Adapting the Rivermead Behavioural Memory Test Extended Version (RBMT-E) for people with restricted mobility

The impact of cerebral anomalies on cognitive outcome in patients with spina bifida: A systematic review

BACKGROUND

Spina bifida is the most common congenital birth defect affecting the central nervous system. Given the frequent association of cerebral anomalies, spina bifida is not a single developmental abnormality of the central nervous system. Patients with spina bifida typically perform below average on cognitive tasks. It has been hypothesized that associated cerebral anomalies as well negatively affect cognition in spina bifida patients.

OBJECTIVE

This study aims to review the impact of cerebral anomalies on cognitive outcome in patients with spina bifida.

METHODS

A systematic search of multiple databases, including Pubmed, Embase, Web of Science and The Cochrane Central Register of Controlled Trials, was performed. All relevant primary research articles were included. All included articles were methodologically evaluated using a critical appraisal checklist.

RESULTS

In total 27 articles were included in this systematic review. A significant impact of different cerebral anomalies on cognition was found. More specifically, hydrocephalus, Chiari malformation type II and anomalies of the corpus callosum, central executive network, default mode network, cortical thickness and gyrification, fornix, grey matter volume and total brain volume were found to have a significant impact on cognitive outcome. The presence of a CSF shunt was also negatively associated with cognition. The results on Chiari malformation type II decompression and CSF shunt complications are inconsistent.

CONCLUSION

Associated cerebral anomalies have a significant impact on cognitive outcome in patients with spina bifida. The interrelatedness of the different cerebral anomalies makes it difficult to distinguish their individual impact on cognition.

Cognitive Outcomes and Activity of Daily Living for Neurosurgical Patients with Intrinsic Brain Lesions: A 1-year Prevalence Study

Background

No prevalence data on cognitive outcomes are available for general neurosurgical patients and few studies have assessed the correlation between common cognitive assessment tools of the occupational therapists and activity of daily living (ADL) at 1 year.

Methods

Consecutive neurosurgical patients with intrinsic brain lesions (brain tumours, traumatic intracerebral haematomas, spontaneous intracerebral haematomas, and cerebral arteriovenous malformations) were approached for consent to participate in the present study.

Results

At 1 year, the Montreal Cognitive Assessment score (mean ± standard deviation) was 20.4 (±8.6) and 42% of the patients had scores less than 22. The median number of the Neurobehavioral Cognitive Status Examination domains below the cutoff values was 8 (interquartile range: 3.5–9.75).

Conclusions

The cognitive assessments–-the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Rivermead Behavioural Memory Test–-showed satisfactory discriminating power for complete independence in instrumental ADL. Instrumental ADL was best correlated with the Rivermead Behavioural Memory Test.

Clinical study on cognitive dysfunction after spontaneous subarachnoid haemorrhage: patient profiles and relationship to cholinergic dysfunction

PURPOSE

We aimed to explore the cognitive profiles of subarachnoid haemorrhage patients who returned to the community, along with the associated risk factors.

METHODS

We recruited 40 Chinese patients with spontaneous subarachnoid haemorrhage 7-27 months after the initial presentation. They had all been discharged to their homes or to care homes for the elderly. For cognitive assessment, we employed the Cognitive Subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) for global cognitive function, the Frontal Assessment Battery (FAB) for frontal lobe function, and the Rivermead Behavioural Memory Test (RBMT) for everyday memory function.

RESULTS

An ADAS-cog of more than 21/85 (poor global cognitive function) was noted in 14 (35%) patients. A FAB of less than 12/18 (poor frontal lobe function) was noted in 13 (27.5%) patients. An RBMT score of less than 15/26 (poor everyday memory function) was noted in 17 (43.6%) patients. Poor cognitive function was found to be associated with chronic hydrocephalus (in terms of FAB), with clinical vasospasm (in terms of RBMT), and with cerebral infarction (in terms of RBMT).

CONCLUSIONS

Poor cognitive function was common and occurred in up to 43.6% of the patients, with the verbal and behavioural memory aspects predominantly affected. We did not find a significant association between cholinergic dysfunction and cognitive dysfunction. Organization of future drug trials and cognitive rehabilitation should take into account the association between frontal lobe dysfunction and chronic hydrocephalus.