Cognitive estimation in aged patients with major depressive disorder

The role of semantic assessment in the differential diagnosis between late-life depression and Alzheimer's disease or amnestic mild cognitive impairment: systematic review and meta-analysis

OBJECT

The cognitive complaints encountered in late-life depression (LLD) make it difficult to distinguish from amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) based on an analysis of neurocognitive disorders. The hypothesis of the early impairment of semantic memory in AD and aMCI is considered a potential differential cognitive clue, but the absence of this impairment has not yet been confirmed in  LLD.

METHOD

Based on the PRISMA method, we systematically seek neuropsychological assessments of individuals with LLD, the present study included 31 studies representing 3291 controls and 2820 people with LLD. Wherever possible, studies that tested simultaneously groups with LLD, AD (or aMCI) were also included. The results of the group of neuropsychological tasks relying on semantic memory were analyzed in two groups of tasks with high- or low-executive demand. The mean average effect of LLD was calculated and compared to the incremental effect of aMCI or AD on the scores. Linear regressions including education, age, and severity and type of depression were run to seek their power of prediction for the mean average effects.

RESULTS

LLD has a medium effect on scores at semantic and phonemic fluency and naming and a small average effect on the low-executive demand tasks. Differences in education is a predictor of the effect of LLD on phonemic fluency and naming but not on semantic fluency or on low-executive demand tasks. Except for semantic fluency, aMCI did not demonstrate an incremental effect on the scores compared to LLD, while AD did, for all the tasks except phonemic fluency.

CONCLUSION

Assessment of semantic memory can be a discriminating clue for the distinction between depression and Alzheimer's disease but some methodological variables are highly influential to the scores, especially education. However, high-executive semantic tasks alone do not allow us to clearly distinguish LLD from AD or aMCI, as both pathologies seem to have a largely dialectical influential relationship, but low-executive semantic tasks appear as more sensible to this pathological distinction.

Quantity as a Fish Views It: Behavior and Neurobiology

An ability to estimate quantities, such as the number of conspecifics or the size of a predator, has been reported in vertebrates. Fish, in particular zebrafish, may be instrumental in advancing the understanding of magnitude cognition. We review here the behavioral studies that have described the ecological relevance of quantity estimation in fish and the current status of the research aimed at investigating the neurobiological bases of these abilities. By combining behavioral methods with molecular genetics and calcium imaging, the involvement of the retina and the optic tectum has been documented for the estimation of continuous quantities in the larval and adult zebrafish brain, and the contributions of the thalamus and the dorsal-central pallium for discrete magnitude estimation in the adult zebrafish brain. Evidence for basic circuitry can now be complemented and extended to research that make use of transgenic lines to deepen our understanding of quantity cognition at genetic and molecular levels.

What determines cognitive estimation ability? Changing contributions of semantic and executive domains as a function of age

The Cognitive Estimation Test (CET) is commonly used in neuropsychological assessment. It is typically assumed to load on executive functions, although research has shown that CET performance also depends on access to semantic knowledge. It is unknown whether these contributions vary with age. It is important to examine this question as these abilities have divergent life course trajectories: executive functions tend to decline as people age but semantic knowledge continues to accrue. In addition, previous research has not examined potential contributions to CET performance from semantic control abilities, that is cognitive control processes involved specifically in the retrieval and use of semantic information. To address these questions, we investigated cognitive predictors of CET performance in healthy young and older adults. We found that better executive function was associated with more accurate estimation in both age groups. However, the effect of semantic knowledge on CET performance was significantly larger in older people, having no predictive power in the younger group. The ability to detect weak semantic associations, which is thought to index controlled search and retrieval of semantic information, also had divergent effects on CET performance in the two age groups. Our results provide empirical support for the idea that older people are more reliant on semantic knowledge when estimating quantities, which may explain why age‐related decline in CET scores is not typically found. We conclude that deficits on the CET may be indicative either of semantic or executive impairments, particularly in older age groups.

The right anterior temporal lobe critically contributes to magnitude knowledge

Cognitive estimation is a mental ability applied to solve numerical problems when precise facts are unknown, unavailable or impractical to calculate. It has been associated with several underlying cognitive components, most often with executive functions and semantic memory. Little is known about the neural correlates of cognitive estimation. To address this issue, the present cross-sectional study applied lesion-symptom mapping in a group of 55 patients with left hemineglect due to right-hemisphere stroke. Previous evidence suggests a high prevalence of cognitive estimation impairment in these patients, as they might show a general bias towards large magnitudes. Compared to 55 age- and gender-matched healthy controls, the patient group demonstrated impaired cognitive estimation. However, the expected large magnitude bias was not found. Lesion-symptom mapping related their general estimation impairment predominantly to brain damage in the right anterior temporal lobe. Also critically involved were the right uncinate fasciculus, the anterior commissure and the right inferior frontal gyrus. The main findings of this study emphasize the role of semantic memory in cognitive estimation, with reference to a growing body of neuroscientific literature postulating a transmodal hub for semantic cognition situated in the bilateral anterior temporal lobe. That such semantic hub function may also apply to numerical knowledge is not undisputed. We here propose a critical contribution of the right anterior temporal lobe to at least one aspect of number processing, i.e. the knowledge about real-world numerical magnitudes.

The ontogeny of continuous quantity discrimination in zebrafish larvae (Danio rerio)

Several studies have investigated the ontogeny of the capacity to discriminate between discrete numerical information in human and non-human animals. Contrarily, less attention has been devoted to the development of the capacity to discriminate continuous quantities. Recently, we set up a fast procedure for screening continuous quantity abilities in adult individuals of an animal model in neurodevelopmental research, the zebrafish. Two different sized holes are presented in a wall that divides the home tank in two halves and the spontaneous preference of fish for passing through the larger hole is exploited to measure their discrimination ability. We tested zebrafish larvae in the first, second and third week of life varying the relative size of the smaller circle (0.60, 0.75, 0.86, 0.91 area ratio). We found that the number of passages increased across the age. The capacity to discriminate the larger hole decreased as the ratio between the areas increased. No difference in accuracy was found as a function of age. The accuracy of larval zebrafish almost overlaps that found in adults in a previous study, suggesting a limited role of maturation and experience on the ability to estimate areas in this species.

Size discrimination in adult zebrafish (Danio rerio): Normative data and individual variation

In humans, aging and neurodegenerative diseases have been found to be associated with impairment in both mathematical abilities and estimation of continuous quantities such as size, weight or distance. Zebrafish (Danio rerio) is rapidly becoming a model for human aging and brain disorders but we currently lack any instrument for rapid assessment of quantity estimation abilities in this species. Here we developed a simple method based on spontaneous preference of zebrafish for using the larger available hole to pass an obstacle. We collected a large amount of data from small groups of zebrafish moving between compartments of their tank and we used these normative data to compare the performance of individually tested fish. Zebrafish significantly discriminated size ratios from 0.60 to 0.91 with their performance decreasing while increasing the size ratio between the smaller and the larger hole presented. On average, individually tested fish showed the same performance, but a large inter-individual variability was observed. Test-retest analyses revealed a good reliability of this test, with 0.60 and 0.75 ratios being the most informative. Experience did not affect individual performance, suggesting the suitability of this test to measure the longitudinal changes and the effects of pharmacological treatments on cognitive abilities.

Classifying major depression patients and healthy controls using EEG, eye tracking and galvanic skin response data

OBJECTIVE

Major depression disorder (MDD) is one of the most prevalent mental disorders worldwide. Diagnosing depression in the early stage is crucial to treatment process. However, due to depression's comorbid nature and the subjectivity in diagnosis, an early diagnosis could be challenging. Recently, machine learning approaches have been used to process Electroencephalography (EEG) and neuroimaging data to facilitate the diagnosis. In the present study, we used a multimodal machine learning approach involving EEG, eye tracking and galvanic skin response data as input to classify depression patients and healthy controls.

METHODS

One hundred and forty-four MDD depression patients and 204 matched healthy controls were recruited. They were required to watch a series of affective and neutral stimuli while EEG, eye tracking information and galvanic skin response were recorded via a set of low-cost, portable devices. Three machine learning algorithms including Random Forests, Logistic Regression and Support Vector Machine (SVM) were trained to build dichotomous classification model.

RESULTS

The results showed that the highest classification f1 score was obtained by Logistic Regression algorithms, with accuracy = 79.63%, precision = 76.67%, recall = 85.19% and f1 score = 80.70% LIMITATIONS: No hospitalized patients were available; only outpatients were included in the present study. The sample consisted mostly of young adult, and no elder patients were included.

CONCLUSIONS

The machine learning approach can be a useful tool for classifying MDD patients and healthy controls and may help for diagnostic processes.

Cognitive estimation: Performance of patients with focal frontal and posterior lesions

The Cognitive Estimation Test (CET) is a widely used test to investigate estimation abilities requiring complex processes such as reasoning, the development and application of appropriate strategies, response plausibility checking as well as general knowledge and numeracy (e.g., Shallice and Evans, 1978; MacPherson et al., 2014). Thus far, it remains unknown whether the CET is both sensitive and specific to frontal lobe dysfunction. Neuroimaging techniques may not represent a useful methodology for answering this question since the complex processes involved are likely to be associated with a large network of brain regions, some of which are not functionally necessary to successfully carry out the CET. Instead, neuropsychological studies may represent a more promising investigation tool for identifying the brain areas necessary for CET performance. We recently developed two new versions of the CET (CET-A and CET-B; MacPherson et al., 2014). We investigated the overall performance and conducted an error analysis on CET-A in patients with focal, unilateral, frontal (n = 38) or posterior (n = 22) lesions and healthy controls (n = 39). We found that frontal patients' performance was impaired compared to healthy controls on CET. We also found that frontal patients generated significantly poorer estimates than posterior patients on CET-A. This could not be explained by impairments in fluid intelligence. The error analyses suggested that for CET-A, extreme and very extreme responses are impaired following frontal lobe damage. However, only very extreme responses are significantly more impaired following frontal lobe than posterior damage and so represent a measure restricted to frontal "executive" impairment, in addition to overall CET performance.

Everyday false memories in older persons with depressive disorder

Generally we tend to think that memory in daily living is complete and accurate in healthy persons. However, current memory research has revealed inconspicuous memory faults. Rarely omissions and distortions of memory are researched with tasks resembling everyday life. We investigated healthy older control subjects (HC) and patients with depressive disorder (DD). Cognitive function was assessed with a comprehensive neuropsychological test battery and mood with the Montgomery-Asberg Depression Scale (MADRS). We assessed everyday veridical and distorted memories on showing participants original news and commercials. In most aspects of attention, executive functions, and memory, patients with DD performed worse than HC. Regarding memory content on viewing news or commercials the difference between patients with DD and HC was more pronounced for false memory content than for veridical memory content. Linear regression analysis showed the extent of false memory content being associated with mental flexibility as assessed with the Trail Making Test and mood as assessed with the MADRS for both information obtained on viewing news and commercials. Increase of false memories impedes overall accuracy of memory more than decrease of veridical memories in older persons with depressive disorder. Diminished executive functions and depressive mood partly explain these memory distortions.

Assessing Cognitive Estimation and Its Effects on Community Integration in People with Acquired Brain Injury Undergoing Rehabilitation

The purpose of the present study was to examine the convergent and divergent validity of the Biber Cognitive Estimation Test (BCET) in individuals with ABI undergoing postacute rehabilitation and to assess the measure's ability to account for unique variance in community integration following rehabilitation. Participants with ABI referred for postacute rehabilitation (N = 201) were assessed on the BCET and a number of other neuropsychological tests that have been demonstrated to rely on aspects of executive processing (Trail-Making Test, Modified Six Elements Test, and verbal fluency measures) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Internal consistency of the total BCET was good; however, interpretable solutions for existing subscales were not discerned. The BCET total score demonstrated positive associations with tests of executive functioning; however, it was also significantly associated with more general aspects of neuropsychological functioning suggesting that it does not solely assess executive processes in ABI patients undergoing rehabilitation. Hierarchical multiple regression suggested that the BCET accounted for significant additional variance in community integration after severity of disability, executive functioning, and more general aspects of neuropsychological status were statistically controlled. While the subscale structure of the BCET may be somewhat inconsistent, the total scale score accounts for some unique variance in pragmatic rehabilitation outcome and may be a useful tool in postacute rehabilitation assessment protocols.

Drug induces depression-like phenotypes and alters gene expression profiles in Drosophila

BACKGROUND

Major depressive disorder (MDD) is a severe mental illness that affects more than 350 million people worldwide. However, the molecular mechanisms of depression are currently unclear. Studies suggest that Drosophila and humans have similar depression-like symptoms under pressure. In this research, we choose Drosophila melanogaster as the animal model to explore the molecular mechanisms that trigger depression.

RESULTS

We found that feeding D. melanogaster with the medium containing Levodopa or Chlorpromazine could induce depression-like phenotypes in both behavioral and biochemical biomarkers, including significantly decreased food intake, mating frequency, serotonin (5-HT) concentration, and increased malondialdehyde (MDA) concentration as well as reduced activity of superoxide dismutase (SOD). Moreover, the progeny of Chlorpromazine-treated flies also showed these depression-like features. By RNA-seq technology, we identified 467 genes that were differentially expressed between Chlorpromazine treated (CPZ) and control male flies [fold-change of ≥2 (q-value<5%)]. When comparing CPZ with control flies, 312 genes were upregulated and 155 genes downregulated. Differential expression of genes related to metabolic pathway, Parkinson's disease, Huntington's disease, Alzheimer's disease and lysozyme pathways were observed. Quantitative reverse transcriptase PCR (qRT-PCR) confirmed that 19 genes are differentially expressed in CPZ and control male flies.

CONCLUSIONS

Levodopa, or Chlorpromazine can induce depression-like phenotypes in D. melanogaster regarding changes of appetite and sexual activity, and some key biochemical markers. A total of 467 genes were identified by RNA-seq analysis to have at least a 2-fold-change in expression between CPZ and control flies, including genes involved in metabolism, neurological diseases and lysozyme pathways. Our data provide additional insight into molecular mechanisms underlying depressive disorders in humans and may also contribute to clinical treatment.

Deconstructing the Cognitive Estimation Task: A Developmental Examination and Intra-Task Contrast

The cognitive estimation task (CET) requires participants to answer estimation questions that lack definitive answers. Few studies examine CET performance in healthy populations, and even fewer in children. Previous research has not considered differences between categories within the CET. The categories differ in their reliance on units of measurement, which is significant when examining CET performance in children due to educational factors. The goal of the study was to examine CET performance in 10 and 12 year-old children and contrast the CET categories. We found a developmental effect in overall CET performance: children’s performance was more extreme than adults but no differences were found between the groups of children. Examination of the CET categories revealed differential developmental trajectories: the children’s scores were more extreme in weight and time, while comparable to adults in quantity. We conclude that CET questions that require application of units of measurement are more difficult for childern due to higher involvement of executive functions, and children have less experience applying them in daily life. The CET is not a unified construct and has the potential to shed light on how children acquire an understanding of magnitudes and units of measurement.

EEG beta and low gamma power correlates with inattention in patients with major depressive disorder

BACKGROUND

Inattention is a common feature of major depressive disorder (MDD). The aim of this study was to explore the relationship between quantitative electroencephalography (qEEG) power of a specific band and inattention severity in patients with MDD.

METHODS

EEG recordings of 73 patients with MDD were collected in during both eyes closed and eyes open conditions. Inattention was assessed by the inattention sub-scale of the Korean version of the Adult ADHD scale (K-AADHD). The severity of symptoms associated with depression and anxiety was assessed with the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), and the Beck Depression Inventory (BDI). Multiple regression and Hayes mediation model were applied for the statistical analysis to verify the effects of clinical variables on inattention score.

RESULTS

The beta (12-30Hz) and low gamma (30-50Hz) powers in fronto-central regions were negatively correlated with inattention scores. Symptom severity scores strongly predicted inattention scores; in particular, the BDI accounted for 23.9% of the variance. In mediation analysis, BDI fully mediated the path of anxiety to inattention.

LIMITATIONS

The medication effect and comorbidity in our participants were not fully controlled. A subjective assessment tool was hired to measure inattention.

CONCLUSIONS

Beta and low gamma power of the fronto-central regions might be a reliable measure of attention deficits in patients with MDD, which in turn, seems to be related to the severity of subjective depressive symptoms. Further work is needed to confirm this finding on larger, drug and comorbidity-free samples, and to test the clinical utility.

Nonlinear analysis of EEG in major depression with fractal dimensions

Major depressive disorder (MDD) is a psychiatric mood disorder characterized by cognitive and functional impairments in attention, concentration, learning and memory. In order to investigate and understand its underlying neural activities and pathophysiology, EEG methodologies can be used. In this study, we estimated the nonlinearity features of EEG in MDD patients to assess the dynamical properties underlying the frontal and parietal brain activity. EEG data were obtained from 16 patients and 15 matched healthy controls. A wavelet-chaos methodology was used for data analysis. First, EEGs of subjects were decomposed into 5 EEG sub-bands by discrete wavelet transform. Then, both the Katz's and Higuchi's fractal dimensions (KFD and HFD) were calculated as complexity measures for full-band and sub-bands EEGs. Last, two-way analyses of variances were used to test EEG complexity differences on each fractality measures. As a result, a significantly increased complexity was found in both parietal and frontal regions of MDD patients. This significantly increased complexity was observed not only in full-band activity but also in beta and gamma sub-bands of EEG. The findings of the present study indicate the possibility of using the wavelet-chaos methodology to discriminate the EEGs of MDD patients from healthy controls.

How many segments are there in an orange: normative data for the new Cognitive Estimation Task in an Italian population

The Cognitive Estimation Test (CET) is widely used by clinicians to assess frontal executive dysfunction. In the present work, the Italian standardization of a new version of the CET is provided. This version consists of two 9-item parallel forms (A and B) that were administered to two hundred and twenty-seven healthy Italian male and female participants aged between 19 and 91 years with 5-24 years of full-time education. Performance on the CET was not related to age or level of education; both forms showed a male CET advantage. The new CET is a useful tool for clinicians and researchers to administer the CET more than once without practice effects, which is considered important when assessing frontal executive abilities.

Bringing the cognitive estimation task into the 21st century: normative data on two new parallel forms

The Cognitive Estimation Test (CET) is widely used by clinicians and researchers to assess the ability to produce reasonable cognitive estimates. Although several studies have published normative data for versions of the CET, many of the items are now outdated and parallel forms of the test do not exist to allow cognitive estimation abilities to be assessed on more than one occasion. In the present study, we devised two new 9-item parallel forms of the CET. These versions were administered to 184 healthy male and female participants aged 18–79 years with 9–22 years of education. Increasing age and years of education were found to be associated with successful CET performance as well as gender, intellect, naming, arithmetic and semantic memory abilities. To validate that the parallel forms of the CET were sensitive to frontal lobe damage, both versions were administered to 24 patients with frontal lobe lesions and 48 age-, gender- and education-matched controls. The frontal patients’ error scores were significantly higher than the healthy controls on both versions of the task. This study provides normative data for parallel forms of the CET for adults which are also suitable for assessing frontal lobe dysfunction on more than one occasion without practice effects.

Spatiotemporal analysis of relative convergence of EEGs reveals differences between brain dynamics of depressive women and men

A new nonlinear technique for analysis of brain dynamics called spatiotemporal analysis of relative convergence (STARC) of electroencephalograms (EEGs) is introduced, based on the relative convergence of EEGs of different loci. This technique shows how many times EEGs of each loci pair converge together, which in turn is used as an indicator to determine the different neuronal regions involved in performing the same task. A higher STARC value indicates that more regions are recruited to perform the same task. The STARC methodology was used to reveal sex difference pathophysiology and brain dynamics, using EEG data from 11 male and 11 female adults with major depressive disorder (MDD). The results show significant differences in relative convergences of EEGs of intraleft temporal and frontoleft temporal lobes at δ band, between male and female patients.

Decreased expression of synapse-related genes and loss of synapses in major depressive disorder

Previous imaging and postmortem studies have reported a lower brain volume and a smaller size and density of neurons in the dorsolateral prefrontal cortex (dlPFC) of subjects with major depressive disorder (MDD). These findings suggest that synapse number and function are decreased in the dlPFC of patients with MDD. However, there has been no direct evidence reported for synapse loss in MDD, and the gene expression alterations underlying these effects have not been identified. Here we use microarray gene profiling and electron microscopic stereology to reveal lower expression of synaptic-function–related genes (CALM2, SYN1, RAB3A, RAB4B and TUBB4) in the dlPFC of subjects with MDD and a corresponding lower number of synapses. We also identify a transcriptional repressor, GATA1, expression of which is higher in MDD and that, when expressed in PFC neurons, is sufficient to decrease the expression of synapse-related genes, cause loss of dendritic spines and dendrites, and produce depressive behavior in rat models of depression.

Fractality analysis of frontal brain in major depressive disorder

EEGs of the frontal brain of patients diagnosed with major depressive disorder (MDD) have been investigated in recent years using linear methods but not based on nonlinear methods. This paper presents an investigation of the frontal brain of MDD patients using the wavelet-chaos methodology and Katz's and Higuchi's fractal dimensions (KFD and HFD) as measures of nonlinearity and complexity. EEGs of the frontal brain of healthy adults and MDD patients are decomposed into 5 EEG sub-bands employing a wavelet filter bank, and the FDs of the band-limited as well as those of their 5 sub-bands are computed. Then, using the ANOVA statistical test, HFDs and KFDs of the left and right frontal lobes in EEG full-band and sub-bands of MDD and healthy groups are compared in order to discover the FDs showing the most meaningful differences between the two groups. Finally, the discovered FDs are used as input to a classifier, enhanced probabilistic neural network (EPNN), to discriminate the MDD from healthy EEGs. The results of HFD show higher complexity of left, right and overall frontal lobes of the brain of MDD compared with non-MDD in beta and gamma sub-bands. Moreover, it is observed that HFD of the beta band is more discriminative than HFD of the gamma band for discriminating MDD and non-MDD participants, while the KFD did not show any meaningful difference. A high accuracy of 91.3% is achieved for classification of MDD and non-MDD EEGs based on HFDs of left, right, and overall frontal brain beta sub-band. The findings of this research, however, should be considered tentative because of limited data available to the authors.

Accelerometer-based physical activity in a large observational cohort--study protocol and design of the activity and function of the elderly in Ulm (ActiFE Ulm) study

BACKGROUND

A large number of studies have demonstrated a positive effect of increased physical activity (PA) on various health outcomes. In all large geriatric studies, however, PA has only been assessed by interview-based instruments which are all subject to substantial bias. This may represent one reason why associations of PA with geriatric syndromes such as falls show controversial results. The general aim of the Active-Ulm study was to determine the association of accelerometer-based physical activity with different health-related parameters, and to study the influence of this standardized objective measure of physical activity on health- and disability-related parameters in a longitudinal setting.

METHODS

We have set up an observational cohort study in 1500 community dwelling older persons (65 to 90 years) stratified by age and sex. Addresses have been obtained from the local residents registration offices. The study is carried out jointly with the IMCA--Respiratory Health Survey in the Elderly implemented in the context of the European project IMCA II. The study has a cross-sectional part (1) which focuses on PA and disability and two longitudinal parts (2) and (3). The primary information for part (2) is a prospective 1 year falls calendar including assessment of medication change. Part (3) will be performed about 36 months following baseline. Primary variables of interest include disability, PA, falls and cognitive function. Baseline recruitment has started in March 2009 and will be finished in April 2010.All participants are visited three times within one week, either at home or in the study center. Assessments included interviews on quality of life, diagnosed diseases, common risk factors as well as novel cognitive tests and established tests of physical functioning. PA is measured using an accelerometer-based sensor device, carried continuously over a one week period and accompanied by a prospective activity diary.

DISCUSSION

The assessment of PA using a high standard accelerometer-based device is feasible in a large population-based study. The results obtained from cross-sectional and longitudinal analyses will shed light on important associations between PA and various outcomes and may provide information for specific interventions in older people.