving written informed consent. Distributions of N-acetylaspartate (NAA), choline (Cho), and creatine (Cr) concentrations in 94 subjects (20 seronegative controls and 74 HIV-positive subjects; 34 of the HIV-positive subjects having HIV-associated dementia; 63 men, 31 women; mean age, 40 years) were determined with proton (hydrogen 1 [(1)H]) MR spectroscopic imaging. HIV-positive subjects underwent neuropsychological testing and blood and cerebrospinal fluid (CSF) analysis. Factor analysis was utilized to determine associations between metabolites across regions. Analysis of variance and t tests were used to isolate differences between cohorts. A "Cho factor" differentiated seronegative controls from HIV-infected cohorts, indicating elevated Cho levels across deep gray and white matter regions of HIV-positive individuals. An "NAA factor" differentiated those with dementia from those without and correlated best with psychomotor and executive function tests. A "Cr factor" indicated Cr elevations correlated with CSF monocyte chemoattractant protein-1 levels. NAA and Cr factor scores were strongly weighted to metabolite changes in white matter regions. These results highlight the importance of white matter involvement in HIV-associated dementia and support the current pathogenesis model of glial cell proliferation in HIV infection, denoted by regional Cho elevations, and neuronal dysfunction and/or death, denoted by NAA decreases, associated with dementia. Factor analysis of MR spectroscopic imaging data is a useful method for determining regional metabolic variations in HIV infection and its neuropsychological correlates.