Visuoconstructive Abilities Research Articles

Allostatic Load and Cognitive Function Among Urban Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study.

Cross-sectional studies have linked cognition to allostatic load (AL) which reflects multisystem dysregulation from life course exposure to stressors. To examine baseline and changes in AL and their relationships with 11 cognitive function test scores, while exploring health disparities according to sex and race. Longitudinal [Visit 1 (2004-2009) and Visit 2 (2009-2013)] data were analyzed from 2,223 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. We calculated AL total score using cardiovascular, metabolic, and inflammatory risk indicators, and applied group-based trajectory modeling to define AL change. Overall and stratum-specific relationships were evaluated using mixed-effects linear regression models that controlled for socio-demographic, lifestyle, and health characteristics. Baseline AL was significantly associated with higher log-transformed Part A Trail Making Test score [Loge (TRAILS A)] (β= 0.020, p = 0.004) and increasing AL was associated with higher Benton Visual Retention Test score [BVRT] (β= 0.35, p = 0.002) at baseline, in models that controlled for age, sex, race, poverty status, education, literacy, smoking, drug use, the 2010 healthy eating index and body mass index. Baseline AL and AL change were not related to change in cognitive function between visits. There were no statistically significant interaction effects by sex or race in fully-adjusted models. At baseline, AL was associated with worse attention or executive functioning. Increasing AL was associated with worse non-verbal memory or visuo-constructional abilities at baseline. AL was not related to change in cognitive function over time, and relationships did not vary by sex or race.

Proposal of a common terminology for the neuropsychological rehabilitation.

The literature on neuropsychological intervention (NI) uses a variety of terms to refer to equivalent constructs, making it difficult to compare intervention programmes and their outcomes. The purpose of this work is to propose a unified terminological framework for describing NI programmes. The terminological framework was developed based on a previous proposal for common terminology by Johnstone and Stonnington (Rehabilitation of neuropsychological disorders: A practical guide for rehabilitation professionals. Psychology Press, 2011) and driven by Cognitive Psychology concepts. The terminological framework was organized into two sections: (a) NI, which includes types of NI, methods and approaches, instructional methods, and strategies; and (b) neurocognitive functions, which include temporal and spatial orientation, sensation, perception, visuo-constructional abilities, attention, memory, language, reasoning of several sorts (e.g., abstract reasoning, and numerical reasoning), and executive functions. Most NI tasks target a main neurocognitive function, but there are underlying neurocognitive functions that may impair performance in the former. Since it is difficult to create a task that is solely focused on one neurocognitive function, the proposed terminology should not be viewed as a taxonomy, but rather as dimensional, with the same task allowing to work different functions, in varying grades. Adopting this terminological framework will allow to define the targeted neurocognitive functions more accurately and simplify the comparison between NI programmes and their outcomes. Future research should focus on describing the main techniques/strategies for each neurocognitive function and non-cognitive interventions.

Neuropsychological Assessment in the Distinction Between Biomarker Defined Frontal-Variant of Alzheimer's Disease and Behavioral-Variant of Frontotemporal Dementia.

Frontal-variant of Alzheimer's disease (fvAD) was purposed for patients with AD pathology that, despite the typical amnestic presentation, show early and progressive deterioration of behavior and executive functions, closely resembling the behavioral-variant of frontotemporal dementia (bvFTD). This leads to a challenging differential diagnosis where neuropsychological evaluation and in vivo pathological evidence are essential. To evaluate the contribution of a comprehensive neuropsychological assessment (NP) battery in distinguishing between fvAD-dementia and bvFTD supported by cerebrospinal fluid (CSF) biomarkers. We included 40 patients with a baseline NP profile with prominent early executive and/or behavioral dysfunction, who meet both diagnosis of bvFTD and fvAD-dementia, according to international criteria. All patients underwent comprehensive NP assessment and CSF-AD biomarker evaluation. Neuropsychological domains as well as clinical and sociodemographic features, and APOE genotype were compared between groups. 21 patients (52.5%) met the biological criteria for AD (decreased Aβ42 together with increased T-tau or P-tau in CSF) and were therefore classified as fvAD (mean age was 64.57, with 47.6% female). There were no differences between groups regarding age/age-at-onset, gender, or educational level. Regarding neuropsychological profile, performances in language and memory functions were equivalent in both groups. Significant differences were found in visuo-constructional abilities (p = 0.004), Trail Making Test A (p < 0.001), and Raven's Colored Progressive Matrices (p = 0.019), with fvAD patients showing worst performances. In patients with an early prominent frontal profile, a higher impairment in attention and visuo-spatial functions, signaling additional right hemisphere fronto-parietal dysfunction, point towards a diagnosis of fvAD-dementia and may be useful in clinical practice.

Visuoconstructional Abilities of Patients With Subjective Cognitive Decline, Mild Cognitive Impairment and Alzheimer's Disease.

Via the Vienna Visuoconstructional Test 3.0 (VVT 3.0) delayed recall we combined the assessment of visuoconstructive abilities and memory and investigated the test's potential to support diagnostic processes, including staging and the elaboration of a cognitive profile. We retrospectively analysed the data of 368 patients of the Department of Neurology, Medical University of Vienna, between 04/2014 and 10/2020 that had performed the VVT 3.0. Our sample involved 70 healthy controls (HC), 29 patients with subjective cognitive decline (SCD), 154 patients with mild cognitive impairment (MCI) and 115 patients with Alzheimer's disease (AD). We investigated the differences in the VVT 3.0 scores, as well as the VVT's ability to differentiate between AD and nonAD by calculating receiver-operating-characteristic (ROC) curves, ideal cut-offs and a logistic regression model. Results stated that the VVT 3.0 delayed recall scores were able to differentiate between all diagnostic groups, respectively, except HC-SCD and SCD-MCI. The ROC analyses determined an AUC of 0.890, 95% CI [0.855; 0.925], P < .001, and the ideal cut-off at 29.5 points that maximised sensitivity at 0.896 and specificity at 0.81. The logistic regression model classified 83.4% of AD patients correctly and delivered a significant Cohen's Kappa of 0.619 (P < .001). As the VVT 3.0 revealed satisfactory values of diagnostic accuracy in our sample, it could enrich clinical diagnosing. However, for more clarity about its informative value in other populations, there remains a need for future studies with other samples.

Protocoles de délégation en santé au travail : investigation et synthèse à partir de l’envoi de 38 services de santé au travail

Due to the rare occurrence of childhood stroke, its impact on later cognitive functioning remains unclear. While it is often assumed that children recover better than adults, recent studies suggest that childhood stroke can negatively affect a wide range of cognitive domains, such as attention, language, and processing speed, among others. We examined the effect of unilateral stroke on children’s visuoconstructive ability and visual memory. Seventeen children with left- or right-sided arterial ischemic stroke were tested using subtests of the Hamburg-Wechsler Intelligenztest für Kinder and the Rey-Osterrieth Complex Figure (ROCF). The ROCF was evaluated both quantitatively and qualitatively with the help of two separate scoring methods. We found that lesion laterality and age at stroke impacted childhood stroke patients’ ability to recall certain elements of the figure. Regarding lesion laterality, left-sided stroke patients had more difficulties recalling internal details than right-sided stroke patients. In terms of age, patients with stroke onset before the age of 5 years remembered fewer structural elements than patients with stroke onset after the age of 5 years did. Moreover, the qualitative scoring method better differentiated between individuals and between groups than the more commonly used quantitative method. The results of this study not only highlight the importance of a qualitative assessment of the ROCF but could also aid clinicians in testing stroke patients more accurately and tailoring subsequent therapy to the patient’s individual needs.

Visuospatial processing skills following unilateral arterial ischemic stroke in childhood.

Due to the rare occurrence of childhood stroke, its impact on later cognitive functioning remains unclear. While it is often assumed that children recover better than adults, recent studies suggest that childhood stroke can negatively affect a wide range of cognitive domains, such as attention, language, and processing speed, among others. We examined the effect of unilateral stroke on children's visuoconstructive ability and visual memory. Seventeen children with left- or right-sided arterial ischemic stroke were tested using subtests of the Hamburg-Wechsler Intelligenztest für Kinder and the Rey-Osterrieth Complex Figure(ROCF). The ROCF was evaluated both quantitatively and qualitatively with the help of two separate scoring methods. We found that lesion laterality and age at stroke impacted childhood stroke patients' ability to recall certain elements of the figure. Regarding lesion laterality, left-sided stroke patients had more difficulties recalling internal details than right-sided stroke patients. In terms of age, patients with stroke onset before the age of 5 years remembered fewer structural elements than patients with stroke onset after the age of 5 years did. Moreover, the qualitative scoring method better differentiated between individuals and between groups than the more commonly used quantitative method. The results of this study not only highlight the importance of a qualitative assessment of the ROCF but could also aid clinicians in testing stroke patients more accurately and tailoring subsequent therapy to the patient's individual needs.

Constructional Impairments and Their Neural Correlates in Nondemented Adults With Cerebral Autosomal-dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy.

Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic small-vessel disease that is characterized by a wide range of neurologic and neuropsychological impairments. Constructional impairments have been reported in some cases but have never been assessed systematically. To evaluate constructional abilities and their cognitive and neural correlates in nondemented individuals with CADASIL. Thirty individuals with CADASIL who were not affected by clinically relevant cognitive deterioration and 30 healthy controls (HC) underwent an extensive cognitive assessment and paper-and-pencil visuoconstructional tasks in order to detect constructional impairments. Performance on the visuoconstructional tasks was correlated with the cognitive assessment scores and with quantitative indices of regional gray matter atrophy (obtained via FreeSurfer image analysis) and white matter involvement. The individuals with CADASIL achieved significantly lower scores on the cognitive assessment compared with the HC. Poor visuoconstructional abilities were observed in seven (23.3%) of the individuals with CADASIL when performing the copy drawing task and in nine (30%) when performing the Rey Complex Figure Test. Logistic regression revealed that visuoconstructional impairments were significantly associated with scores on the Frontal Assessment Battery and the Attentional Matrices Test. Morphometric results revealed that scores on the visuoconstructional tasks were related to gray matter atrophy of the left frontal lobe and right parietal lobe. Impairments on visuoconstructional tasks are quite common in individuals with CADASIL, even in the lack of clinically relevant cognitive deterioration, and are critically related to frontal and parietal atrophy.

Employing Robotics in Education to Enhance Cognitive Development—A Pilot Study

(1) Background: Info-communication technology (ICT) offers opportunities for innovations in teaching and learning methods, bringing significant changes in the world of pedagogy. The field called educational robotics is both a motivational basis for teaching and learning coding and programming, and a tool for linking STEM (Science, Technology, Engineering, and Mathematics) fields. Moreover, it might contribute to the development of cognitive and social skills. The aim of the present paper is to report on a pilot study at the intersection of neurodiversity and educational robotics. (2) Methods: The pilot study was part of a larger project, namely Robotics for the Inclusive Development of Atypical and Typical Children (RIDE). A pre-test/post-test design was used to examine the development of different cognitive processes in sixth-grade students, such as computational thinking (CT), spatial relations, visuo-constructive ability, attention, and reading ability, in relation to a robotics development program employed in the classroom. (3) Results: The results suggest a general improvement on nearly all measures. Specifically, participants’ performance improved significantly from pre-test to post-test in the visuo-constructive abilities test, they made significantly fewer reading errors, and improved substantially in their reading comprehension. (4) Conclusions: The RIDE project’s curriculum development has resulted in a highly innovative, sustainable, and inclusive package of pedagogical methods, and the pilot research shows promising results regarding the implementation of robotics in education.

The Test of Visuospatial Construction: A Novel Test of Non-motoric Visuoconstruction.

The Test of Visuospatial Construction (TVSC) was designed as an easily administered measure of non-motor visuoconstruction, though only preliminary data exists regarding the clinical utility of this task. The current study examined the diagnostic accuracy of the TVSC by comparing performance between healthy subjects and various clinical groups. The authors also wanted to determine whether previous findings could be replicated regarding its effectiveness at tracking cognitive decline. Archival data collected over a period of more than 10years were utilized and the overall sample consisted of 955 individuals, 372 healthy subjects, and 583 subjects who were categorized into various clinical groups. Only TVSC test data and demographic variables were utilized for statistical analyses in this study. The control group obtained significantly higher scores on the TVSC than the clinical groups. AUC values were indicative of excellent discrimination between cases and controls. Exploratory ROC curve analyses suggested adequate to excellent discrimination between the control group and the individual clinical groups as well as between the mild cognitive impairment (MCI) subgroups and the two dementia groups. This study demonstrates that the TVSC can effectively differentiate between healthy subjects and neurologically compromised individuals. Additionally, the TVSC may be able to measure the progressive decline in visuoconstructive abilities that occurs as patients traverse the spectrum of MCI and dementia.

Metabolic syndrome and cognition: A systematic review across cognitive domains and a bibliometric analysis

The aim of this review is to investigate the association between metabolic syndrome (MetS) and cognitive decline in distinct cognitive domains, and to perform a complementary study description through the bibliometric analysis. PubMed and Scopus databases were searched from inception to 15 December 2021 to identify longitudinal studies that examined the association of MetS with incident decline, in order to prevent reverse causality. The Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was used to conduct the present systematic review. Thirty studies were included and results were analyzed across the cognitive domains of global cognition, memory, executive functions, attention, visuoconstructive abilities, and language. The majority of the studies reviewed did not report statistically significant results for most cognitive domains investigated, and decline in specific cognitive domains was not consistently associated with the presence of MetS. Meta-analyses were not conducted due to the high degree of between-study heterogeneity regarding the MetS definitions, the cognitive domains examined, the specific tests used for each cognitive domain and the different measures of association used. Bibliometric analysis revealed that most studies are conducted by research teams from USA and China, and that cognitive tasks that reflect real-life abilities are rarely examined. Future studies should employ larger sample sizes, longer follow-up periods, a global consensus for MetS definition and standardized tests of the above mentioned cognitive domains as well as problem-solving tasks with high sensitivity and specificity to clarify the impact of MetS on cognition and its underlying mechanisms.

Neuropsychological Profile of Traumatic Brain Injury Patients with Medicolegal Cases: A Pilot Study

Abstract Introduction Traumatic brain injury (TBI) is a global health problem and is a silent epidemic of the modern times. Studies indicate litigation is a prominent factor that accounts for poor outcome and prolonged recovery from mild TBI. Depression is the most frequently diagnosed psychiatric disorder after TBI. Postconcussion symptoms, litigation, and suboptimal effort could contribute to the neuropsychological functioning of TBI patients medicolegal cases (MLCs). With increase in TBI and medicolegal cases, there is a requirement for comprehensive neuropsychological assessment. Method The aim of the study was to evaluate the cognitive functions, postconcussion, and depressive symptoms in TBI patients with MLC and without MLCs (non-MLC). Patients were also assessed on electrophysiological parameters. An observational cross-sectional design was adopted, the sample size was 30 TBI patients in total, 15 (MLC) and 15 (non-MLC), and 11 patients from each group for electrophysiological assessment. The patients were in the age range of 18 to 50 years. Results The MLC group had poor performance compared with the non-MLC group on both neuropsychological and electrophysiological measures. There was evidence of significant difference in verbal working memory, verbal learning, and memory and visuoconstructive ability. In the MLC group, postconcussion and depressive scores were negatively correlated with visuospatial span. Conclusion Findings from this study indicate differences in the neuropsychological performance and electroencephalographic measures in between MLC and non-MLC groups. The results could be indicative of persistent cognitive problems associated with TBI for patients pursuing litigation. Poor performance could also be attributed to suboptimal level of effort. However, being a preliminary study with a small sample size, the findings need to be treated with caution.

Neuropsychological functioning in children and adolescents with anti-NMDA receptor encephalitis (anti-NMDARE).

The objective of this study was to describe neuropsychological functioning and associated medical features in pediatric patients with anti-NMDA receptor encephalitis (anti-NMDARE). Retrospective data were collected from electronic medical records and neuropsychological reports of 15 children and adolescents with cerebral spinal fluid antibody-confirmed anti-NMDARE who were 7-21years old at the time of the neuropsychological evaluation. The median time between treatment initiation for anti-NMDARE and neuropsychological testing was 228days (IQR 431, range 41-927). Consistent with the limited literature, this pediatric sample with anti-NMDARE generally had average IQs, but had scores falling in the low average range on tests of verbal and visual memory as well as aspects of executive functioning (set shifting and phonemic verbal fluency). Other relative weaknesses were observed in visuo-constructional ability and reading comprehension. Future prospective studies are needed to replicate these data and explore disease and treatment variables that reduce or exacerbate the risk for neuropsychological sequelae, while longitudinal analyses are required to better characterize academic, vocational, and social outcomes.

Reproductive hormone levels, androgen receptor CAG repeat length and their longitudinal relationships with decline in cognitive subdomains in men: The European Male Ageing Study.

ObjectiveIt has been proposed that endogenous sex hormone levels may present a modifiable risk factor for cognitive decline. However, the evidence for effects of sex steroids on cognitive ageing is conflicting. We therefore investigated associations between endogenous hormone levels, androgen receptor CAG repeat length, and cognitive domains including visuoconstructional abilities, visual memory, and processing speed in a large-scale longitudinal study of middle-aged and older men. MethodsMen aged 40-79 years from the European Male Ageing Study (EMAS) underwent cognitive assessments and measurements of hormone levels at baseline and follow-up (mean = 4.4 years, SD ± 0.3 years). Hormone levels measured included total and calculated free testosterone and estradiol, dihydrotestosterone, luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulphate and sex hormone-binding globulin. Cognitive function was assessed using the Rey-Osterrieth Complex Figure Copy and Recall, the Camden Topographical Recognition Memory and the Digit Symbol Substitution Test. Multivariate linear regressions were used to examine associations between baseline and change hormone levels, androgen receptor CAG repeat length, and cognitive decline. ResultsStatistical analyses included 1,827 and 1,423 participants for models investigating relationships of cognition with hormone levels and CAG repeat length, respectively. In age-adjusted models, we found a significant association of higher baseline free testosterone (β=-0.001, p=0.005) and dihydrotestosterone levels (β=-0.065, p=0.003) with greater decline on Rey-Osterrieth Complex Figure Recall over time. However, these effects were no longer significant following adjustment for centre, health, and lifestyle factors. No relationships were observed between any other baseline hormone levels, change in hormone levels, or androgen receptor CAG repeat length with cognitive decline in the measured domains. ConclusionsIn this large-scale prospective study there was no evidence for an association between endogenous sex hormone levels or CAG repeat length and cognitive ageing in men. These data suggest that sex steroid levels do not affect visuospatial function, visual memory, or processing speed in middle-aged and older men.

Retrograde Procedural Memory in Parkinson's Disease: A Cross-Sectional, Case-Control Study.

Background: The analysis of the procedural memory is particularly relevant in neurodegenerative disorders like Parkinson’s disease, due to the central role of the basal ganglia in procedural memory. It has been shown that anterograde procedural memory, the ability to learn a new skill, is impaired in Parkinson’s disease. However, retrograde procedural memory, the long-term retention and execution of skills learned in earlier life stages, has not yet been systematically investigated in Parkinson’s disease.Objective: This study aims to investigate retrograde procedural memory in people with Parkinson’s disease. We hypothesized that retrograde procedural memory is impaired in people with Parkinson’s disease compared to an age- and gender-matched control group.Methods: First, we developed the CUPRO evaluation system, an extended evaluation system based on the Cube Copying Test, to distinguish the cube copying procedure, representing functioning of retrograde procedural memory, and the final result, representing the visuo-constructive abilities. Development of the evaluation system included tests of discriminant validity.Results: Comparing people with typical Parkinson’s disease (n = 201) with age- and gender-matched control subjects (n = 201), we identified cube copying performance to be significantly impaired in people with Parkinson’s disease (p = 0.008). No significant correlation was observed between retrograde procedural memory and disease duration.Conclusion: We demonstrated lower cube copying performance in people with Parkinson’s disease compared to control subjects, which suggests an impaired functioning of retrograde procedural memory in Parkinson’s disease.

Profile of cognitive impairment in late-stage Parkinson's disease.

IntroductionThe profile of cognitive impairment associated with the late stages of Parkinson's disease (LSPD) is rarely reported. Its characterization is necessary to better understand the cognitive changes that occur as the disease progresses and to better contribute to its management.MethodsIn this cross‐sectional study, we characterized the cognitive profile of LSPD patients using the comprehensive assessment methodology proposed by the International Parkinson and Movement Disorders Society Task Force. The association of clinical and demographic variables with dementia diagnosis was also investigated using binary logistic regression analysis.ResultsEighty‐four LSPD patients were included (age 75.4 ± 6.9; disease duration 16.9 ± 7.5). Fifty‐four (64.3%) were classified as demented and presented a global impairment cognitive profile. In the nondemented group (N = 30), 25 (83.3%) LSPD patients met the diagnostic criteria for mild cognitive impairment, mostly with multiple domain impairment (96.0%) and a heterogeneous profile. Memory was the most frequent and severely impaired cognitive domain in both groups. Disease disability, orientation, complex order comprehension, verbal learning, and visuoconstructive abilities were significantly associated with dementia diagnosis (p < .05).ConclusionsCognitive impairment in multiple domains was common in LSPD patients. The most frequent and prominent deficits were in the memory domain, with a strong interference from attention impairment. Disease disability, orientation, complex order comprehension, verbal learning, and visuoconstructive abilities proved to be important determinants for dementia diagnosis.

Neuropsychological performances in patients with infiltrative non-GBM gliomas after postoperative adjuvant photon or proton radiotherapy: A prospective and preliminary investigation

Infiltrative non-GBM gliomas are common primary intracranial malignancies, and postoperative adjuvant radiotherapy is recommended for most adult patients diagnosed with this disease to enhance local control and prolong intracranial progression-free survival (PFS). However, RT-related neurocognitive function (NCF) consequences should not be ignored. Early neurocognitive decline principally includes episodic memory, associated significantly with functions of the hippocampus. This prospective study aims to investigate the impact of adjuvant brain irradiation on neurocognitive performances and relevant oncological outcomes. Twenty-five patients with intracranial infiltrative non-GBM gliomas were enrolled when postoperative adjuvant RT was recommended. All recruited patients should receive baseline brain magnetic resonance imaging, and neuropsychological assessments before and 4 months after the RT course. A battery of neuropsychological measures, mainly including executive functions, memory, psychomotor speed and visuoconstructive ability, was used to evaluate NCFs of interest. Analyzing the delta values between post-irradiation and baseline NCF scores, we observed a robust trend reflecting cognitive stabilization rather than deterioration in almost all NCF. Both verbal and visual memory functions exhibited significant differences in the corresponding scaled scores (Z = −2.722, p = .006, regarding verbal memory; Z = −2.246, p = .025, concerning non-verbal memory). Moreover, patients' neuropsychological performances associated with psychomotor speed and executive functions also disclosed a tendency toward stabilization/improvement. This prospective study demonstrated that patients with infiltrative non-GBM exhibited a marked tendency toward neurocognitive stabilization after receiving postoperative adjuvant RT. Clinical trial registration: Trial Registration with ClinicalTrials.gov identifier: NCT03534050

The Impact of Hearing Loss and Hearing Aid Usage on the Visuospatial Abilities of Older Adults in a Cohort of Combined Hearing and Cognitive Impairment.

IntroductionIt has been proposed that hearing loss may result in improved visuospatial abilities. The evidence for this assertion is inconsistent, and limited to studies in congenitally deaf children, despite older adults with age-related hearing loss constituting the vast majority of the hearing impaired population. We assessed visuospatial (visuoconstruction and visuospatial memory) ability in older adult hearing aid users with and without clinically significant cognitive impairment. The primary aim of the study was to determine the effect of hearing loss on visuospatial abilities.MethodSeventy-five adult hearing aid users (HA) aged over 65 were recruited, out of whom 30 had normal cognition (NC-HA), 30 had mild cognitive impairment (MCI-HA), and 15 had dementia (D-HA). The Rey Osterrieth Complex figure test (ROCFT) copy, 3 min recall and 30 min recall tests were performed to evaluate the visuoconstructional and visuospatial memory abilities of the participants.ResultsThere were significant differences between the ROCFT copy, 3 min recall, and 30 min recall among the three cohorts (p < 0.005). Compared with previously published normative data, the NC-HA performed significantly better in the ROCFT copy (p < 0.001), immediate recall (p < 0.001), and delay recall (p = 0.001), while the MCI-HA performed similarly to the expected norms derived from population (p = 0.426, p = 0.611, p = 0.697, respectively), and the D-HA performed below this norm.ConclusionThough visuospatial abilities tend to decline when the global cognitive functioning declines, we found suggestive evidence for positive effects of age-related hearing loss on visuospatial cognitive ability. Participants with mild cognitive impairment and hearing loss, who would have been expected to perform worse than normative data, were in fact performing as well as cognitively healthy subjects without hearing loss. Visuospatial ability could be targeted when providing rehabilitation for the older adults with hearing loss.

The Relationship Between Visuoconstructive Abilities and Language Performance in Patients With Aphasia After Stroke.

This study aimed to investigate the visuoconstructive abilities and the relationship between visuoconstructive function and language performance in aphasic patients. Right-handed 24 aphasic patients (males 14, females 10) with at least 3 months post-stroke and 32 age-matched healthy controls participated in this study. Visuoconstructive function was assessed by 3 levels of task difficulty: simple (drawing objects), intermediate (clock drawing), and complex (copy subtest of Rey complex figure test and block construction). Aphasic patients were divided into 3 sub-groups (mild, moderate to severe, and very severe group) according to severity of aphasia and compared with the control group, respectively. We analyzed the relation all levels of visuoconstructive tasks to aphasia quotient (AQ) and sub-domain scores of K-WAB. Moderate to severe aphasia group demonstrated no significant differences in scores of simple drawing objects compared to controls, but clock drawing, Rey complex figure copy and block design showed significantly decreased scores. Very severe group showed significantly lower scores in all levels of visuoconstructive tasks than the control. Correlation between all levels of visuoconstructive tasks except drawing objects and AQ were found to be statistically significant. Among the tasks, the clock drawing test revealed the highest correlation with language performance. Visuoconstructive abilities varied according to the severity of aphasia and the level of visuoconstructive tasks. Therefore, a thorough individual assessment of visuoconstructive function is needed to plan and predict the treatment and prognosis of aphasia and the clock drawing test may be a useful screening tool to evaluate this function.

Distinct cognitive and neuropsychiatric features of amnestic dementia with comorbid Alzheimer’s and TDP‐43 proteinopathies

AbstractBackgroundInclusions containing phosphorylated transactive response DNA‐binding protein 43 (TDP‐43) aggregates have been shown to coexist in ∼60% of cases with postmortem Alzheimer’s disease (AD) pathology, typically confined to mediotemporal brain regions. Together, these comorbid proteinopathies (TDP/AD) can lead to an amnestic dementia syndrome. The goal of this study was to identify, at early symptom onset, the shared versus distinct clinical, neuropsychological, and psychiatric features of cases with amnestic dementia and comorbid TDP/AD compared to those with AD as the primary neuropathologic diagnosis.MethodTwenty‐six individuals with amnestic impairment (Memory CDR=0.5 or 1) were identified from the Northwestern Alzheimer’s Disease Research Center and stratified by the presence of either postmortem AD pathology (N=13) or comorbid TDP/AD (N=13). Neuropsychological scores from tests of attention, language, executive functioning, visuoconstructional abilities, and mood/neuropsychiatric symptoms were analyzed from the NIA’s Uniform Data Set, version 2.0 or 3.0. Verbal (narrative and list‐learning) encoding and recall, and visual recall were included in memory assessment. In a subset of cases, a “visual‐to‐verbal” recall score was computed to determine the relative strength of visual memory compared to verbal. Student t‐tests with Welch’s correction were used to determine differences between groups.ResultThere were no differences in age at onset or death, frequency of APOE‐4 allele, or years of education between clinical groups. Preliminary findings showed no differences in attentional, executive, language, or visuoconstructional abilities. However, at disease onset, the TDP/AD group showed substantially higher frequency and severity of neuropsychiatric symptoms, including depression (p&lt;0.005). Memory testing showed no group differences at the levels of learning/encoding verbal information; however, the TDP/AD group performed significantly worse in long‐term recall for narrative information (p&lt;0.05). Qualitatively, the TDP/AD group showed stronger visual recall abilities (relative to verbal), whereas the AD group showed comparable performances in recall of material‐specific information.ConclusionPreliminary findings suggest that comorbid TDP/AD underlying amnestic impairments demonstrate a distinct cognitive and neuropsychiatric phenotype at disease onset. These findings help lay the groundwork for future in‐depth clinicopathologic studies and can help guide proper diagnosis of multiple etiology amnestic dementia.

Cognitive and Psychological Functioning in Chiari Malformation Type I Before and After Surgical Decompression - A Prospective Cohort Study.

Chiari Malformation Type I (CM-I) is defined as cerebellar tonsil displacement more than 5mm below the foramen magnum. This displacement can alter cerebrospinal fluid flow at the cervicomedullary junction resulting in Valsalva-induced headaches and syringomyelia and compress the brainstem resulting in bulbar symptoms. However, little is known about cognitive and psychological changes in CM-I. To prospectively assess cognitive and psychological performance in CM-I and determine whether changes occur after surgical decompression. Blinded evaluators assessed symptomatic CM-I patients ages ≥18 with a battery of neuropsychological and psychological tests. Testing was conducted preoperatively and 6 to 18 mo postoperatively. Data were converted to Z-scores based on normative data, and t-tests were used to analyze pre-post changes. A total of 26 patients were included, with 19 completing both pre- and post-op cognitive assessments. All patients had resolution of Valsalva-induced headaches and there was improvement in swallowing dysfunction (P<.0001), ataxia (P=.008), and sleep apnea (P=.021). Baseline performances in visual perception and construction (z = -1.11, P=.001) and visuospatial memory (z = -0.93, P=.002) were below average. Pre-post comparisons showed that CM-I patients had stable cognitive and psychological functioning after surgery, without significant changes from preoperative levels. CM-I patients had below average performance in visuospatial and visuoconstructional abilities preoperatively. Prospective longitudinal data following surgery demonstrated improved neurologic status without any decline in cognition or psychological functioning. Routine pre- and postoperative formal neuropsychological assessment in CM-I patients help quantify cognitive and behavioral changes associated with surgical decompression.