Time Of Cognitive Assessment Research Articles

Neuropsychological performance in women at risk of postpartum depression and postpartum psychosis.

While neuropsychological deficits are commonly observed in affective and psychotic disorders, this remains unexplored in these disorders when they occur during pregnancy and the postpartum period. A neuropsychological test battery was administered to women defined at risk of postpartum depression (PD, N = 53) because having either a current or past diagnosis of major depressive disorder, women at risk of postpartum psychosis (PP, N = 43) because of a diagnosis of bipolar disorder or schizoaffective disorder and/or a previous episode of PP and women not at risk (NR, N = 48) in the third trimester of pregnancy. Generalized and specific cognitive abilities were compared between groups. Women at risk of PP presented worse executive functions and processing speed compared to NR and worse performance compared to women at risk of PD across all cognitive domains. In addition, women at risk of PP who developed a psychiatric relapse in the first four weeks post-partum showed worse verbal learning and memory, visual memory, executive functions and processing speed in pregnancy compared to NR, whereas women at risk of PP who remained well presented neuropsychological performance that was intermediate between that of the women NR and those at risk of PP who developed symptoms. There were no differences in performance between women at risk of PD and the NR women, even if 31 women at risk of PD presented depressive symptoms at the time of cognitive assessment. Our findings in women at risk of PP align with neuropsychological findings in individuals with, or at risk of psychosis unrelated to pregnancy. In addition, initial evidence that women at risk of PP who develop a psychiatric relapse in the postpartum show a particularly poor neuropsychological performance in pregnancy suggests that this could be considered part of a phenotype for the disease and help guiding future preventive strategies in this clinical population. In women at risk of PD, the presence of depressive symptoms did not influence cognitive performance.

Cognitive sequelae in MOG antibody-associated disease (P13-5.025)

Cognitive sequelae in MOG antibody-associated disease (P13-5.025)

Clinical associations of cognitive dysfunction in systemic lupus erythematosus

ObjectiveCognitive dysfunction in SLE is common, but clinical risk factors are poorly understood. This study aims to explore the associations of cognitive dysfunction in SLE with disease activity, organ damage,...

T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas.

Survival outcomes for patients with lower grade gliomas (LrGG) continue to improve. However, damage caused both by tumor growth and by the consequences of treatment often leads to significantly impaired cognitive function and quality of life (QoL). While neuropsychological testing is not routine, serial clinical MRIs are standard of care for patients with LrGG. Thus, having a greater understanding of MRI indicators of cognitive and QoL impairment risk could be beneficial to patients and clinicians. In this work we sought to test the hypothesis that in clinically stable LrGG patients, T2 FLAIR hyperintensity volumes at the time of cognitive assessment are associated with impairments of cognitive function and QoL and could be used to help identify patients for cognitive and QoL assessments and interventions. We performed anatomical MR imaging, cognitive testing and QoL assessments cross-sectionally in 30 clinically stable grade 2 and 3 glioma patients with subjective cognitive concerns who were 6 or more months post-treatment. Larger post-surgical T2 FLAIR volume at testing was significantly associated with lower cognitive performance, while pre-surgical tumor volume was not. Older patients had lower cognitive performance than younger patients, even after accounting for normal age-related declines in performance. Patients with Astrocytoma, IDH mutant LrGGs were more likely to show lower cognitive performance than patients with Oligodendroglioma, IDH mutant 1p19q co-deleted LrGGs. Previous treatment with combined radiation and chemotherapy was associated with poorer self-reported QoL, including self-reported cognitive function. This study demonstrates the importance of appreciating that LrGG patients may experience impairments in cognitive function and QoL over their disease course, including during periods of otherwise sustained clinical stability. Imaging factors can be helpful in identifying vulnerable patients who would benefit from cognitive assessment and rehabilitation.

Effect of Hypertension Duration and Blood Pressure Control During Early Adulthood on Cognitive Function in Middle Age.

Elevated blood pressure (BP) is a risk factor for cognitive impairment. We aim to explore the association between the duration of hypertension in early adulthood, with cognitive function in midlife. Furthermore, we investigate whether this asssociation is altered among participants with controlled BP. This prospective study included 2,718 adults aged 18-30 years without hypertension at baseline who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Duration of hypertension was calculated based on repeat measurements of BP performed at 2, 5, 7, 10, 15, 20, and 25 years after baseline. Cognitive function was assessed at Year-25 using the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop test. After multivariable adjustment, a longer hypertension duration was associated with worse verbal memory (RAVLT, p trend = 0.002) but not with processing speed (DSST, p trend = 0.112) and executive function (Stroop test, p trend = 0.975). Among subgroups of participants with controlled (BP < 140/90 mmHg) and uncontrolled (SBP≥140 mmHg or DBP≥90 mmHg) BP at the time of cognitive assessment (i.e., Year-25 BP), longer duration of hypertension was associated with worse verbal memory. Similar results were observed in subgroups with controlled and uncontrolled average BP prior to cognitive assessment. Longer duration of hypertension during early adulthood is associated with worse verbal memory in midlife regardless of current or long-term BP control status. The potential risk of hypertension associated cognitive decline should not be overlooked in individuals with a long duration of hypertension, even if BP levels are controlled.

Current and long‐term trajectories of high BMI are associated with poorer cognitive functioning in middle‐aged adults at high Alzheimer’s risk due to a maternal family history

The deleterious impact of adiposity on cognition in older adults is well-established. Alzheimer's disease (AD) neuropathology begins accumulating decades prior to symptoms so investigation of associations of adiposity with cognition in middle-aged adults may illuminate pathways underlying the earliest stages of cognitive decline. We examined the relationship of body mass index (BMI) with cognitive functioning in middle-aged adults at high AD risk due to a parental family history. We also investigated whether this association differs by maternal (FHm) versus paternal (FHp) family history. Participants are offspring of AD patients from the Israel Registry of Alzheimer's Prevention (IRAP Study; N=271). We examined the association of BMI at the time of cognitive assessment, and of long-term trajectories of BMI, with global cognition and specific cognitive domains. Linear regressions assessed the associations of BMI and cognition adjusting for sociodemographic and cardiovascular risk factors. An interaction term assessed whether associations of BMI with cognition differed by FHm/FHp. ANCOVAs examined the association of trajectories of BMI ("normal" BMI, N=154; "overweight/obese" N= 86), with cognition. For the whole sample, higher BMI was associated with worse language functioning (p=.045). Interactions of BMI with parental history of AD were significant for episodic memory (p=.023), language (p=.027), working memory (p=.006), and global cognition (p=.008), such that the associations of BMI with cognition were consistently stronger among FHm than for FHp. For the BMI trajectories, no significant differences in cognition were identified between normal and overweight/obese trajectories for the entire sample, but the interactions of BMI trajectories with parental history of AD were significant for episodic memory (p=.017), language (p=.013), working memory (p=.001), and global cognition (p=.005), with stronger associations for FHm than for FHp. Higher BMI and ∼20 years of trajectories of overweight/obesity were associated with poorer cognitive function in cognitively normal middle-aged adults with a maternal history of AD, but not in those with a paternal history of AD. Exposure to greater adiposity over time may have a detrimental impact on the brain already in midlife. Investigation of genetic and environmental contribution of maternal history of AD to these associations is merited.

Long-term changes in retinal vascular diameter and cognitive impairment in type 1 diabetes.

To assess associations between cognitive impairment and longitudinal changes in retinal microvasculature, over 18 years, in adults with type 1 diabetes. Participants of the Pittsburgh Epidemiology of Diabetes Complications Study received ≥3 fundus photographs between baseline (1986-1988) and time of cognitive assessment (2010-2015: N = 119; 52% male; mean age and type 1 diabetes duration 43 and 34 years, respectively). Central retinal arteriolar equivalent and central retinal venular equivalent were estimated via computer-based methods; overall magnitude and speed of narrowing were quantified as cumulative average and slope, respectively. Median regression models estimated associations of central retinal arteriolar equivalent and central retinal venular equivalent measures with cognitive impairment status, adjusted for type 1 diabetes duration. Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were assessed. Compared with participants without cognitive impairment, those with clinically relevant cognitive impairment experienced 1.8% greater and 31.1% faster central retinal arteriolar equivalent narrowing during prior years (t = -2.93, p = 0.004 and t = -3.97, p < 0.0001, respectively). Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were not significant. No associations were found between central retinal arteriolar equivalent at baseline, at time of cognitive testing, or any central retinal venular equivalent measures, and cognitive impairment. Long-term arterial retinal changes could indicate type 1 diabetes-related cognitive impairment. Studies examining longitudinal central retinal arteriolar equivalent changes as early biomarkers of cognitive impairment risk are warranted.

Metformin, Lifestyle Intervention, and Cognition in the Diabetes Prevention Program Outcomes Study.

OBJECTIVEWe examined the association of the Diabetes Prevention Program (DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures.RESEARCH DESIGN AND METHODSThe DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score.RESULTSA total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 ± 10.7 years underwent cognitive assessments; 67.7% women, 54.6% non-Hispanic white, 20.7% non-Hispanic black, 14.6% Hispanic, 5.5% American Indian, and 4.6% Asian; 26.6% were homozygous or heterozygous for APOE-ε4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9%; P < 0.001) compared with lifestyle (47.0%) and metformin (50.4%). Metformin exposure was higher in the metformin group (8.72 years; P < 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition.CONCLUSIONSExposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.

The association between cognitive function and subsequent depression: a systematic review and meta-analysis.

Despite a growing interest in understanding the cognitive deficits associated with major depressive disorder (MDD), it is largely unknown whether such deficits exist before disorder onset or how they might influence the severity of subsequent illness. The purpose of the present study was to conduct a systematic review and meta-analysis of longitudinal datasets to determine whether cognitive function acts as a predictor of later MDD diagnosis or change in depression symptoms. Eligible studies included longitudinal designs with baseline measures of cognitive functioning, and later unipolar MDD diagnosis or symptom assessment. The systematic review identified 29 publications, representing 34 unique samples, and 121 749 participants, that met the inclusion/exclusion criteria. Quantitative meta-analysis demonstrated that higher cognitive function was associated with decreased levels of subsequent depression (r = -0.088, 95% confidence interval. -0.121 to -0.054, p < 0.001). However, sensitivity analyses revealed that this association is likely driven by concurrent depression symptoms at the time of cognitive assessment. Our review and meta-analysis indicate that the association between lower cognitive function and later depression is confounded by the presence of contemporaneous depression symptoms at the time of cognitive assessment. Thus, cognitive deficits predicting MDD likely represent deleterious effects of subclinical depression symptoms on performance rather than premorbid risk factors for disorder.

Effects of Previous Major Depressive Illness on Cognition in Alzheimer Disease Patients

Objective Major Depressive Disorder (MDD) may be a risk factor for subsequent development of irreversible dementia; however, the influence of a premorbid history of MDD on the clinical course of patients diagnosed with probable Alzheimer disease (AD) has not been fully explored. Methods Forty-three AD patients with mild-to-moderate cognitive impairment were screened for a life-long history of MDD with the Clinical Assessment of Depression in Dementia Scale. Twenty-two subjects had a history of MDD before onset of cognitive impairment, but none was suffering from an MDD episode at time of cognitive assessment. Results After controlling for age, education, duration of illness, gender, and medication status, subjects with a history of MDD had significantly lower scores, as a group, on cognitive performance tests, including the Mini-Mental State Exam, WAIS Full-Scale and Verbal Scale I.Q., and the Initiation/Perseveration subscale of the Mattis Dementia Rating Scale. These subjects also developed symptoms of dementia at a significantly earlier age than the subjects who had no premorbid history of MDD. Conclusions Although previous studies have shown that late-onset MDD may increase risk for subsequent dementia, the current results suggest that premorbid MDD is associated with more severe cognitive deficits during the actual course of dementia.

Cognitive Effects of Once Weekly (QW) Epoetin Alfa in Anemic Patients (pts) with Hematologic Malignancies Receiving Chemotherapy (CT): Interim Results of the EPOLYM Trial.

CT-associated cognitive dysfunction, which frequently manifests as subtle changes in memory, concentration, and ability to remain focused or organized, can adversely affect cancer pts' QOL. EPOLYM, a prospective, international, multicenter, open-label, phase IIIb trial has been conducted to investigate the efficacy, safety, and clinical outcomes, including effect on cognitive function, of epoetin alfa 40,000 IU sc QW in anemic (Hb <12 g/dL) pts with hematologic malignancies. Pts enrolled had either non-Hodgkin's lymphoma, multiple myeloma, Hodgkin's disease, or chronic lymphocytic leukemia, for which they were receiving or were expected to receive CT (planned N = 1,000). Dosage increases or decreases were to be made based on clinical response (target Hb, 11.5–13.0 g/dL). Cognitive function was evaluated from baseline to Week 24 (or last evaluation) using the Cognitive Drug Research Computerised Cognitive Assessment System, patient-completed, computer-scored tasks of attention (Simple Reaction Time, Choice Reaction Time, Digit Vigilance), working memory (Numeric Working Memory), and secondary memory (Immediate and Delayed Word Recognition, Picture Recognition). To further characterize the data, task scores were variously summed to provide 4 factor scores (and aspects of cognitive function measured): Power of Attention (concentration intensity), Continuity of Attention (ability to sustain concentration), Quality of Memory (amount of information that can be stored and successfully retrieved in working and long-term memory), and Speed of Memory (speed in ability to recognize information previously presented or held in working memory). Changes from baseline in Hb levels and transfusion requirements were determined and QOL was assessed using the Functional Assessment of Cancer Therapy-Anemia Subscale and the Linear Analog Scale Assessment. Because of the apparent relationship between affect and cognition, anxiety and depression were evaluated at the time of cognitive assessment using the Hospital Anxiety and Depression Scale (HADS). Transfusion, QOL, and HADS results are not considered here. The cognitive data for 568 pts who had completed up to 24 weeks of therapy were examined in an interim analysis. Results showed that Power of Attention was slightly impaired and Continuity of Attention was slightly improved over the course of the study; however, these effects were small and unlikely to have everyday behavioral significance. Greater changes were observed in regard to memory. Mean Speed of Memory was decreased 358.9 msec by Week 24, representing an 8% improvement from baseline. Also, improvement was noted in Quality of Memory, with the score for this factor increased by 0.0899 at Week 24 from a baseline value of 2.895. The improvement in cognitive function was associated with an increase in Hb from 10.5 g/dL at baseline to about 12 g/dL beginning at Weeks 8 to 12 and sustained for up to 24 weeks. Results of this interim analysis suggest improvement in several aspects of cognitive function associated with increased Hb levels in anemic CT pts with hematologic malignancies. These results will have to be confirmed by findings based on the full study cohort.

Dementia and its associations in type 2 diabetes mellitus: The Fremantle Diabetes Study

Background: recent studies indicate that diabetes is an important risk factor for dementia in older patients, but the cause remains unknown. Objectives: to determine whether vascular or diabetes-related risk factors predict the development of dementia in older subjects with diabetes. Patients: 63 patients with type 2 diabetes of mean age 75.3 years. Methods: Subjects were screened for cognitive impairment using the Mini-Mental State Examination (MMSE) and informants who knew the subjects answered the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Probable dementia was diagnosed using highly specific criteria based on the combination of both tests. Potential risk factors for dementia obtained at the time of the cognitive test and annually from a median of 3.2 years previously were examined using univariate methods and simple general linear modelling. Results: since there was a significant association between MMSE and English speaking ability, ten non-Anglo–Celt patients were excluded from the analysis. Probable dementia was diagnosed in six of the remaining 53 subjects (11%). Dementia was significantly and independently associated with higher diastolic and mean arterial blood pressure measurements over the 3 years before assessment. Blood pressure declined over this time in the patients with probable dementia and was similar to that in non-demented subjects at the time of cognitive assessment. Conclusions: these preliminary data suggest that the high rate of dementia found in older people with diabetes may be explained by the high rate of hypertension in this population.

The role of cortical cholinergic afferent projections in cognition: impact of new selective immunotoxins

Previous investigations aimed at determining the role of corticopetal cholinergic afferents in cognition have relied upon human psychopharmacological studies, neuropsychological analyses of Alzheimer's patients, or psychopharmacological manipulations and excitotoxic lesions in animals. Unfortunately, each approach has its limitations. The interpretation of neuropsychological data relies upon correlations of post-mortem assessments of cholinergic degeneration that may be quite temporally distant from the time of cognitive assessment. In contrast, the use of animals allows direct manipulations of the cholinergic system and the establishment of causal relationships between acetylcholine and cognitive function but is limited by the selectivity of the toxins and drugs available to manipulate the system. The recent introduction of immunotoxins to lesion cortical cholinergic pathways with greater selectivity has allowed the effective testing of these hypotheses of cholinergic functions in cognition. Previous neuropsychological, psychopharmacological and excitotoxic lesion data are reviewed and compared to results produced using the more selective immunotoxins to provide an update to the current hypotheses of the role of corticopetal cholinergic afferents in cognitive function. Additionally, the conceptual and methodological cost and benefits of the methods of infusion used to produce lesions with these immunotoxins is assessed.

Cognitive correlates of long-term cannabis use in Costa Rican men.

Cognitive correlates of long-term cannabis use have been elusive. We tested the hypothesis that long-term cannabis use is associated with deficits in short term memory, working memory, and attention in a literate, westernized culture (Costa Rica) in which the effects of cannabis use can be isolated. Two cohorts of long-term cannabis users and nonusers were studied. Within each cohort, users and nonusers were comparable in age and socioeconomic status. Polydrug users and users who tested positive for the use of cannabis at the time of cognitive assessment after a 72-hour abstention period were excluded. The older cohort (whose age was approximately 45 years) had consumed cannabis for an average of 34 years, and comprised 17 users and 30 nonusers, who had been recruited in San José, Costa Rica, and had been observed since 1973. The younger cohort (whose age was approximately 28 years) had consumed cannabis for an average of 8 years, and comprised 37 users and 49 nonusers. Short-term memory, working memory, and attentional skills were measured in each subject. Older long-term users performed worse than older nonusers on 2 short-term memory tests involving learning lists of words. In addition, older long-term users performed worse than older nonusers on selective and divided attention tasks associated with working memory. No notable differences were apparent between younger users and nonusers. Long-term cannabis use was associated with disruption of short-term memory, working memory, and attentional skills in older long-term cannabis users.

Side of onset of motor symptoms influences cognition in Parkinson's disease

Studies attempting to relate cognitive impairment to asymmetry of motor symptoms in Parkinson's disease (PD) have found contradictory results. We examined 88 patients with unilateral onset of idiopathic PD who underwent a comprehensive neuropsychological assessment, including language, visuospatial abilities, abstraction and reasoning, attention and mental tracking, set shifting, and memory. Patients whose motor signs began on the left side of the body consistently performed more poorly on the battery of cognitive measures than did patients with right-side onset. Significant differences were found on immediate and delayed verbal recall, word retrieval, semantic verbal fluency, visuospatial analysis, abstract reasoning, attention span, and mental tracking. These differences could not be attributed to differences in the overall severity of motor symptoms at the time of cognitive assessment, or the current pattern of motor asymmetry. This finding suggests that damage to right-hemisphere dopamine systems plays a disproportionately greater role in PD-related cognitive decline than a presumably comparable left-hemisphere dopamine depletion.