Trail Making Test A Research Articles

Reduced thalamic resting-state functional connectivity and impaired cognition in acute abstinent heroin users.

As a critical component of cortico‐striato‐thalamo‐cortical loop in addiction, our understanding of the thalamus in impaired cognition of heroin users (HU) has been limited. Due to the complex thalamic connection with cortical and subcortical regions, thalamus was divided into prefrontal (PFC), occipital (OC), premotor, primary motor, sensory, temporal, and posterior parietal association subregions according to white matter tractography. We adopted seven subregions of bilateral thalamus as regions of interest to systematically study the implications of distinct thalamic nuclei in acute abstinent HU. The volume and resting‐state functional connectivity (RSFC) differences of the thalamus were investigated between age‐, gender‐, and alcohol‐matched 37 HU and 33 healthy controls (HCs). Trail making test‐A (TMT‐A) was adopted to assess cognitive function deficits, which were then correlated with neuroimaging findings. Although no significant different volumes were found, HU group showed decreased RSFC between left PFC_thalamus and middle temporal gyrus as well as between left OC_thalamus and inferior frontal gyrus and supplementary motor area relative to HCs. Meanwhile, the higher TMT‐A scores in HU were negatively correlated with PFC_thalamic RSFC with inferior temporal gyrus, fusiform, and precuneus. Craving scores were negatively correlated with OC_thalamic RSFC with accumbens, hippocampus, and insula. Opiate Withdrawal Scale scores were negatively correlated with left PFC/OC_thalamic RSFC with orbitofrontal cortex and medial PFC. We indicated two thalamus subregions separately involvement in cognitive control and craving to reveal the implications of thalamic subnucleus in pathology of acute abstinent HU.

Lower Plasma α-Synuclein Levels are Associated with Cognitive Impairment in Parkinson's Disease.

α-Synuclein (α-syn) has a central role in the development of Parkinson's disease (PD). Plasma α-syn has been associated with the presence of cognitive impairment in PD although data have been inconsistent. The aim of this study was to explore the correlation between plasma α-syn levels and cognitive impairment in PD. A total of 53 participants, 26 patients with PD and 27 healthy controls were included in the study. Unified Parkinson's Disease Rating Scale (UPDRS) part Ⅲ and Hohen-Yahr scale (H-Y scale) were used to detect PD severity. The cognitive function was assessed with Montreal Cognitive Assessment (MoCA) scale, Frontal Assessment Battery (FAB), Trail Making Test A (TMT-A), Verbal Function Test (VFT), Clock Drawing Test (CDT), and Rey's Auditory Verbal Learning Test (RAVLT). Enzyme-Linked Immunosorbent Assay (ELISA) method was used to measure α-syn and hemoglobin (Hb) concentration in the plasma samples collected from participants. Plasma α-syn in PD patients was significantly lower than those in the control group (p < 0.01). No associations were found between plasma α-syn and Hb or gender (p > 0.05). The decline in plasma α-syn in PD patients was negatively correlated with disease severity, including UPDRS Ⅲ scores and H-Y scale. Furthermore, lower plasma α-syn was negatively associated with the scores of MoCA, FAB, and RAVLT (immediate recall) scores in PD group. Our data suggest that lower plasma α-syn levels are associated with cognitive decline in PD. Thus, plasma α-syn may be a novel biomarker for patients at risk of cognitive decline.

Symptom recovery and the relationship between post-injury symptom scores and neurocognitive performance in athletes with sport-related concussion

IntroductionA multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective self-reported symptoms and objective measures of cognitive function in the post-injury state is not well understood. The aims of the study were to determine symptom severity throughout the post-injury continuum of care and the association between symptom severity and performance on measures of neurocognitive function.MethodsAn observational cohort study was conducted on 1257 high school and collegiate athletes (67% male and 33% female) who had sustained a concussion. Student-athletes were included in the study if they had a healthy baseline assessment and at least one follow-up injury assessment utilizing the Cleveland Clinic Concussion Application (C3 App). Symptom severity was assessed during the acute (0–7 days post-injury), subacute (8–20 days post-injury), and post-concussive (≥21 days post-injury) phases. Neurocognitive performance was assessed using the following measures: Simple Reaction Time (SRT), Choice Reaction Time (CRT), Processing Speed Test (PST), Trail Making Test A (TMT-A), and Trail Making Test B (TMT-B). To determine the relationship between symptom severity and neurocognitive test performance, athletes were stratified into two groups for comparison: symptom score ≤7 or &gt;7, utilizing the 27-item graded symptom checklist within the C3 App. Neurocognitive performance was analyzed with separate linear mixed effect models for each module to compare within-phase differences. Significance for each module at each phase was tested at P &lt; .05 and adjusted for multiple comparisons.ResultsMedian symptom severity during the acute post-injury phase was 10 declining to 2 during the subacute and post-concussive phases. Performance on each of the C3 App modules (SRT, CRT, PST, Trails A, and Trails B) were significantly better in athletes reporting a symptom score of ≤7 compared to those reporting a symptom score &gt;7 at each of the post-injury phases (P &lt; 0.05 on all comparisons).ConclusionsSymptomatic athletes performed worse on all measures of neurocognitive function, regardless of time from injury. While symptoms alone should not be used to determine recovery, our data indicate that symptom severity may aide in deciding when to initiate post-injury neurocognitive testing to determine readiness for treatment progression.

Does participation in Downhill mountain biking affect measures of executive function?

This study assessed the influence of downhill mountain biking on acute measures of executive function. Twenty-three participants took part in the study and were assigned to either, FIELD (N=7, mean age 27 ± 9 yrs), LAB (N=8, mean age 36 ± 9 yrs) or CONTROL (N=8, mean age 41 ± 9 yrs) groups. Participants performed the Stroop colour-word test via a tablet pc app (EncephalApp). Additionally, the Trail Making Test A (TMT-A) and B (TMT-B) were completed. Significant main effects were found for OffTime (F2,12 = 13.04; p = .001; ηp2 = .69), OnTime (F2,12 = 4.31; p = .04; ηp2 = .42) and OnTrials (F2,12 = 10.74; p = .002; ηp2 = .64), with the results showing a decrement in Stroop test performance following Trial1 and Trial4 compared to BL for the FIELD group. A significant main effect was found for TMT-A (F2,12 = 7.50; p = .008; ηp2 = .56), with performance improving following Trial4 compared to BL for the FIELD group. LAB and CONTROL groups significantly improved on the TMT-B from BL to Trial1 and Trial4 (F2,14 = 4.31; p = .04; ηp2 = .38 and F2,14 = 13.70; p = .001; ηp2 = .66, respectively). Results suggest participation in downhill mountain biking in this cohort significantly impaired executive function when compared to repeated sprint activity within a laboratory. This is indicative of repeated head accelerations caused by riding over rough terrain.

Clinical observation on therapeutic effect of moxibustion on cognitive decline in type 2 diabetes mellitus

To observe the effect of moxibustion on cognitive function in patients with cognitive decline of type 2 diabetes mellitus (T2DM). A total of 47 patients with cognitive decline of T2DM were randomized into an observation group (24 cases, 4 cases dropped off ) and a control group (23 cases, 3 cases dropped off ). Conventional hypoglycemic intervention was adopted in the control group. On the basis of the treatment in the control group, Huayu Tongluo moxibustion (moxibustion for removing stasis and clearing collaterals) was applied at Baihui (GV 20), Dazhui (GV 14), Shenting (GV 24), once every 2 days, 4 weeks were as one course, totally 3 courses were required. Before and after treatment, scores of auditory verbal learning test (AVLT), complex figure test (CFT), Montreal cognitive assessment (MoCA) and trail making test-A (TMT-A) were observed in the both groups, and the clinical effective rates were compared. After treatment, the scores of immediate memory and delayed memory of AVLT in the observation group were higher than those before treatment and those in the control group (P<0.05). After treatment, the scores of visual space and executive function, delayed memory, attention and orientation of MoCA in the observation group were higher than those before treatment and those in the control group (P<0.05). The effective rate was 85.0% (17/20) in the observation group, which was superior to 10.0% (2/20) in the control group (P<0.05). Huayu Tongluo moxibustion has a definite effect on cognitive decline of type 2 diabetes mellitus.

Attention processing speed impairment in early dementia with Lewy bodies correlates with white matter damage on volumetric and diffusion tensor imaging

AbstractBackgroundAttentional deficit is a prominent and distinguishing neuropsychological feature of Dementia with Lewy Bodies (DLB) since the prodromal stages. Our group recently highlighted, using voxel based morphometry (VBM), the importance of the basal ganglia grey matter (GM) integrity for attention processing speed, however, one can hypothesize that white matter (WM) would also be affected. Accordingly, this study aimed at investigating, in early DLB patients, the relationship between impaired attention processing speed and white matter changes using WM‐VBM and diffusion tensor imaging (DTI).MethodSeventy‐three prodromal to moderate DLB patients (mean MMSE = 26.4) and thirty healthy elderly subjects (mean MMSE = 28.9), matched in terms of age and educational level, were selected to participate in the study. The Trail Making Test A (TMTA) was used to assess attention processing speed. Behavioral performances were compared between patients and control subjects. Three‐dimensional (3D) MRI and diffusion tensor images (DTI) were acquired and correlational analyses were performed in the patient group using GM‐ and WM‐VBM, fractional anisotropy (FA) and mean diffusivity (MD) DTI.ResultAs expected, DLB patients took significantly more time to achieve completion of the TMTA in comparison to control subjects (p = .004), indicating an impairment in speed of processing. Correlational analyses using VBM revealed negative GM correlations in the basal ganglia bilaterally (p &lt; .001), and negative WM correlations in a bilateral but left‐predominant cluster including mainly the corpus callosum and the anterior cingulate region and a smaller cluster in the right anterior cingulum (p &lt; .05 FDR corrected). Using DTI in correlation with TMTA scores (p &lt; .05 FDR corrected), we found reduced FA in bilateral frontal and posterior regions, and increased MD in widespread lateral and medial anterior and posterior regions.ConclusionWM‐VBM analysis revealed the involvement of the anterior corpus callosum and cingulum in processing speed, which could indicate a disruption of the loops connecting striatal regions and the prefrontal cortex. Changes in both FA and MD were also found: their distribution suggest that attention processing speed might be particularly dependent on the integrity of white matter connections throughout the brain.

Trajectories and risk factors of dementia progression: a memory clinic cohort followed up to 3 years from diagnosis.

Patients with dementia follow different trajectories of progression. We aimed to investigate which factors at the time of diagnosis could predict trajectory group membership. Longitudinal observational study. Specialized memory clinic, Oslo University Hospital in Norway. Patients assessed at the memory clinic, between 12 January 2009 and 31 July 2016, who were registered in the Norwegian Registry of persons assessed for cognitive symptoms (NorCog) and diagnosed with dementia after the baseline examination period (n = 442). The patients were followed up to 3 years, with an average of 3.5 examinations. Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry of Alzheimer's disease (CERAD) 10-item word list delayed recall, the Clock Drawing Test, (CDT) Trail Making Test A (TMT-A), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Based on changes in scores on the CDR-SB, we used group-based trajectory modeling (GBTM) to explore the presence of trajectory groups. Multinomial logistic regression was used to explore whether a set of baseline variables could predict trajectory group membership. Three trajectory groups were identified, one with a slow progression rate and two with more-rapid progression. Rapid progression was associated with older age, lower cognitive function (MMSE and TMT-A), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis. Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes. For future intervention studies, our results may guide the selection of patients.

Effects of Persistent Concussion Symptoms on Executive Function in Working-aged Adults using a Novel Sensorimotor Assessment Tool

To examine neurocognitive performance of persistent concussion symptom patients using a novel sensorimotor technology. In patients with persistent concussion symptoms, neurocognitive deficits have been routinely identified; however, most of the current literature focuses on athletes and military veterans. Middle aged community members face unique challenges related to jobs, family, and transportation which can all be adversely affected by neurocognitive deficits. Thirteen adults (44.3 ± 12.6 years) with self-reported persistent-concussion symptoms (PCS) at least 3 months post-injury, and thirteen sex and age matched healthy controls (37.5 ± 8.8 years) were recruited. Participants performed the Trail-Making Test A (TMT-A) and Trail-Making Test B (TMT-B) on a novel sensorimotor assessment tool, the KINARM (BKIN Technologies, Kingston, ON, Canada). Using their dominant hand, TMT-A required participants to connect numbered dots in ascending order as quickly as possible. TMT-B required connecting dots with either a number or letter inside, in an alternating number-letter fashion (i.e.,: 1-A-2-B-3-C…). Total number of symptoms and a symptom severity score were assessed using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). An independent samples t-test was used to analyze group differences of total time to completion, dwell time, and number of errors. As expected, PCS patients had a significantly higher number of symptoms and severity score (PCS: 13.4 ± 2.3 and 36.2 ± 14.5, respectively; Controls: 3.4 ± 3.7 and 5.3 ± 5.6, respectively, p < 0.001). PCS patients were significantly slower on TMT-A (46.3 ± 20.1 sec; and 34.7 ± 6.5 sec respectively, p = 0.047). There were no group differences in TMT-B. Our results suggest that neurocognitive function may remain unaffected by persistent concussion symptoms in working-aged adults. The lack of task performance differences may be a result of neurocognitive function recovery, or the need for a more sensitive task to assess neurocognitive function in this population.

Correlation of serum homocysteine with attention and executive functions in patients with type I stable bipolar affective disorder

Objectives: The current study aimed to examine the correlation of the level of homocysteine (Hcy) in the serum with attention and executive functions in patients suffering from type I stable bipolar affective disorder. Methods: The present cross-sectional study was conducted on 170 participants in Huzhou, Zhejiang province, China, within July 2016 to December 2017. The subjects were divided into patients with schizophrenia (n=100) as the study group and healthy volunteers (n=70) as the control group. The Hcy and folic acid levels of fasting ulnar vein serum were determined using the chemiluminescent microparticle immunoassay. Patient attention was evaluated by the Trail Making Test A (TMTA), and executive functions were assessed using the Trail Making Test B (TMTB) and Stroop Color and Word Test (SCWT). Results: The serum Hcy value was significantly higher in the study group than that reported for the control group (19.01±5.83 and 11.40±4.62; P&lt;0.001). The results of several tests of attention (59.39±19.27 and 53.26±14.82; P=0.027) and executive functions (123.75±40.60 and 107.52±29.31; P=0.013) were poorer in the study group. The serum Hcy value positively correlated with the disturbance variables of the TMTA, TMTB, and Trail Making Test. However, the duration of the Stroop-C test (SCT) and SCWT negatively correlated with the correct number of the SCT and SCWT. Conclusions: The increase in the level of serum Hcy is closely correlated with the impairment of attention and executive functions in patients suffering from type I stable bipolar affective disorder.

Altered Cerebellar-Cerebral Circuits in Patients With Type 2 Diabetes Mellitus.

The role of the cerebellum in type 2 diabetes mellitus (T2DM) has been receiving increased attention. However, the functional connectivity (FC) between the cerebellar subregions and the cerebral cortex has not been investigated in T2DM. Therefore, the purpose of this study was to investigate cerebellar-cerebral FC and the relationship between FC and clinical/cognitive variables in patients with T2DM. A total of 34 patients with T2DM and 30 healthy controls were recruited for this study to receive a neuropsychological assessment and undergo resting-state FC. We selected four subregions of the cerebellum (bilateral lobules IX, right and left Crus I/II, and left lobule VI) as regions of interest (ROIs) to examine the differences in cerebellar-cerebral circuits in patients with T2DM compared to healthy controls. Correlation analysis was performed to examine the relationship between FC and clinical/cognitive variables in the patients. Compared to healthy controls, patients with T2DM showed significantly decreased cerebellar-cerebral FC in the default-mode network (DMN), executive control network (ECN), and visuospatial network (VSN). In the T2DM group, the FC between the left cerebellar lobule VI and the right precuneus was negatively correlated with the Trail Making Test A (TMT-A) score (r = −0.430, P = 0.013), after a Bonferroni correction. In conclusion, patients with T2DM have altered FC between the cerebellar subregions and the cerebral networks involved in cognitive and emotional processing. This suggests that a range of cerebellar-cerebral circuits may be involved in the neuropathology of T2DM cognitive dysfunction.

Interventions Made to Preserve Cognitive Function Trial (IMPCT) study protocol: a multi-dialysis center 2x2 factorial randomized controlled trial of intradialytic cognitive and exercise training to preserve cognitive function

BackgroundKidney disease and dialysis significantly impact cognitive function across the age spectrum. Cognitive training (CT) and/or exercise training (ET) are promising approaches to preserve cognitive function among community-dwelling older adults, but have not been tested for cognition preservation in hemodialysis patients of all ages. In this manuscript, we summarize the protocol for the Interventions Made to Preserve Cognitive Function Trial (IMPCT).MethodsWe will perform a 2 × 2 factorial randomized controlled trial (RCT) of eligible adult (≥18 years) hemodialysis initiates (n = 200) to test whether intradialytic CT (brain games on a tablet PC), ET (foot peddlers) and combined CT + ET while undergoing hemodialysis preserves executive function compared to standard of care (SC). Participants will engage in the interventions to which they are randomized for 6 months. The primary objective is to compare, among interventions, the 3-month change in executive function measured using the Trail Making Test A (TMTA) and B (TMTB); specifically, executive function is calculated as TMTB-TMTA to account for psychomotor speed. This primary outcome was selected based on findings from our pilot study. The secondary objectives are to compare the risk of secondary cognitive outcomes, ESKD-specific clinical outcomes, and patient-centered outcomes at 3-months and 6-months. All data collection and interventions are conducted in the dialysis center.DiscussionWe hypothesize that receiving intradialytic CT or ET will better preserve executive function than SC but receiving combined CT + ET, will be the most effective intervention. The current trial will be an important step in understanding how intradialytic interventions might preserve cognitive health.Trial RegistrationClinicaltrials.Gov (Date: 8/6/18): # NCT03616535. Protocol Version: 10 (April 2020). Funding: NIDDK R01DK114074.

Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians

HIV-associated neurocognitive deficits include impaired speed-of-information processing (SIP) and motor functions. There is lack of Cameroonian adult norms for assessing SIP or motor functions. This study of 683 Cameroonians (320 HIV+, 363 HIV−) establishes demographically-adjusted norms for six SIP [Wechsler-Adult-Intelligence-Scale (WAIS)-III Digit Symbol (WAIS-IIIDS) and Symbol Search (WAIS-IIISS), Stroop Color-Naming, Stroop Word-Reading, Trail-Making Test-A (TMT-A), Color Trails-1 (CTT1)], and two motor function [Grooved Pegboard-dominant (GP-DH) and non-dominant (GP-NDH) hands] tests. We assessed viral effects on SIP and motor functions. HIV-infected persons had significantly lower (worse) T scores on GP-DH, WAIS-IIIDS, Stroop Word-Reading, TMT-A; lower motor and SIP summary T scores. Significantly higher proportion of cases (20.7%) than controls (10.3%) had impaired SIP. Male cases had better T scores than female cases on GP-NDH, WAIS-IIIDS, WAIS-IIISS, TMT-A, CTT1; better SIP summary T scores. Antiretroviral therapy (ART) was associated with significantly better T scores on GP-NDH, WAIS-IIIDS, Stroop Color-Naming; better motor and SIP summary T scores. Cases with higher CD4 had better T scores on WAIS-IIIDS, TMT-A, CTT1; better SIP summary T scores. Overall, we demonstrate that HIV infection in Cameroon is associated with deficits in SIP and motor functions; ART and higher CD4 are associated with better cognitive performance. We provide SIP and psychomotor functions normative standards, which will be useful for neurobehavioral studies in Cameroon of diseases affecting the brain.

Effects of transcranial magnetic stimulation on the performance of the activities of daily living and attention function after stroke: a randomized controlled trial

Objective: We aimed to interrogate the effects of transcranial magnetic stimulation (TMS) on the performance in activities of daily living (ADL) and attention function after stroke. Design: Randomized controlled trial. Setting: Inpatient rehabilitation hospital. Subjects: We randomized 62 stroke patients with attention dysfunction who were randomly assigned into two groups, and two dropped out from each group. The TMS group (n = 29) and a sham group (n = 29), whose mean (SD) was 58.12 (6.72) years. A total of 33 (56.9%) patients had right hemisphere lesion while the rest 25 (43.1%) patients had left hemisphere lesion. Interventions: Patients in the TMS group received 10 Hz, 700 pulses of TMS, while those in the sham group received sham TMS for four weeks. All the participants underwent comprehensive cognitive training. Main measures: At baseline, and end of the four-week treatment, the performance in the activities of daily living was assessed by Functional Independence Measure (FIM). On the other side, attention dysfunction was screened by Mini-Mental State Examination (MMSE), while the attention function was assessed by the Trail Making Test-A (TMT-A), Digit Symbol Test (DST) and Digital Span Test (DS). Results: Our data showed a significant difference in the post-treatment gains in motor of Functional Independence Measure (13.00 SD 1.69 vs 4.21 SD 2.96), cognition of Functional Independence Measure (4.69 SD 1.56 vs 1.52 SD 1.02), total of Functional Independence Measure (17.69 SD 2.36 vs 5.72 SD 3.12), Mini-Mental State Examination (3.07 SD 1.36 vs 1.21 SD 0.62), time taken in Trail Making Test-A (96.67 SD 25.18 vs 44.28 SD 19.45), errors number in Trail Making Test-A (2.72 SD 1.03 vs 0.86 SD 1.03), Digit Symbol Test (3.76 SD 1.09 vs 0.76 SD 0.87) or Digital Span Test (1.69 SD 0.54 vs 0.90 SD 0.72) between the TMS group and the sham group (P < 0.05). Conclusions: Taken together, we demonstrate that TMS improves the performance in the activities of daily living and attention function in patients with stroke.

Functional Charateristics Of Musculoskeletal Ambulation Disability Symptom Complex (mads) In Community-dwelling Older Women

PURPOSE: For promoting the independence and prevention of falls of older adults, new category of motor disorders was established: musculoskeletal ambulation disability symptom complex (MADS). MADS is defined as an increased risk of falls and isolation due to an age-related decline in balance and walking ability. The purpose of this study was to understand functional charactertistics of MADS by examining the association among physical performance, cognitive functions and sedentary behavior in older community-dwellers in Japan. METHODS: Participants: 59 women aged 65 years and older (mean age 71 ± 4 yrs.) participated in this study. After the participants completed a demographic questionnaire, motor function assessments measurments, one-leg standing time with eyes open (OLS) and timed up-and-go test (TUG), were conducted as diagnostic criteria for MADS. Then, the participants were divided into two groups according to OLS time; G1: longer than 15 sec. and G2: less than 15 sec. Measurements: Following variables were measured; 1) physical function -- hand-grip strength, chair-stand, functional reach, gait speed (10 m), 2) cognitive function -- Mini-Mental State Examination (MMSE) and Trail Making Test-A (TMT-A), and 3) sedentary behavior -- self-reported questionnaire. Data are presented as means ± SD, and analyzed using unpaired t-test and ANCOVA. RESULTS: The average time of OLS was significantly different between G1 and G2 groups (61.3 ± 36.9 and 8.2 ± 3.6 sec., p<0.01). Age was significantly different between the G1 and G2 (70.3 ± 2.5 vs. 72.7 ± 3.2 yrs., p<0.05). The results show that maximal gate speed and TUG were significantly lower in G1 than G2 (1.82 ± 0.24 vs. 1.66 ± 0.25 m/sec., p<0.01) and (7.0 ± 1.1 vs. 8.0 ± 1.5 sec., p<0.05), respectively. In ANCOVA adjusting for the age, TMT-A and sedentary time were significantly different between G1 and G2; TMT-A : 93.9 ± 29.8 sec. vs. 103.3 ± 30.6 sec., p<0.01 and sedentary time: 8.8 ± 0.9 vs. 10.2 ± 1.5 hrs./day, p<0.05. MADS may affect the TMT-A and sedentary time in the older women. CONCLUSIONS: These results suggest that decline in physical and cognitive functions, and sedentary behavior may be significantly associated with the risk of MADS in older women. Follow up studies are necessary to examine physical and cognitive functions of older adults with and without MADS.

Clinical and cognitive correlates of childhood attention-deficit/hyperactivity disorder in first-episode psychosis: A controlled study

The relationship between childhood attention-deficit/hyperactivity disorder (c-ADHD) and psychosis has been understudied. Cognitive dysfunction is a core feature of both disorders, but no previous study has investigated whether first-episode psychosis (FEP) with c-ADHD (FEP-ADHD+) presents a different cognitive profile than FEP without c-ADHD (FEP-ADHD−). One hundred and thirty-three FEP outpatients were screened for c-ADHD through a diagnostic interview and underwent a comprehensive clinical and cognitive assessment with the MATRICS Consensus Cognitive Battery (MCCB). Cognitive differences among FEP groups, and a group of 65 healthy controls (HCs) were analysed by multivariate analysis of covariance. Nearly 25% of FEP fulfilled criteria for c-ADHD. Both FEP groups performed worse than HCs in speed processing, executive function and social cognition, but only the FEP-ADHD+group was significantly more impaired than the HC group in attention (F = 4.35; p = 0.04). Only the Trail Making Test A (TMT-A) (F = 6.99; p = 0.01) within the domain of processing speed and the Neuropsychological Assessment Battery (NAB) (F = 6.46; p = 0.01) within the domain of executive function reliably differentiated the two clinical groups. The FEP groups did not differ in the severity of psychopathology, but the FEP-ADHD+reported fewer years of education than the FEP-ADHD− and were more likely to use tobacco and cannabis and to require higher doses of antipsychotics to achieve a clinical response. In conclusion, we found a gradient of severity in cognitive performance between groups, with FEP-ADHD+ having the greatest cognitive impairment. Our results suggest that FEP-ADHD+ represents a subgroup with a worse prognosis than FEP-ADHD−.

Reduced suprathreshold auditory nerve responses are associated with slower processing speed and thinner temporal and parietal cortex in presbycusis.

Epidemiological evidence shows an association between hearing loss and dementia in elderly people. However, the mechanisms that connect hearing impairments and cognitive decline are still unknown. Here we propose that a suprathreshold auditory-nerve impairment is associated with cognitive decline and brain atrophy. Methods: audiological, neuropsychological, and brain structural 3-Tesla MRI data were obtained from elders with different levels of hearing loss recruited in the ANDES cohort. The amplitude of waves I (auditory nerve) and V (midbrain) from auditory brainstem responses were measured at 80 dB nHL. We also calculated the ratio between wave V and I as a proxy of suprathreshold brainstem function. Results: we included a total of 101 subjects (age: 73.5 ± 5.2 years (mean ± SD), mean education: 9.5 ± 4.2 years, and mean audiogram thresholds (0.5–4 kHz): 25.5 ± 12.0 dB HL). We obtained reliable suprathreshold waves V in all subjects (n = 101), while replicable waves I were obtained in 92 subjects (91.1%). Partial Spearman correlations (corrected by age, gender, education and hearing thresholds) showed that reduced suprathreshold wave I responses were associated with thinner temporal and parietal cortices, and with slower processing speed as evidenced by the Trail-Making Test-A and digit symbol performance. Non-significant correlations were obtained between wave I amplitudes and other cognitive domains. Conclusions: These results evidence that reduced suprathreshold auditory nerve responses in presbycusis are associated with slower processing speed and brain structural changes in temporal and parietal regions.

No evidence for amyloid pathology as a key mediator of neurodegeneration post-stroke - a seven-year follow-up study

BackgroundCognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after stroke is common. The role of amyloid pathology in post-stroke CI is unclear. We hypothesize that amyloid deposition, measured with Flutemetamol (18F-Flut) positron emission tomography (PET), is common in seven-year stroke survivors diagnosed with CI and, further, that quantitatively assessed 18F-Flut-PET uptake after 7 years correlates with amyloid-β peptide (Aβ42) levels in cerebrospinal fluid (CSF) at 1 year, and with measures of neurodegeneration and cognition at 7 years post-stroke.Methods208 patients with first-ever stroke or transient Ischemic Attack (TIA) without pre-existing CI were included during 2007 and 2008. At one- and seven-years post-stroke, cognitive status was assessed, and categorized into dementia, mild cognitive impairment or normal. Etiologic sub-classification was based on magnetic resonance imaging (MRI) findings, CSF biomarkers and clinical cognitive profile. At 7 years, patients were offered 18F-Flut-PET, and amyloid-positivity was assessed visually and semi-quantitatively. The associations between 18F-Flut-PET standardized uptake value ratios (SUVr) and measures of neurodegeneration (medial temporal lobe atrophy (MTLA), global cortical atrophy (GCA)) and cognition (Mini-Mental State Exam (MMSE), Trail-making test A (TMT-A)) and CSF Aβ42 levels were assessed using linear regression.ResultsIn total, 111 patients completed 7-year follow-up, and 26 patients agreed to PET imaging, of whom 13 had CSF biomarkers from 1 year. Thirteen out of 26 patients were diagnosed with CI 7 years post-stroke, but only one had visually assessed amyloid positivity. CSF Aβ42 levels at 1 year, MTA grade, GCA scale, MMSE score or TMT-A at 7 years did not correlate with 18F-Flut-PET SUVr in this cohort.ConclusionsAmyloid binding was not common in 7-year stroke survivors diagnosed with CI. Quantitatively assessed, cortical amyloid deposition did not correlate with other measures related to neurodegeneration or cognition. Therefore, amyloid pathology may not be a key mediator of neurodegeneration 7 years post-stroke.Trial registrationClinicaltrials.gov (NCT00506818). July 23, 2007. Inclusion from February 2007, randomization and intervention from May 2007 and trial registration in July 2007.

Baduanjin mind-body exercise improves logical memory in long-term hospitalized patients with schizophrenia: A randomized controlled trial.

Neurocognitive impairment is one of the core symptoms in schizophrenia and poses a great challenge to effective treatment. Sixty-one long-term hospitalized patients with schizophrenia were recruited and randomly assigned to two groups: Baduanjin exercise and brisk walking. Patients in the Baduanjin group received 24 weeks of Baduanjin training (5 days/week, 40 min/day), while patients in the brisk walking group received 24 weeks of brisk walking (5 days/week, 40 min/day). Scores on the Wechsler Memory Scale, Digit Symbol Substitution Test (DSST), and the positive and negative syndrome scale were used to evaluate the logical memory (LM), processing speed, and clinical symptoms of all participants, while the score of Trail Making Test-A (TMT-A) was applied to assess the visual attention and graphomotor speed, at baseline and the 16th week and 24th week of intervention. The one-way repeated measures analysis of variance (ANOVA) was used to test the differences in neurocognitive changes between the two groups. Repeated measures ANOVA showed significant differences between the two groups in the LM immediate (F = 6.21, p = 0.003) and LM delayed (F=5.60, p = 0.005) scores, but not in the completion times of TMT-A (F=.22, p = 0.806) or DSST scores (F=0.97, p = 0.328). A significant effect of time was also detected in the LM immediate (F=10.24, p = 0.000) and LM delayed (F=4.93, p = 0.009) scores and in the completion time of the TMT-A (F=33.10, p = 0.000), but not in the DSST scores (F=2.12, p = 0.122). Baduanjin exercise could improve logical memory in the long-term hospitalized patients with schizophrenia.

Cognitive scores as a potential diagnostic tool in schizophrenia: The use of raw and discrepancy scores

ObjectiveCognitive scores could be a useful tool when discriminating between patients with schizophrenia (SZ) and non‐psychiatric population. However, whether these scores can contribute to the accurate diagnosis of the disease is still unclear. Therefore, this study aimed to identify the best approach as to the inclusion of cognitive impairment as a potential clinical tool in the diagnosis of SZ.MethodA total of 258 patients with SZ and 202 healthy controls (HC) were assessed by means of the Hopkins Verbal Learning Test‐Revised (HVLT‐R) and the Trail Making Test‐A (TMT‐A). In addition to raw scores, participants' discrepancy scores (DS) in these two cognitive measures were calculated using regression‐based norms controlling for age, years of education and premorbid intelligence quotient. Receiver‐operating characteristic analyses were performed for both scores in order to assess their diagnostic properties.ResultsThe areas under the curve (AUC) of the HVLT‐R total and delayed recall, and TMT‐A raw scores were statistically significant and ranged from 0.67 to 0.87. Although significant, AUC of verbal memory DS were lower than those of raw scores (AUC = 0.84; AUC = 0.80). AUC of TMT‐A DS was not significant.ConclusionsResults suggest that cognitive scores are useful and accurate when discriminating and classifying patients with SZ and HC in the present sample. Raw scores were shown to be more accurate than DS in patients with SZ and to present good diagnostic properties especially regarding verbal memory measures. Obtained indices support the use of cognitive scores as diagnostic criterion in the diagnosis of SZ.

Beneficial effect of computer-based multidomain cognitive training in patients with mild cognitive impairment

The purpose of the present study was to explore the effects of computer-based multidomain cognitive training program on Greek patients with Mild Cognitive Impairment (MCI). Forty-six patients with MCI were randomly divided into two groups; (a) the training group, which received a computer-based multidomain cognitive training program with the use of the RehaCom software and (b) the control group, which underwent standard-clinical care. The duration of the computer-based training program was 15 weeks, administered twice a week for approximately one hour per session. Analysis of the baseline versus endpoint performance of each group demonstrated that in the control group delayed memory and executive function had deteriorated over the observation period of 15 weeks, while improvement was observed in the training group’s performance on delayed memory, word recognition, Boston Naming Test (BNT), Clock Drawing Test (CDT), Semantic Fluency (SF), Trail Making Test-A (TMT-A) and Trail Making Test-B (TMT-B). Comparison between the two groups presented asignificant effect of the intervention for most cognitive domains. These findings are promising for the development of training methods designed to delay cognitive decline in patients with MCI, which is considered to be the prodromal stage of Alzheimer’s Disease (AD).