Vascular Neurocognitive Disorder Research Articles

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Dementia subtypes, cognitive decline and survival among older adults attending a memory clinic in Cape Town, South Africa: a retrospective study

BackgroundThere are no published longitudinal studies from Africa of people with dementia seen in memory clinics. The aim of this study was to determine the proportions of the different dementia subtypes, rates of cognitive decline, and predictors of survival in patients diagnosed with dementia and seen in a memory clinic.MethodsData were collected retrospectively from clinic records of patients aged ≥ 60 seen in the memory clinic at Groote Schuur Hospital, Cape Town, South Africa over a 10-year period. Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria were used to identify patients with Major Neurocognitive Disorders (dementia). Additional diagnostic criteria were used to determine the specific subtypes of dementia. Linear regression analysis was used to determine crude rates of cognitive decline, expressed as mini-mental state examination (MMSE) points lost per year. Changes in MMSE scores were derived using mixed effects modelling to curvilinear models of cognitive change, with time as the dependent variable. Multivariable cox survival analysis was used to determine factors at baseline that predicted mortality.ResultsOf the 165 patients who met inclusion criteria, 117(70.9%) had Major Neurocognitive Disorder due to Alzheimer’s disease (AD), 24(14.6%) Vascular Neurocognitive Disorder (VND), 6(3.6%) Dementia with Lewy Bodies (DLB), 5(3%) Parkinson disease-associated dementia (PDD), 3(1.8%) fronto-temporal dementia, 4(2.4%) mixed dementia and 6(3.6%) other types of dementia. The average annual decline in MMSE points was 2.2(DLB/PDD), 2.1(AD) and 1.3(VND). Cognitive scores at baseline were significantly lower in patients with 8 compared to 13 years of education and in those with VND compared with AD. Factors associated with shorter survival included age at onset greater than 65 (HR = 1.82, 95% C.I. 1.11, 2.99, p = 0.017), lower baseline MMSE (HR = 1.05, 95% C.I. 1.01, 1.10, p = 0.029), Charlson’s comorbidity scores of 3 to 4 (HR = 1.88, 95% C.I. 1.14, 3.10, p = 0.014), scores of 5 or more (HR = 1.97, 95% C.I. 1.16, 3.34, p = 0.012) and DLB/PDD (HR = 3.07, 95% C.I. 1.50, 6.29, p = 0.002). Being female (HR = 0.59, 95% C.I.0.36, 0.95, p = 0.029) was associated with longer survival.ConclusionsKnowledge of dementia subtypes, the rate and factors affecting cognitive decline and survival outcomes will help inform decisions about patient selection for potential future therapies and for planning dementia services in resource-poor settings.

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Background: Many efforts had been made to combat the symptoms of incontinence over the past decades, yet difficulties still remain. To stimulate the cortical urination center might theoretically be useful for regulating urination process. In this case of urinary incontinence with major vascular neurocognitive disorder, repetitive transcranial magnetic stimulation (rTMS) on the bilateral paracentral lobule was applied and therapeutic effect was obvious. Case report: A 67-year-old female farmer suffered from urinary incontinence over two weeks. She was diagnosed with major vascular neurocognitive disorder. The patient received rTMS on the bilateral paracentral lobule. Stimulation was administered at 20 Hz with 25 stimulation trains of 30 stimuli each with a 30-second intertrain interval. After a 5-day course of rTMS intervention, the patient reported full awareness of her urination, but her neurocognitive decline had not improved at all. Conclusions: rTMS on bilateral paracentral lobule could be used for treating urinary incontinence in major vascular neurocognitive disorder patients.

A new approach for cognitive impairment pattern in chronic kidney disease.

Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have a specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease). We used the Mini Mental State Examination score (MMSE) to assess cognitive patterns in 3003 CKD patients (stage 3-4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort. After normalizing MMSE scores to a 0-to-100 scale, the associations between the baseline estimated glomerular filtration rate (eGFR, using the Chronic Kidney Disease Epidemiology Collaboration creatinine formula) and changes in each MMSE domain score were assessed in linear mixed models. Patients (age: 67±13years old; males: 65%, mean eGFR: 33± 12mL/min/1.73m2) had a good baseline cognitive functions: the mean MMSE score was 26.9/30±2.9. After adjustment for age, sex, educational level, depression (past or present), cardiovascular risk factors and cerebrovascular disease, a lower baseline eGFR (per 10mL/min/1.73m2) was associated with a 0.53-point decrement [P<.001; 95% confidence interval (CI) (-0.98, -0.08)] for orientation, a 1.04-point decrement [P=.03; 95% CI (-1.96, -0.13)] for attention and calculation, a 0.78-point decrement [P=.003; 95% CI (-1.30, -0.27)] for language, and a 0.94-point decrement [P=.02; 95% CI (-1.75, -0.13)] for praxis. Baseline eGFR was not, however, associated with significant changes over time in MMSE domain scores. A lower eGFR in CKD patients was associated with early impairments in certain cognitive domains: praxis, language and attention domains before an obvious cognitive decline. Early detection of NCD in CKD patients must be performed before clinically cognitive decline using preferably tests assessing executive, attentional functions and language, rather than memory tests. This early cognitive screening could lead to a better management of cognitive impairment and their consequences on CKD management.

AGR - 1 A Case Study of Cognitive Reserve and Wernicke's Aphasia Status-Post Insular Stroke.

The case is an 88-year-old, woman, formerly a successful surgeon for decades, with Wernicke's aphasia due to dominant insular stroke. Our evaluation explored her deficits in the context of the heterogeneous presentations of insular strokes and how speech rehabilitation has impacted her language abilities given her cognitive reserve prior to her stroke. The patient sustained a left MCA embolic stroke in 2020. Neurodiagnostics revealed an infarct in the insula, dominant temporal, frontal, and parietal lobes. Baseline language assessment was completed. Results included moderate-severe receptive language impairment; intact fluency; deficits in writing and repetition; and significant paraphasias. Neuropsychological assessment demonstrated prominent deficits in repetition with paraphasias and irritability. Auditory learning, attention, and working memory were invalid due to deficits in repetition. She was diagnosed with mild vascular neurocognitive disorder and conduction aphasia. Despite comprehension having improved, the patient's paraphasias resemble the presentation of Wernicke's aphasia. Interestingly, there were some consistencies in paraphasic errors, such as consistently swapping certain words or letters, demonstrating diminished but not absent volition of speech. Story memory was the most effective measure of auditory memory given repetition deficits. Despite repetition deficits commonly localizing to the supramarginal gyrus, her repetition difficulty is likely related to language network disruption due to her insular infarct. Rehabilitation for comprehension was successful despite age at time of injury. Consistent with previous research, results suggest despite cognitive reserve, repetition is resistant to rehabilitation; however, in this case, paraphasic errors were also resistant. Rehabilitation should include a behavioral component for insular stroke patients.

Neuroimaging determinants of cognitive impairment in the memory clinic: how important is the vascular burden?

While neurodegenerative and vascular neurocognitive disorder (NCD) often co-occur, the contribution of vascular lesions, especially stroke lesions identified on MRI, to global cognition in a real-life memory clinic population remains unclear. The main objective of this retrospective study was to determine NCD neuroimaging correlates: the GM atrophy pattern and vascular lesions (especially stroke lesion localization by voxel-based lesion-symptom mapping, VLSM) in a memory clinic. We included 336 patients with mild or major NCD who underwent cerebral MRI and a neuropsychological assessment. The GM atrophy pattern (obtained by voxel-based morphometry, VBM) and the stroke lesion localization (obtained by VLSM) associated with G5 z-score (a global cognitive score), were included as independent variables with other neuroimaging and clinical indices in a stepwise linear regression model. The mean age was 70.3years and the mean MMSE score 21.3. On MRI, 75 patients had at least one stroke lesion. The G 5 z-score was associated with GM density in the pattern selected by the VBM analysis (R2 variation = 0.166, p < 0.001) and the presence of a stroke lesion in the region selected by the VSLM analysis (mainly in the right frontal region; R2 variation = 0.018, p = 0.008). The interaction between the two factors was insignificant (p = 0.374). In conclusion, in this first study combining VBM and VLSM analysis in a memory clinic, global cognition was associated with a specific GM atrophy pattern and the presence of a stroke lesion mainly in the right frontal region.

Treatment of hypertension and obstructive sleep apnea counteracts cognitive decline in common neurocognitive disorders in diagnosis-related patterns

The aim of this study was to investigate the effect of arterial hypertension (AH) and of obstructive sleep apnea (OSA) on cognitive course in the neurocognitive disorder (NCD) cohort RIFADE which enrolled patients with NCD due to Alzheimer’s disease (AD), vascular NCD (vNCD), and mixed NCD (AD + vNCD = mNCD). Multiple risk factors (RF), including AH and OSA, that contribute to the development of various kinds of dementia have been identified in previous studies. Studies that observed AH lacked investigation of long-term effects and did not isolate it from other RF. Studies involving OSA as a risk factor did not include participants with all stages of NCD. 126 subjects were screened for AH and OSA. Repeated cognitive measurements were performed with the DemTect as primary outcome and the clock drawing test as secondary outcome measure. 90 patients had AH (71.4%) and 40 patients had OSA (31.7%). RF-status had a significant effect on cognitive outcome in models with RF as single factors (AH p = 0.027, OSA p < 0.001), a 2-factor analysis with AH × OSA (AH as main factor p = 0.027) as well as a model including the 3 factors AH × OSA × diagnosis (p = 0.038). Similarly, a 3-factor model was significant for the clock-drawing test, whereas single factor-models remained insignificant. AH and OSA appear to be risk factors in common NCD and cognitive decline can be mitigated by treatment of these RF.

The neurocognitive disorder cohort RIFADE: Aims, methods, first results showing cognitive improvement in a subgroup

BackgroundThe NCD cohort study RIFADE (RIsk FActors of DEmentia) investigates the interaction of risk factors and neurocognitive disorders (NCDs) due to Alzheimer’s disease (NCD-AD) and NCD of vascular type (NCD-vascular). Retrospective recruitment referred to a period from 2007 to 2018 in a single centre. In addition to the baseline visit, follow-up visits took place at 3, 6, 12 months followed by yearly visits. Visit times varied in part depending on adherence. The study also comprises an EEG bank and a bank with cerebral MRI (c-MRI).MethodsInclusion criteria were broad in order to cover a wide range of patterns of NCD. At baseline, patients underwent a large panel of assessments, e.g. including clinical history, diagnostic evaluation for NCD according to DSM-IV and NINDS AIREN criteria, a cognitive test battery including the DemTect, the clock drawing test and the Instrumental-Activities-of-Daily-Living-scale of Lawton and Brodie, EEG and c-MRI. At each follow-up visit, cognitive tests were repeated, in most cases also EEGs and in some cases c-MRIs. Numerous risk factors (RF) including vascular RF, atrial fibrillation, heart failure, sleep apnoea and lifestyle factors such as sedentary lifestyle, low cognitive style and smoking were evaluated for presence and for correction status at each visit, and modulation of uncorrected RF was initiated.ResultsOverall, 126 subjects with a clinical diagnosis of NCD were included (52% female, mean age 71 ± 10.6 years (range 35e86)), number of follow-up visits per subject 2.9 ± 2.4, observation time per subject 3.4 ± 2.8 years). Of these, 55/28/17% presented with the clinical stages subjective cognitive decline (SCD)/mild cognitive impairment (MCI)/dementia (major NCD). Clinical diagnoses, retrospectively re-evaluated according to DSM-5, were 5/21/68/6% Alzheimer´s disease (NCD-AD)/vascular NCD (NCD-vascular) / mixed NCD (NCD-AD + NCD-vascular)/unspecified NCD. First longitudinal results revealed a mean DemTect score at baseline 12.6 ± 4.2 vs last visit 12.0 ± 4.8 (p = 0.08) and a clock drawing test score at baseline 1.9 ± 1.3 vs last visit 2.3 ± 1.5 (p < 0.0001). Of all subjects with MCI or major NCD (n = 57), 19 improved in the clinical stage from baseline to last visit (33.3%). Sixteen subjects progressed from SCD or MCI (n = 104) to major NCD (15.4%).ConclusionThe German NCD cohort RIFADE comprises patients with all clinical stages of NCD. A considerable subgroup improved in clinical stage. Further analysis is needed to answer the question of whether modulation of multiple risk factors provides a favourable effect on cognitive outcome in NCD.

Computer-aided cognitive training in patients with neurocognitive vascular impairment: effects on cognition, depression and behavior

Aim. The study evaluated the efficacy of computer-aided cognitive training program on cognitive measures, behavioral and depressive symptoms in persons suffering from Major Vascular Neurocognitive Disorder (vNCD).Methods. Retrospective study on a panel of 55 subjects with vNCD divided into a treatment group (n. 31) and a control group (n. 24) evaluated at baseline (T0) and at endpoint (T1) at 24 weeks. All subjects received the Mini Mental State Examination (MMSE), the Montgomery and Aasberg Depression Rating Scale (MADRS) and the Neuropsychiatric Inventory (NPI-P). The treatment group underwent a 24 weeks of computer-aided cognitive training. Results. Significant better performances of the treatment group were recorded at T1on MMSE. A significant reduction of behavioral disorders was shown by the treatment group as compared to the control group. No effect was observed on depression. Conclusions. Computer aided cognitive training showed positive effects on both behavioral and cognitive dimensions in persons suffering from vNCD.

A-18 Early Pattern of Cognitive Changes Associated with Insulin Resistance in a Sample of Young Adults

Abstract Objective Insulin resistance increases the risk of developing type 2 diabetes and subsequently cardiovascular and cerebrovascular disease. It is also linked to neurocognitive disorders and accelerated cognitive aging (Ekblad et al, 2017; Levine, Harrati, &amp; Crimmins, 2018). Using baseline data from a longitudinal study in a sample of 126 cognitively intact adults aged 25–50 years (36.5% males), we assessed cognitive performance in relation to insulin resistance to determine whether an early prodromal pattern of cognitive changes exists prior to advanced metabolic disease. Methods Steady state plasma glucose (SSPG) was used to measure insulin resistance. Multivariate regression analyses were conducted using age, years of education, body mass index (BMI), and SSPG as predictors of neuropsychological functioning. In-person and tele-neuropsychological assessment was administered using standard neuropsychological measures. Results Higher insulin resistance was associated with significantly worse attention (WAIS-III Digit Span total; B = -0.018, p = 0.03), executive functioning (D-KEFS Color-Word Inhibition/Switching; B = 0.047, p = 0.04) and dominant fine motor abilities (Purdue Pegboard; B = -0.008, p = 0.02). Higher insulin resistance was also associated with trend level worsening of other measures of executive functioning, namely D-KEFS Trails 4 (B = 0.099, p = 0.07) and DKEFS Color-Word Inhibition errors (B = 0.007, p = 0.09). Conclusions In young adults, higher insulin resistance was associated with declines in attention, executive functioning, and fine motor abilities. This early pattern of subtle cognitive changes associated with higher insulin resistance seen in this sample of younger adults is consistent with later cognitive declines found in type 2 diabetes and vascular neurocognitive disorder, namely declines in attention, executive functioning, and motor abilities with eventual memory declines in advanced disease.

A-57 The Neuropsychological Impact of Antiphospholipid Antibody Syndrome: A Case Study

Abstract Objective Antiphospholipid Antibody Syndrome (APS), also known as Hughes Syndrome, is an autoimmune condition linked to various adverse medical and neurological outcomes affecting 5 in 100,000. APS results from antibodies (aPL) that attack blood proteins that bind to phospholipids (e.g., 2-glycoprotein I and prothrombin), which can cause blood flow problems, increased risk of blood clots, and recurrent vascular thrombotic events. Research suggests APS may lead to various neurologic/medical issues including memory loss, visual disturbances, and dementia. Method Neuropsychological evaluation of 48-year-old female with triple-positive APS and history of bilateral superior parietal chronic ischemic infarctions, multiple bilateral lacunar infarctions, and bilateral encephalomalacia. Reports progressive cognitive changes (&amp;lt; 1 year). Results Neuropsychological evaluation evidenced low average premorbid functioning and currently, extremely low overall cognitive ability. Memory was variable with significant visual and working memory impairment but preserved delayed recall of contextual information. While verbal abilities were intact, deficits were noted in executive functioning, attention, processing speed, visuomotor, visual–spatial, and fine motor skills. Conclusion This 48-year-old woman’s cognitive profile is consistent with findings in the APS literature and is indicative of an early onset major vascular neurocognitive disorder. Retrospective studies suggest that cognitive deficits often precede somatic symptoms of APS and abnormal neuroimaging findings; she presents atypically, as somatic symptoms and abnormal neuroimaging preceded cognitive decline. This case adds to the limited body of neuropsychological data regarding the effects of APS on cognitive functioning, as the pathogenesis of cognitive impairment in APS is unclear and leads to questions regarding differences in, and trajectories of, cognitive deficits in APS.

Turkish Version of the Test Your Memory (TYM-TR) as a Screening Tool in Memory Clinics.

This study compared the Turkish version of Test Your Memory (TYM) MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test) in patients with neurocognitive disorder. After a thorough medical workup, patients with a diagnosis of neurocognitive disorder were enrolled. A cross-sectional design was used to compare the TYM results with those of MMSE and CDT. This study was conducted on 100 patients, including 46 males and 54 females, aged 52 to 86. The majority of patients were diagnosed with vascular neurocognitive disorder. The z-score of TYM-TR was significantly lower in the domains of registration, recall, visuospatial, and total score. The same results were achieved when CDT was added to MMSE. The same pattern was observed separately for those who were diagnosed with a mild or major neurocognitive disorder. Patients' cognitive deficits might be more evident when measured by the TYM-TR compared to the MMSE.

Incidence and distribution of subtypes of early-onset dementia in Japan: A nationwide analysis based on annual performance reports of the Medical Centers for Dementia.

Investigating the incidence rate of early-onset dementia is challenging. We explored the incidence rate of early-onset dementia in Japan using annual performance reports from the Medical Centers for Dementia. Medical Centers for Dementia are specialized health services for dementia established as part of Japan's national health program. There are 440 such centers nationwide as of 2018. Using the annual performance reports of these centers, we calculated the number of newly diagnosed cases of early-onset dementia or late-onset dementia from April 1, 2018 to March 31, 2019, and the composition ratio by diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The annual incidence rate of early-onset dementia was estimated using the number of cases as the numerator and the national population aged 18-64 years as the denominator. In total, 1733 of cases were diagnosed with early-onset dementia, of which 52.1% were diagnosed as major neurocognitive disorder due to Alzheimer's disease, 8.9% major frontotemporal neurocognitive disorder, 8.8% major vascular neurocognitive disorder, 7.1% substance/medication-induced major neurocognitive disorder, 6.5% major neurocognitive disorder with Lewy bodies and 3.9% major neurocognitive disorder due to another medical condition. The annual incidence rate of early-onset dementia was estimated to be 2.47/100 000 person-years. This study provides the first nationwide estimate of the incidence rate of early-onset dementia in Japan and suggests that Medical Centers for Dementia are important resources for the epidemiological monitoring of early-onset dementia nationwide. Geriatr Gerontol Int 2020; 20: 1050-1055..

A-074 Evidence of Cognitive Decline in a Patient with CADASIL Without Major Stroke Event

Abstract Objective Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a genetic disease that impacts small arteries in the brain and can result in ischemic strokes, seizures, and cognitive decline. This case study of a 61-year-old male illustrates the cognitive profile of an individual with CADASIL who has not suffered a major stroke event. Neuroimaging shows subcortical compromise in a diffuse manner. Methods The patient was assessed in an out-patient institutional practice. The individual was assessed with a clinical interview and comprehensive Neuropsychological Battery. The battery included cognitive and psychological measures with free-standing and imbedded validity measures. Results Cognitive testing demonstrated significant impairment in visuo-motor processing speed, executive planning, cognitive flexibility, verbal fluency, decision making, and visual memory, and suggests that the patients abilities show deterioration of subcortical regions, and is consistent with his CADASIL diagnosis. The patient was diagnosed with Mild Neurocognitive Disorder, due to medical condition. Conclusion Individuals with CADASIL often suffer from ischemic strokes and cognitive impairment. This study suggests that despite no major stroke event, individuals with CADASIL may still exhibit cognitive decline especially in subcortical regions. This case supports the theory that progressive cognitive decline in CADASIL patients does not begin as a result of a major stroke and can continue as a distinct cause of vascular neurocognitive disorder.

A Systematic Approach to Spanish Neuropsychological Evaluation: Case Report with a Mexican Woman in an Outpatient Setting

Abstract Objective The following case will demonstrate a systematic approach to neuropsychological evaluation with Spanish-speaking individuals, which includes creating a suitable test battery, interpreting results with appropriate normative samples, and incorporating personal history. Case Description 61-year-old, right-handed, Mexican female with 2 years of formal education, and with a recent history of subarachnoid hemorrhage with hydrocephalus. She was referred by her social worker and primary care provider to discern whether the reported cognitive complaints were due to a neurocognitive condition or depression. Diagnostic Impressions and Outcomes The evaluation was administered entirely in Spanish and some exams were modified to accommodate her limited literacy skills. She exhibited deficits in executive functioning, verbal fluency, and memory. Emotional testing revealed moderate depression with anxious distress, which she attributed to significant changes in everyday life. Her family informed us that she was the “matriarch of the family” and worked as a farm field truck driver, with significant difficulties/lack of engagement in both of these roles. Therefore, diagnoses of probable major vascular neurocognitive disorder and major depressive disorder with anxious distress were assigned. With this information, her providers were able to connect the family with community resources. Discussion The Hispanic population continues to be the fastest growing demographic in the United States. As more clinicians will work with members of this ethnicity in outpatient settings, it is important that they incorporate culturally-relevant factors in their approach to testing and interpretation of results. Nonetheless, this case demonstrates the current challenges and limitations, including modification of exams, differences in educational system that underlie test construction, and patient’s history. Recommendations for future areas of study and practice will also be discussed.

AGR - 3 Socially Responsible Neuropsychology (SRN) in Action: Navigating Relevant Socio-Cultural and Educational Factors in Frontotemporal Dementia

Abstract Objective Socio-cultural factors obscure diagnostic specificity for neurodegenerative disorders, particularly among minority or foreign-born patients with limited access to education. Our objective with the following case presentation is to illustrate the utility of a Socially Responsible Neuropsychology (SRN) model in guiding clinical practice through the comprehensive incorporation of significant, yet common, socio-cultural factors throughout the neuropsychological assessment. Method The present case involved a 79-year-old Spanish-speaking Mexican woman with two years of education, who underwent two serial neuropsychological assessments, as well as, structural/functional neuroimaging to monitor acute onset of telegraphic speech following the kidnapping of her husband. The SRN model guided clinical decision-making in understanding the onset and progression of symptoms within the context of medical-psychiatric comorbidities intertwined with socio-cultural and educational factors. Results Mild vascular neurocognitive disorder and complicated grief were the initial diagnostic impressions as supported by structural neuroimaging. Neuropsychological assessment over time, however, revealed progressive global cognitive decline whereas psychiatric symptomatology remained stable. In the presence of equivocal converging evidence from available neuroimaging studies (PET vs MRI), strong suspicion for the language variant of frontotemporal neurocognitive disorder was considered given the onset and progressive decline of expressive/receptive language, executive and memory abilities, and qualitative evidence for progressive behavioral disihibition. Conclusion Telegraphic speech in an elderly Latina woman that initially appeared most consistent with vascular neurocognitive disorder in the context of complex trauma with possible conversion disorder, was deemed most consistent with a neurodegenerative process after careful consideration of the time course and evolution of the neurocognitive profile over time within an SRN model.

Efficacy of PASS Reading Enhancement Programme on Neuropsychological Functions of a Child with Mild Vascular Neurocognitive Disorder and Comorbid Attention Deficit Hyperactivity Disorder: A Case Study.

Background:PASS Reading Enhancement Programme (PREP), a reading enhancement tool focusing on successive and simultaneous processing tasks, has been used successfully to improve the information processing strategies that underlie reading. The study explored the effects of training with successive processing task of PREP on various cognitive and neuropsychological functioning of an 8-year-old child with mild vascular neurocognitive disorder with comorbid attention deficit hyperactivity disorder.Materials and Methods:A pre–post intervention single case design was used. AIIMS Comprehensive Neuropsychological Battery in Hindi, Children's Form was used to assess the baseline performance on various neuropsychological domains. After 25 sessions of weekly outpatient-based training with PREP, reassessment was done using the same test battery.Results:Results indicated posttraining global improvement in the neuropsychological functioning like receptive and expressive speech, intellectual processes, memory, and reading and writing abilities.Conclusion:Cognitive remediation programs focusing on training in successive processing could be used in the enhancement of overall neuropsychological functioning in children with neurocognitive disorder.

The 2018 Stockport Vascular Neuro Cognitive Disorder Investigation, Treatment and Annual Review Guidelines (Including the Spectrum from Mild Vascular Cognitive Impairment to Vascular Dementia) Supporting Primary and Secondary Care Physicians

The 2018 Stockport Vascular Neuro Cognitive Disorder Investigation, Treatment and Annual Review Guidelines (Including the Spectrum from Mild Vascular Cognitive Impairment to Vascular Dementia) Supporting Primary and Secondary Care Physicians

Ceramide Accumulation Is Associated with Declining Verbal Memory in Coronary Artery Disease Patients: An Observational Study.

Background:Biomarkers in cognitively vulnerable populations, like those with coronary artery disease (CAD), may inform earlier intervention in vascular neurodegeneration. Circulating ceramide C18:0 (CerC18:0) is associated with changes in verbal memory in early neurodegeneration and CAD progression.Objective:To investigate whether plasma CerC18:0 accumulation is associated with longitudinal declines in verbal memory performance in CAD.Methods:In addition to total CerC18:0, we assessed its relative abundance to its precursors as ratios: CerC18:0 to monohexosylceramide C18:0 (MHxCer18:0), CerC18:0 to sphingomyelin C18:0 (SM18:0), and CerC18:0 to sphingosine-1-phosphate (S1P). Verbal memory was assessed using the California Verbal Learning Test 2nd Ed. Using mixed models in 60 CAD participants, we evaluated associations between baseline CerC18:0 ratios and changes in verbal memory performance, adjusting for age, body mass index, and education. Given that cognitive decline is more rapid following onset of deficits, these associations were compared between those with possible mild vascular neurocognitive disorder (MVND).Results:Increased baseline CerC18:0 concentrations correlated with worse verbal memory performance over time (b[SE] = – 0.91[0.30], p = 0.003). Increased baseline CerC18:0/SM18:0 (b[SE] = – 1.11[`], p = 0.03) were associated with worse verbal memory performance over time. These associations were not mediated by whether or not patients had possible MVND at baseline.Conclusion:These findings support aberrant CerC18:0 metabolism as an early neurobiological change in vascular neurodegeneration. Future studies should measure enzymes responsible for conversion of sphingolipid precursors into CerC18:0 to assess enzymatic activity.

Specific Cognitive-Psychopathological Phenotypes in Patients With Early Stages of Subcortical Vascular Neurocognitive Disorders: A Hospital-Based Case-Control Study.

Diagnosis of subcortical vascular neurocognitive disorders' (ScVNCDs) is currently based on neuropsychological and neuroimaging approaches; nevertheless, clinical features, apart from cognitive impairments (CI), may provide additional information about ScVNCD phenotypes. We aimed to determine whether CI and neuropsychiatric symptoms (NPS) form such clinical phenotypes in the mild and early stage of major ScVNCD. Our sample included 88 cognitively normal elderly individuals, 100 patients with mild ScVNCD, and 60 patients with early major ScVNCD. All participants had neuropsychological, neuropsychiatric, neurological, and functional evaluations. The prevalence of NPS was based on the neuropsychiatric inventory. The statistical analyses included parametric and nonparametric tests and multivariate regression. The severity of executive dysfunction increased through stages of ScVNCD progression ( P < .0001). The NPS with significant predictive value for mild ScVNCD membership was depression (odds ratio [OR] = 7.4), whereas for early major ScVNCD were depression (OR = 5.5) and apathy (OR = 7.6). Those distinguishing NPS and impairments of executive tests' performance significantly correlated ( P < .05) in patients with mild/major ScVNCD. Significant correlation between pathognomonic cognitive and NPS in compared groups suggest that dysexecutive-depressive syndrome can be the main phenotype in mild ScVNCD, while dysexecutive-depressive-apathetic syndrome in the early stage of major ScVNCD. Obtained cognitive-psychopathological phenotypes may allow a better comprehension of the ScVNCD pathophysiology and improve the diagnostic and therapeutic approach.