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McGrath K, Laurent D, Otero O, Hey G, Tomdio M, Sorrentino Z, Riklan J, Chowdhury MAB, Isom E, Schreffler A, Musalo M, Rahman M. An Interdisciplinary Protocol for Ventriculoperitoneal Shunt Patient Selection in Normal Pressure Hydrocephalus. World Neurosurg 2024:S1878-8750(24)00697-1. [PMID: 38679380 DOI: 10.1016/j.wneu.2024.04.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Normal pressure hydrocephalus (NPH) can be treated with ventriculoperitoneal shunt (VPS) placement, but no broadly implemented indication for VPS exists. METHODS Our protocol consists of physical therapy and occupational therapy practitioners administering validated tests of gait, balance, and cognition before and after lumbar drain (LD) placement. Specific tests include: Timed "Up & Go", Tinetti Gait and Balance Assessment, Berg Balance Scale, Mini Mental Status Exam, Trail Making Test Part B, and the Rey Auditory and Visual Learning Test. Minimal clinically important difference values for each test were determined from literature review. A retrospective review of patients treated under this protocol was performed. The primary outcomes were candidacy for VPS based on the protocol and patient-reported symptomatic improvement after VPS placement. RESULTS 48/75 (64%) patients received VPS. 43/48 (89.6%) of those shunted reported improved symptoms at 6 week follow up. However, 10/22 (45.5%) reported worsening symptoms at 1 year follow up. The mean Tinetti score significantly increased after LD in patients who improved with VPS compared to the no shunt group (4.27 vs -0.48, p<0.001). 6/33 (18%) patients with post-op imaging had a subdural fluid collection identified and 3/49 (6%) had other complications, including 1 seizure, 1 intracerebral hemorrhage, and 1 stroke. CONCLUSIONS Standardized assessment of gait, balance, and cognition before and after temporary CSF diversion identifies patients with NPH likely to benefit from VPS placement with a low complication rate. One year after VPS, approximately half of patients had symptoms recur.
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Affiliation(s)
| | - Dimitri Laurent
- Lillian S. Wells Department of Neurosurgery, University of Florida
| | - Oriana Otero
- Lillian S. Wells Department of Neurosurgery, University of Florida
| | - Grace Hey
- University of Florida College of Medicine
| | - Macaulay Tomdio
- Lillian S. Wells Department of Neurosurgery, University of Florida
| | | | | | | | - Emily Isom
- UF Health- Heart Vascular and Neuromedicine Hospital
| | | | | | - Maryam Rahman
- Lillian S. Wells Department of Neurosurgery, University of Florida
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2
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Duff K, Hammers DB, Koppelmans V, King JB, Hoffman JM. Short-Term Practice Effects on Cognitive Tests Across the Late Life Cognitive Spectrum and How They Compare to Biomarkers of Alzheimer's Disease. J Alzheimers Dis 2024:JAD231392. [PMID: 38669544 DOI: 10.3233/jad-231392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Practice effects on cognitive testing in mild cognitive impairment (MCI) and Alzheimer's disease (AD) remain understudied, especially with how they compare to biomarkers of AD. Objective The current study sought to add to this growing literature. Methods Cognitively intact older adults (n = 68), those with amnestic MCI (n = 52), and those with mild AD (n = 45) completed a brief battery of cognitive tests at baseline and again after one week, and they also completed a baseline amyloid PET scan, a baseline MRI, and a baseline blood draw to obtain APOE ɛ4 status. Results The intact participants showed significantly larger baseline cognitive scores and practice effects than the other two groups on overall composite measures. Those with MCI showed significantly larger baseline scores and practice effects than AD participants on the composite. For amyloid deposition, the intact participants had significantly less tracer uptake, whereas MCI and AD participants were comparable. For total hippocampal volumes, all three groups were significantly different in the expected direction (intact > MCI > AD). For APOE ɛ4, the intact had significantly fewer copies of ɛ4 than MCI and AD. The effect sizes of the baseline cognitive scores and practice effects were comparable, and they were significantly larger than effect sizes of biomarkers in 7 of the 9 comparisons. Conclusion Baseline cognition and short-term practice effects appear to be sensitive markers in late life cognitive disorders, as they separated groups better than commonly-used biomarkers in AD. Further development of baseline cognition and short-term practice effects as tools for clinical diagnosis, prognostic indication, and enrichment of clinical trials seems warranted.
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Affiliation(s)
- Kevin Duff
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Dustin B Hammers
- Department of Neurology, Indiana University School of Medicine, Indiana, USA
| | | | - Jace B King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - John M Hoffman
- Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
- University of Utah Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, USA
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3
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Binoy S, Montaser-Kouhsari L, Ponger P, Saban W. Corrigendum: Remote assessment of cognition in Parkinson's disease and cerebellar ataxia: the MoCA test in English and Hebrew. Front Hum Neurosci 2024; 18:1401098. [PMID: 38638808 PMCID: PMC11025350 DOI: 10.3389/fnhum.2024.1401098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fnhum.2023.1325215.].
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Affiliation(s)
- Sharon Binoy
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Loyola Stritch School of Medicine, Chicago, IL, United States
| | - Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Penina Ponger
- Movement Disorders Division, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - William Saban
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Richey LN, Abad Coronel MX, Bryant BR, Esagoff AI, White J, Cranston CC, Peters ME. A systematic review of cognition in idiopathic intracranial hypertension. Clin Neuropsychol 2024; 38:612-643. [PMID: 37614079 DOI: 10.1080/13854046.2023.2249176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
Background: Cognitive disturbance is not pathognomonic of idiopathic intracranial hypertension (IIH), and therefore is not routinely assessed unless it presents as a major complaint. Consequently, cognition has been slow to gain substantial traction in IIH-related research, despite its notable impact on a subset of patients. We completed a systematic review of the literature examining the neurocognitive profile of patients with IIH. Methods: A PRISMA compliant literature search was conducted in Ovid Medline, PubMed, PsycInfo, Embase, Web of Science, Cochrane, Cinahl, and Scopus databases. The initial query yielded 1376 unique articles. These articles were narrowed to those including empirical analyses of cognitive assessment in adult patients with IIH. Results: A final cohort of nine articles resulted, comprising the findings from 309 patients with IIH and 153 healthy control subjects. Although there was considerable variability in methodology particularly with respect to cognitive assessment, fairly consistent deficits were observed across studies in the domains of processing speed, working memory, sustained and complex attention, set-shifting, and confrontation naming. Body mass index and body weight were not associated with cognitive performance. Pertinent limitations of the literature were identified, most notably failure to report trial-level cognitive testing data, the need for more comprehensive testing batteries with less reliance on screening tools, and not controlling for variables that may impact cognition. Conclusions: A more complete understanding of the cognitive profile in patients with idiopathic intracranial hypertension could lead to the increased -relevance of cognitive screening in disease management, and therefore more appropriate neuropsychological referral, earlier identification of functional limitations, and targeted neurorehabilitation.
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Affiliation(s)
- Lisa N Richey
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marcelo X Abad Coronel
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry R Bryant
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron I Esagoff
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacob White
- Welch Medical Library, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher C Cranston
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E Peters
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Furey RT, Bowden SC, Jewsbury PA, Sudarshan NJ, Connolly ML. Investigating the Latent Structure of Executive Function in the Delis-Kaplan Executive Function System Using Cattell-Horn-Carroll Theory. Assessment 2024; 31:363-376. [PMID: 37012706 PMCID: PMC10822067 DOI: 10.1177/10731911231161779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To replicate a seven-factor model previously reported for the Delis-Kaplan Executive Function System (D-KEFS). METHOD This study used the D-KEFS standardization sample including 1,750 non-clinical participants. Several seven-factor models previously reported for the D-KEFS were re-evaluated using confirmatory factor analysis (CFA). Previously published bi-factor models were also tested. These models were compared with a three-factor a priori model based on Cattell-Horn-Carroll (CHC) theory. Measurement invariance was examined across three age cohorts. RESULTS All previously reported models failed to converge when tested with CFA. None of the bi-factor models converged after large numbers of iterations, suggesting that bi-factor models are ill-suited to represent the D-KEFS scores as reported in the test manual. Although poor fit was initially observed for the three-factor CHC model, inspection of modification indices showed potential for improvement by including method effects via correlated residuals for scores derived from similar tests. The final CHC model showed good to excellent fit and strong metric measurement invariance across the three age cohorts with minor exceptions for a subset of Fluency parameters. CONCLUSIONS CHC theory extends to the D-KEFS, supporting findings from previous studies that executive functions can be integrated into CHC theory.
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Affiliation(s)
| | - Stephen C. Bowden
- The University of Melbourne, Australia
- St. Vincent’s Hospital Melbourne, Australia
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Kjeldsen PL, Damholdt MF, Madsen LS, Nissen PH, Aanerud JFA, Parbo P, Ismail R, Kaasing M, Eskildsen SF, Østergaard L, Brooks DJ. Performance on complex memory tests is associated with β-amyloid in individuals at risk of developing Alzheimer's disease. J Neuropsychol 2024; 18:120-135. [PMID: 37382036 DOI: 10.1111/jnp.12332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
The pathophysiological development of Alzheimer's disease (AD) begins in the brain years before the onset of clinical symptoms. The accumulation of beta-amyloid (Aβ) is thought to be the first cortical pathology to occur. Carrying one apolipoprotein E (APOE) ε4 allele increases the risk of developing AD at least 2-3 times and is associated with earlier Aβ accumulation. Although it is difficult to identify Aβ-related cognitive impairment in early AD with standard cognitive tests, more sensitive memory tests may be able to do this. We sought to examine associations between Aβ and performance on three tests within three subdomains of memory, verbal, visual, and associative memory, to elucidate which of these tests were sensitive to Aβ-related cognitive impairment in at-risk subjects. 55 APOE ε4 carriers underwent MRI, 11 C-Pittsburgh Compound B (PiB) PET, and cognitive testing. A composite cortical PiB SUVR cut-off score of 1.5 was used to categorise subjects as either APOE ε4 Aβ+ or APOE ε4 Aβ-. Correlations were carried out using cortical surface analysis. In the whole APOE ε4 group, we found significant correlations between Aβ load and performance on verbal, visual, and associative memory tests in widespread cortical areas, the strongest association being with performance on associative memory tests. In the APOE ε4 Aβ+ group, we found significant correlations between Aβ load and performance of verbal and associative, but not visual, memory in localised cortical areas. Performance on verbal and associative memory tests provides sensitive markers of early Aβ-related cognitive impairment in at-risk subjects.
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Affiliation(s)
- Pernille Louise Kjeldsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Malene Flensborg Damholdt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Lasse Stensvig Madsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Peter Henrik Nissen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter Parbo
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Rola Ismail
- Department of Nuclear Medicine, Sygehus Lillebaelt, Vejle, Denmark
| | - Malene Kaasing
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Simon Fristed Eskildsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Leif Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - David James Brooks
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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7
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Macoir J. Language Impairment in Vascular Dementia: A Clinical Review. J Geriatr Psychiatry Neurol 2024; 37:87-95. [PMID: 37551643 PMCID: PMC10802085 DOI: 10.1177/08919887231195225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Vascular cognitive impairment (VCI) encompasses a wide range of conditions, including cognitive impairment associated with stroke or vascular brain injury, mild vascular cognitive impairment, and vascular dementia (VD). Knowledge of language impairment associated with VD is far less extensive than that of Alzheimer's disease. Although not prevalent in VD, impairment in language skills has been reported. A better understanding of the neurolinguistic features associated with the different presentations of VD could facilitate medical diagnosis. In this article, we report data on language impairment in VD, with particular attention to their primary or secondary functional origin. To better appreciate this functional origin, we also outline the main characteristics of impairment in other cognitive functions. Key elements that should be considered in the speech-language assessment of individuals with possible or proven VD are also highlighted.
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Affiliation(s)
- Joël Macoir
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
- Centre de Recherche CERVO – Brain Research Centre, Québec, QC, Canada
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8
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Prichard EC, Clarkson EM, Christman SD. Differences Between Consistent and Inconsistent Handedness Remain Consistently Interesting: Ten Years of Research on the Consistency of Handedness With the Edinburgh Handedness Inventory. Percept Mot Skills 2024; 131:5-16. [PMID: 37994625 DOI: 10.1177/00315125231217624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Almost 10 years ago Prichard et al. (2013) published a literature review on consistency of handedness. They described how consistency of handedness, typically measured by the Edinburgh Handedness Inventory (EHI), predicted outcomes in memory and decision-making paradigms better than direction of handedness. In the last 10 years, new research has extended these findings and added new theoretical perspectives. The goal of this short form review is to highlight and summarize some of these more intriguing findings and to encourage researchers in the fields of memory and decision making to incorporate handedness as a variable in future research.
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Affiliation(s)
- Eric C Prichard
- School of Social and Behavioral Sciences, University of Arkansas at Monticello, Monticello, AR, USA
| | - Evan M Clarkson
- Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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Binoy S, Montaser-Kouhsari L, Ponger P, Saban W. Remote assessment of cognition in Parkinson's disease and Cerebellar Ataxia: the MoCA test in English and Hebrew. Front Hum Neurosci 2024; 17:1325215. [PMID: 38259338 PMCID: PMC10800372 DOI: 10.3389/fnhum.2023.1325215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
There is a critical need for accessible neuropsychological testing for basic research and translational studies worldwide. Traditional in-person neuropsychological studies are inherently difficult to conduct because testing requires the recruitment and participation of individuals with neurological conditions. Consequently, studies are often based on small sample sizes, are highly time-consuming, and lack diversity. To address these challenges, in the last decade, the utilization of remote testing platforms has demonstrated promising results regarding the feasibility and efficiency of collecting patient data online. Herein, we tested the validity and generalizability of remote administration of the Montreal Cognitive Assessment (MoCA) test. We administered the MoCA to English and Hebrew speakers from three different populations: Parkinson's disease, Cerebellar Ataxia, and healthy controls via video conferencing. First, we found that the online MoCA scores do not differ from traditional in-person studies, demonstrating convergent validity. Second, the MoCA scores of both our online patient groups were lower than controls, demonstrating construct validity. Third, we did not find differences between the two language versions of the remote MoCA, supporting its generalizability to different languages and the efficiency of collecting binational data (USA and Israel). Given these results, future studies can utilize the remote MoCA, and potentially other remote neuropsychological tests to collect data more efficiently across multiple different patient populations, language versions, and nations.
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Affiliation(s)
- Sharon Binoy
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Loyola Stritch School of Medicine, Chicago, IL, United States
| | - Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Penina Ponger
- Movement Disorders Division, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - William Saban
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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10
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Lynch ST, Dornbush R, Shahar S, Mansour R, Klepacz L, Primavera LH, Ferrando SJ. Change in Neuropsychological Test Performance Seen in a Longitudinal Study of Patients With Post-acute Sequelae of COVID-19: A 6-Month Follow-up Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(23)00856-X. [PMID: 38171454 DOI: 10.1016/j.jaclp.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection and relying on subjective complaints, screening instruments, or computerized testing. This group previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person 7 months post-COVID-19, particularly those seeking care for cognitive complaints. The current study describes the initial and 6-month follow-up results of an expanded cohort of 75 participants. OBJECTIVE To measure longitudinal changes in neuropsychological test performance, as well as medical and psychiatric changes, post-COVID-19. METHODS Participants underwent NP, psychiatric, and medical assessments approximately 7 months after acute COVID-19 infection. Sixty-three (84%) returned approximately 6 months later for repeat evaluation. RESULTS At the initial visit, 29 (38.7%) met criteria for low NP performance, and 16 (21.3%) met criteria for extremely low NP performance. At 6-month follow-up, several NP domains that were significantly below normative values at the initial visit were no longer abnormal, with the exception of language. Only measures of delayed memory and fatigue showed significant improvements between the 2 time points. CONCLUSIONS A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over 1 year after infection. While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly between times 1 and 2. No individual declined in NP test performance, though relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports. Longitudinal follow-up of this cohort is in progress.
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Affiliation(s)
- Sean T Lynch
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY
| | - Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Rayah Mansour
- School of Public Health, New York Medical College, Valhalla, NY
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY
| | - Louis H Primavera
- School of Health Sciences, Touro College and University System, Valhalla, NY
| | - Stephen J Ferrando
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY.
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Ciccone JR, Fisher J, Jones JCW. Forensic neuropsychiatric evaluation of a personal injury case. Behav Sci Law 2024; 42:46-55. [PMID: 38145476 DOI: 10.1002/bsl.2642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/22/2023] [Indexed: 12/26/2023]
Abstract
Civil litigation involving the forensic neuropsychiatric evaluation of a personal injury case requires an assessment of damages and causation. The expert witness is obliged to integrate data from three critical sources of information: the review of records; the results of neuropsychological testing; and the findings from the clinical examination. In civil litigation involving a personal injury claim, the expert witness can be expected to address causation and prognosis of any neuropsychiatric damages. We discuss the undertaking of a forensic neuropsychiatric evaluation, psychiatric disorders often encountered in personal injury litigation, provide case vignettes and describe a number of special types of forensic neuropsychiatric evaluations, for example, Workers' Compensation, VA Disability and Social Security Disability.
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Affiliation(s)
| | - Jerid Fisher
- University of Rochester Medical Center, Rochester, New York, USA
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Turner TH, Scott EP, Barlis K, Rodriguez-Porcel F, Sartori AC, Joseph J. The Rapid Access Memory Program for Addressing Concerns of Incipient Dementia in Academic Primary Care Settings. J Geriatr Psychiatry Neurol 2023:8919887231225482. [PMID: 38156442 DOI: 10.1177/08919887231225482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Expedient diagnosis of incipient dementia is often hindered by time constraints in primary care visits, shortage of dementia specialists, and extended waitlists for comprehensive neuropsychological evaluations. METHODS We developed the Rapid Access Memory Program (RAMP) to improve access of neuropsychological services for older adults presenting to our institutional primary care clinics with concerns of cognitive decline. RAMP provides abbreviated neurocognitive assessment, same-day patient feedback, expedited reporting to referring providers, and is financially self-supported. Here, we describe development of RAMP and clinical outcomes from the first 3 years. RESULTS Of 160 patients seen, dementia was diagnosed in 30% and Mild Cognitive Impairment in 50%; Alzheimer's disease was the most common suspected etiology. New psychiatric diagnosis was made in about one-third (n = 54). Most frequent recommendations involved medication adjustments (initiating cholinesterase inhibitors, deprescribing anticholinergics), safety (driving, decision-making), and specialist referrals. Additionally, 27 (17%) subsequently enrolled in local research. CONCLUSIONS Results support feasibility and utility of RAMP for connecting older adults in primary care with neuropsychological services.
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Affiliation(s)
- Travis H Turner
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- WCG Clinical Endpoint Solutions, Princeton, NJ, USA
| | - Emmi P Scott
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Barlis
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | | | - Andrea C Sartori
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Jane Joseph
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
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Harvey PD, Strassnig A, Strassnig M, Heaton A, Kuehn K, Torre P, Sundermann EE, Pinkham A, Depp CA, Black G, Wharton W, Waldrop D, Anderson AM, Moore RC. Mild Cognitive Impairment, But Not HIV Status, is Related to Reduced Awareness of Level of Cognitive Performance Among Older Adults. Am J Geriatr Psychiatry 2023; 31:1117-1128. [PMID: 37544836 PMCID: PMC10732243 DOI: 10.1016/j.jagp.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Self-assessment of cognitive abilities can be an important predictor of clinical outcomes. This study examined impairments in self-assessments of cognitive performance, assessed with traditional neuropsychological assessments and novel virtual reality tests among older persons with and without human immunodeficiency virus (HIV) and mild cognitive impairment (MCI). METHODS One hundred twenty-two participants (82 persons with HIV; 79 MCI+) completed a traditional neuropsychological battery, DETECT virtual reality cognitive battery, and self-reported their general cognitive complaints, depressive symptoms, and perceptions of DETECT performance. Relationships between DETECT performance and self-assessments of performance were examined as were the correlations between general cognitive complaints and performance. These relations were evaluated across HIV and MCI status, considering the associations of depressive symptoms, performance, and self-assessment. RESULTS We found no effect of HIV status on objective performance or self-assessment of DETECT performance. However, MCI+ participants performed worse on DETECT and traditional cognitive tests, while also showing a directional bias towards overestimation of their performance. MCI- participants showed a bias toward underestimation. Cognitive complaints were reduced compared to objective performance in MCI+ participants. Correlations between self-reported depressive symptoms and cognitive performance or self-assessment of performance were nonsignificant. CONCLUSIONS MCI+ participants underperformed on neuropsychological testing, while overestimating performance. Interestingly, MCI- participants underestimated performance to approximately the same extent as MCI+ participants overestimated. Practical implications include providing support for persons with MCI regarding awareness of limitations and consideration that self-assessments of cognitive performance may be overestimated. Similarly, supporting older persons without MCI to realistically appraise their abilities may have clinical importance.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL; Research Service (PDH), Miami VA Healthcare System, Miami, FL
| | | | - Martin Strassnig
- Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL
| | - Anne Heaton
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA
| | - Kevin Kuehn
- Department of Medicine (KK), University of California San Diego, San Diego, CA
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences (PT), San Diego State University, San Diego, CA
| | - Erin E Sundermann
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA
| | - Amy Pinkham
- School of Behavioral and Brain Sciences (AP), The University of Texas at Dallas, Richardson, TX
| | - Colin A Depp
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA; VA San Diego Healthcare System (CAD), San Diego, CA
| | | | | | | | | | - Raeanne C Moore
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA.
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14
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Crișan I, Ali S, Cutler L, Matei A, Avram L, Erdodi LA. Geographic variability in limited English proficiency: A cross-cultural study of cognitive profiles. J Int Neuropsychol Soc 2023; 29:972-983. [PMID: 37246143 DOI: 10.1017/s1355617723000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This study was designed to evaluate the effect of limited English proficiency (LEP) on neurocognitive profiles. METHOD Romanian (LEP-RO; n = 59) and Arabic (LEP-AR; n = 30) native speakers were compared to Canadian native speakers of English (NSE; n = 24) on a strategically selected battery of neuropsychological tests. RESULTS As predicted, participants with LEP demonstrated significantly lower performance on tests with high verbal mediation relative to US norms and the NSE sample (large effects). In contrast, several tests with low verbal mediation were robust to LEP. However, clinically relevant deviations from this general pattern were observed. The level of English proficiency varied significantly within the LEP-RO and was associated with a predictable performance pattern on tests with high verbal mediation. CONCLUSIONS The heterogeneity in cognitive profiles among individuals with LEP challenges the notion that LEP status is a unitary construct. The level of verbal mediation is an imperfect predictor of the performance of LEP examinees during neuropsychological testing. Several commonly used measures were identified that are robust to the deleterious effects of LEP. Administering tests in the examinee's native language may not be the optimal solution to contain the confounding effect of LEP in cognitive evaluations.
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Affiliation(s)
- Iulia Crișan
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Sami Ali
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Alina Matei
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Luisa Avram
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Laszlo A Erdodi
- Department of Psychology, University of Windsor, Windsor, Canada
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15
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Medina-Rodríguez JC. Cerebellar Cognitive-Affective Syndrome Secondary to Epstein-Barr Virus Infection: A Case Report. Cureus 2023; 15:e49855. [PMID: 38169722 PMCID: PMC10758583 DOI: 10.7759/cureus.49855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
Throughout history, the cerebellum was initially perceived as potentially vestigial until the 19th century. However, subsequent research illuminated its pivotal role in coordination. Over the course of the 20th century, it became predominantly associated with motor functions. Nevertheless, in the latter half of the century, Schmahmann's pioneering research expanded the understanding of the cerebellum to encompass its involvement in cognition and emotions. In light of this evolving background, the primary objective of this paper is to present a clinical case featuring a 60-year-old male with a history of Epstein-Barr virus. This patient underwent a comprehensive neuropsychiatric assessment at a tertiary care hospital, involving thorough clinical, paraclinical, and neuroimaging examinations. The extensive medical findings strongly indicate the presence of a cognitive-affective cerebellar syndrome.
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Affiliation(s)
- José Carlos Medina-Rodríguez
- Department of Education, National Institute of Psychiatry, Mexico City, MEX
- Department of Neurology and Neuropsychiatry, National Institute of Psychiatry, Mexico City, MEX
- Postgraduate Studies Division, National Autonomous University of Mexico, Mexico City, MEX
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16
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Morales Mejia YL, Thompson JL, Woods SP. A Process Analysis of Rey-Osterrieth Complex Figure Test Performance Using the Boston Qualitative Scoring System in HIV-Associated Neurocognitive Disorders. Percept Mot Skills 2023; 130:2530-2546. [PMID: 37921056 DOI: 10.1177/00315125231212682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Deficits in episodic verbal memory are commonly observed in persons with HIV (PWH) disease, in whom they are characterized by dysregulation of the executive aspects of encoding and retrieval and adversely impact everyday functioning. Deficits in episodic visual memory are also apparent in PWH, but we know less about their cognitive architecture. This study used the Boston Qualitative Scoring System (BQSS) for the Rey-Osterrieth Complex Figure (ROCF) to examine visual learning and recall in 43 individuals without HIV and 141 PWH who completed a full research neuropsychological, psychiatric, and medical assessment. A mixed model covarying for education and estimated verbal IQ showed that participants with HIV-associated neurocognitive disorders (HAND) performed worse than PWH without neurocognitive disorders and HIV- participants at comparable medium-to-large effect sizes across the Copy, Immediate, and Delayed trials of the BQSS-ROCF, suggesting a primary encoding deficit. A component process analysis of the BQSS-ROCF Copy Trial revealed that participants with HAND had specific difficulties with configural accuracy, cluster accuracy, and cluster placement. Within the PWH sample, measures of motor coordination and executive functions emerged as independent predictors of BQSS-ROCF Copy Trial performance. Findings extend prior research by showing that HAND may be associated with a primary encoding deficit for complex visuomotor learning and memory tasks that is driven by a combination of visuospatial, motor, and executive difficulties.
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Affiliation(s)
- Yenifer L Morales Mejia
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychology and Counseling, University of Texas at Tyler, Tyler, TX, USA
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17
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Holz MR, Kochhann R, da Silva PF, Wilson MA, Fonseca RP. Brief instrument for direct complex functionality assessment: a new ecological tool. Front Neurosci 2023; 17:1250188. [PMID: 38027502 PMCID: PMC10654966 DOI: 10.3389/fnins.2023.1250188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Direct Assessment of Functional Status (DAFS) is the only instrument validated in Brazil that assesses functionality directly with the patient. However, this clinical tool takes a long time to be administered. This limits its use in hospitals and outpatient clinics that require brief assessment instruments. Additionally, we need to count with a direct assessment because the number of older adults living alone is increasing and we thus lack reliable informants. Objective This study aimed to present the development and content validity evidence of a direct complex functionality test for older adults, the Brief Instrument for Direct Functionality Assessment (BIDFA). Method A total sample of 30 older adults and eight expert judges took part in the study stages. The BIDFA construction stages were: (1) literature review of functionality instruments; (2) development of seven ecological tasks to evaluate the performance of daily complex activities with the older adults; (3) content analysis by eight expert judges; (4) pilot study with 30 older adults; (5) the ecological analysis of items; (6) focus group analysis; and (7) final version of the BIDFA. Results The BIDFA had evidence of content validity with an agreement index of 96.5%. The final version of BIDFA was left with six domains of complex functionality divided into semantic memory and time orientation; shopping skills; executive attention, math and finance skills; organization; planning and procedural memory; and problem-solving. The complex functionality score by BIDFA ranges from 0 to 100 points. Conclusion The BIDFA was found to have good content validity by the expert judges and by the ecological analysis of the items by the older adults. The new instrument is expected to help assess the functional status of older adults, in an abbreviated context including complex functionality demands, with a wider range of total and subdomain scores.
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Affiliation(s)
- Maila Rossato Holz
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Patrícia Ferreira da Silva
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Maximiliano A. Wilson
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) and École des Sciences de La Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Rochele Paz Fonseca
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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18
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Kassam F, Chen H, Nosheny R, McGirr A, Williams T, Ng N, Camacho M, Mackin R, Weiner M, Ismail Z. Cognitive profile of people with mild behavioral impairment in Brain Health Registry participants. Int Psychogeriatr 2023; 35:643-652. [PMID: 35130991 PMCID: PMC10063171 DOI: 10.1017/s1041610221002878] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR). DESIGN Observational cohort study. SETTING Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal. PARTICIPANTS The final sample included 499 participant-informant dyads. MEASUREMENTS Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/- individuals, as was the association between cognitive scores and MBI symptom severity. RESULTS Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity. CONCLUSION These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.
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Affiliation(s)
- F. Kassam
- University of Calgary, Hotchkiss Brain Institute
| | - H. Chen
- University of Calgary, Hotchkiss Brain Institute
| | - R.L. Nosheny
- University of California, San Francisco, Department of Psychiatry
| | - A. McGirr
- University of Calgary, Department of Psychiatry
| | - T. Williams
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | | | - Monica Camacho
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - R.S. Mackin
- University of California, San Francisco, Department of Psychiatry
| | - M.W. Weiner
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - Z. Ismail
- University of Calgary, Hotchkiss Brain Institute
- University of Calgary, Department of Psychiatry
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19
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Eremija J, Patel S, Rice S, Daines M. Intravenous immunoglobulin treatment improves multiple neuropsychiatric outcomes in patients with pediatric acute-onset neuropsychiatric syndrome. Front Pediatr 2023; 11:1229150. [PMID: 37908968 PMCID: PMC10613689 DOI: 10.3389/fped.2023.1229150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is defined by acute onset of diverse neuropsychiatric manifestations, presumably in the setting of underlying immune dysfunction. We used standardized neuropsychological testing to assess how intravenous immunoglobulins (IVIG) impact neurological and cognitive functions in PANS patients by comparing pretreatment with post-treatment scores. A 5-year retrospective study was undertaken in Children's Postinfectious Autoimmune Encephalopathy Center at University of Arizona. We identified 12 children diagnosed with PANS and treated with immunomodulatory IVIG doses, who also completed neuropsychological testing before and after treatment. We tracked multiple patient characteristics, type/timeline of testing, and number of IVIG courses. Score change of 1 standard deviation in any tested domain/subdomain was considered improvement. We further reviewed records for laboratory signs of triggering infection and immune dysfunction. Improvement occurred in 11/12 patients, in one or multiple domains/subdomains, independently of time between disease onset and IVIG initiation (0-7 years). Participants received 1-7 IVIG courses. Improvement was primarily seen in memory (58%), sensory-motor (37%) and visual-motor integration (30%). In 5/12 patients we detected hypogammaglobulinemia requiring ongoing IVIG replacement, one patient had isolated low IgA. Only one patient had to discontinue IVIG therapy due to severe adverse effects. Standardized neuropsychological testing represents an important tool to objectively measure improvement in PANS patients. IVIG was tolerated well and showed efficacy in the vast majority of participants, independently from timelapse since disease onset, emphasizing impact of immunomodulation in PANS. Significant presence of baseline hypogammaglobulinemia in children with PANS emphasizes the presumed role of immune dysfunction in disease pathogenesis.
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Affiliation(s)
- Jelena Eremija
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Arizona, Tucson, AZ, United States
| | - Sanjay Patel
- Department of Internal Medicine, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, United States
| | - Sydney Rice
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Arizona, Tucson, AZ, United States
| | - Michael Daines
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Arizona, Tucson, AZ, United States
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20
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Shahar S, Lynch S, Dornbush R, Klepacz L, Smiley A, Ferrando SJ. Frequency and Characteristics of Depression and Its Association with Diminished Quality of Life in a Cohort of Individuals with Post-Acute Sequelae of COVID-19. Neuropsychiatr Dis Treat 2023; 19:2069-2079. [PMID: 37810951 PMCID: PMC10559789 DOI: 10.2147/ndt.s427957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Background Approximately one-third of COVID-19 survivors will experience persistent symptoms, which may include neurological and psychiatric disturbances. Previous research has suggested that up to 45% of people develop clinically significant depressive symptoms post-COVID. This study sought to determine frequency, symptom profile, and clinical correlates of depression post-COVID. Methods Seventy-five participants who had recovered from COVID-19 underwent neurocognitive, psychiatric, medical, and cognitive testing/screening. The primary measures of interest in this report included the Patient Health Questionnaire (PHQ-9), a 9-item depression-screening tool, and the Endicott Quality of Life Enjoyment and Satisfaction Questionnaire. Results One-third of study participants screened as positive on the PHQ-9 for clinically significant depression, with the most commonly reported symptom being fatigue, followed by sleep disturbance and poor concentration. Also reported were decreased satisfaction in employment, sexual life, and mood. Depressed patients described greater illness severity during COVID-19 infection and subjective cognitive impairment, which was not found on neurocognitive testing. The only significant predictor of depression was COVID-19 illness severity. Limitations A significant portion of participants was a clinical population with specific post-COVID complaints and was predominately comprised of white females. Formal psychiatric evaluation was not performed. Conclusion Many individuals may experience depression after COVID-19 infection, with symptoms appearing to be predominately somatic in nature and correspond with COVID-19 illness severity.
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Affiliation(s)
- Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York City, NY, USA
| | - Sean Lynch
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, NY, USA
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Stephen J Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
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21
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Kim MS, Torres K, Kang HJ, Drane DL. Specificity of performance validity tests in patients with confirmed epilepsy. Clin Neuropsychol 2023; 37:1530-1547. [PMID: 36219095 DOI: 10.1080/13854046.2022.2127424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
Objective: While assessment of performance validity is essential to neuropsychological evaluations, use of performance validity tests (PVTs) in an epilepsy population has raised concerns due to factors that may result in performance fluctuations. The current study assessed whether specificity was maintained at previously suggested cutoffs in a confirmed epilepsy population on the Warrington Recognition Memory Test (WRMT) - Words and Test of Memory Malingering (TOMM). Method: Eighty-two confirmed epilepsy patients were administered the WRMT-Words and TOMM as part of a standardized neuropsychological evaluation. Frequency tables were utilized to investigate specificity rates on these two PVTs. Results: The suggested WRMT-Words Accuracy Score cutoff of ≤42 was associated with a specificity rate of 90.2%. Five out of the 8 individuals falling below the Accuracy Score cutoff scored 42, suggesting specificity could be further improved by slightly lowering the cutoff. The WRMT-Words Total Time cutoff of ≥207 seconds was associated with 95.1% specificity. A TOMM Trial 1 cutoff of <40 was associated with 93.9% specificity, while the established cutoff of <45 on Trial 2 and the Retention Trial yielded specificity rates of 98.6% and 100.0%, respectively. Conclusions: Our findings demonstrate acceptable performance on two PVTs in a select confirmed epilepsy population without a history of brain surgery, active seizures during testing, and/or low IQ, irrespective of various factors such as seizure type, seizure lateralization/localization, and language lateralization. The possible presence of interictal discharges were not controlled for in the current study, which may have contributed to reduced PVT performances.
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Affiliation(s)
- Michelle S Kim
- Department of Neurology, University of Washington, Seattle, USA
| | - Karen Torres
- Department of Neurology, University of Washington, Seattle, USA
| | - Hyun Jin Kang
- Department of Neurology, University of Washington, Seattle, USA
| | - Daniel L Drane
- Department of Neurology, University of Washington, Seattle, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
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22
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Tsushima WT, Lawton DRY, Kimata C, Siu AM. Prevalence of invalid ImPACT baseline test results among high school athletes with invalidity and sandbagging indices. Clin Neuropsychol 2023; 37:1516-1529. [PMID: 36458597 DOI: 10.1080/13854046.2022.2148282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
Objective: The comparison of baseline neuropsychological test results with post-concussion neuropsychological test results is a common practice to assess the aftermath of a sport-related concussion. The effectiveness of this approach is compromised when invalid baseline test performances occur. The present study was designed to assess the prevalence of invalid baseline test results of high school athletes, using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Method: A large sample of 8938 high school athletes' baseline test data were examined, including the four ImPACT Composite scores and three sets of embedded invalid indices: five ImPACT Invalidity Indicators, four ImPACT sandbagging red flags, and two ImPACT sandbagging subtest flags. Results: There were 8394 (93.91%) Valid scorers, who failed no Invalidity Indicators; 544 (6.09%) Invalid scorers, who failed at least one Invalidity Indicator, 2718 (30.41%) Red Flag scorers, who had at least one Red Flag score; and 4154 (46.47%) Subtest Flag scorers, who had at least one Subtest Flag score. Of the entire sample, 4485 (54.65%) failed at least one of the invalid indices. Conclusions: As in prior studies of high school athletes, the Invalidity Indicators identified a low portion (6.09%) of the athletes with invalid baseline test results, while other invalidity measures found 30.41% to 46.48% of the athletes producing questionable test results. The high rate of invalid test findings suggested in this research calls for greater efforts to improve the accuracy of baseline test results.
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Affiliation(s)
- William T Tsushima
- Psychiatry and Psychology Department, Straub Medical Center, Honolulu, HI, USA
| | - Dylan R Y Lawton
- Department of Biology, Santa Clara University, Santa Clara, CA, USA
| | - Chieko Kimata
- Research Institute, Hawaii Pacific Health, Honolulu, HI, USA
| | - Andrea M Siu
- Research Institute, Hawaii Pacific Health, Honolulu, HI, USA
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23
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Scott JC, Moore TM, Roalf DR, Satterthwaite TD, Wolf DH, Port AM, Butler ER, Ruparel K, Nievergelt CM, Risbrough VB, Baker DG, Gur RE, Gur RC. Development and application of novel performance validity metrics for computerized neurocognitive batteries. J Int Neuropsychol Soc 2023; 29:789-797. [PMID: 36503573 PMCID: PMC10258222 DOI: 10.1017/s1355617722000893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Data from neurocognitive assessments may not be accurate in the context of factors impacting validity, such as disengagement, unmotivated responding, or intentional underperformance. Performance validity tests (PVTs) were developed to address these phenomena and assess underperformance on neurocognitive tests. However, PVTs can be burdensome, rely on cutoff scores that reduce information, do not examine potential variations in task engagement across a battery, and are typically not well-suited to acquisition of large cognitive datasets. Here we describe the development of novel performance validity measures that could address some of these limitations by leveraging psychometric concepts using data embedded within the Penn Computerized Neurocognitive Battery (PennCNB). METHODS We first developed these validity measures using simulations of invalid response patterns with parameters drawn from real data. Next, we examined their application in two large, independent samples: 1) children and adolescents from the Philadelphia Neurodevelopmental Cohort (n = 9498); and 2) adult servicemembers from the Marine Resiliency Study-II (n = 1444). RESULTS Our performance validity metrics detected patterns of invalid responding in simulated data, even at subtle levels. Furthermore, a combination of these metrics significantly predicted previously established validity rules for these tests in both developmental and adult datasets. Moreover, most clinical diagnostic groups did not show reduced validity estimates. CONCLUSIONS These results provide proof-of-concept evidence for multivariate, data-driven performance validity metrics. These metrics offer a novel method for determining the performance validity for individual neurocognitive tests that is scalable, applicable across different tests, less burdensome, and dimensional. However, more research is needed into their application.
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Affiliation(s)
- J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Tyler M. Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David R. Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D. Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison M. Port
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ellyn R. Butler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline M. Nievergelt
- Center for Excellent in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California (UCSD), San Diego, CA, USA
| | - Victoria B. Risbrough
- Center for Excellent in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California (UCSD), San Diego, CA, USA
| | - Dewleen G. Baker
- Center for Excellent in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California (UCSD), San Diego, CA, USA
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Mormando M, Galiè E, Bianchini M, Lauretta R, Puliani G, Tanzilli A, Anceschi U, Simone G, Petreri G, Graziano G, Pace A, Appetecchia M. Neurological adverse events of mitotane in adrenocortical carcinoma: results of a pilot study. Front Oncol 2023; 13:1222002. [PMID: 37645432 PMCID: PMC10461107 DOI: 10.3389/fonc.2023.1222002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Mitotane, the only drug approved by the Food and Drug Administration (FDA) for the treatment of adrenocortical carcinoma, is associated with several side effects including neurotoxicity. The aim of our study is to investigate the relationship between mitotane plasma levels and neurological toxicity. Methods We have considered five patients affected by adrenocortical carcinoma treated with mitotane. The neurological assessment included a neurological examination, an electroencephalogram, event-related potentials (P300), and a neuropsychological assessment. All of the patients were first considered at the onset of symptoms of neurotoxicity or when mitotanemia levels were above 18 mg/L, for the second time at mitotanemia normalization and subsequently at its further increase, or in case of persistent neurological abnormalities, some months after normalization. Results At the first neurotoxicity, four patients showed impaired neurological examination, electroencephalogram, and P300; three patients had impaired neuropsychological assessment; one patient, only P300. At mitotanemia normalization, the neurological examination became normal in all patients and electroencephalogram normalized in one patient, improved in another one, continuing to be altered in the other three. P300 latency and neuropsychological assessment normalized in two patients and persisted altered in the patient experiencing long-term mitotane toxicity. At the third evaluation, in the patient with prolonged mitotane toxicity, the normal mitotanemia in the previous 9 months restored P300 and improved the electroencephalogram but not the neuropsychological assessment. In the two patients experiencing a further rise of mitotanemia, neurological examination was normal but P300 and electroencephalogram were altered. Conclusion The results of our study highlighted the presence of neurophysiological and neuropsychological abnormalities associated with mitotane values above 18 mg/L.
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Affiliation(s)
- Marilda Mormando
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edvina Galiè
- Neuro-oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marta Bianchini
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosa Lauretta
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Puliani
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Tanzilli
- Neuro-oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Gianluca Petreri
- Neuro-oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuliana Graziano
- Neuro-oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Pace
- Neuro-oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Turner TH. Fully-immersive virtual reality instrumental activities of daily living training for mild dementia accelerates cognitive decline: a safety warning? Ann Palliat Med 2023; 12:679-681. [PMID: 37164971 DOI: 10.21037/apm-23-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Travis H Turner
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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26
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Mäurer A, Himmel G, Lange C, Mathies F, Apostolova I, Peters O, Buchert R. Individualized Summary Assessment of Detailed Neuropsychological Testing for the Etiological Diagnosis of Newly Detected Cognitive Impairment in Hospitalized Geriatric Patients. J Alzheimers Dis 2023:JAD221273. [PMID: 37302033 DOI: 10.3233/jad-221273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Neuropsychological testing (NPT) of geriatric inpatients can be affected by the acute illness and/or the hospitalization. OBJECTIVE To test individualized interpretation of detailed NPT for the differentiation between primary 'neurodegenerative' etiologies (predominantly Alzheimer's disease) and 'other' etiologies (including cerebrovascular disease) of newly detected cognitive impairment in geriatric inpatients without and with delirium in remission. METHODS 96 geriatric inpatients (81.9±5.6 years, 64.6% females) with clinically uncertain cognitive impairment were included. 31.3% had delirium in remission that was not considered the primary cause of the cognitive impairment. Categorization of the most likely etiology as 'neurodegenerative' or 'other' was established retrospectively by a study neuropsychologist based on individualized summary assessment of detailed NPT compiled in a standardized vignette. The etiological diagnosis based on FDG-PET served as gold standard (54.2% 'neurodegenerative', 45.8% 'other'). RESULTS Individualized summary assessment by the study neuropsychologist was correct in 80 patients (83.3%, 8 false positive, 8 false negative). The impact of delirium in remission was not significant (p = 0.237). Individualized summary assessment by an independent neuropsychologist resulted in more false positive cases (n = 22) at the same rate of false negative cases (n = 8). Automatic categorization with a decision tree model based on the most discriminative NPT scores was correct in 68 patients (70.8%, 14 false positive, 14 false negative). CONCLUSION Individualized summary assessment of detailed NPT in the context of relevant clinical information might be useful for the etiological diagnosis of newly detected cognitive impairment in hospitalized geriatric patients, also in patients with delirium in remission, but requires task-specific expertise.
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Affiliation(s)
- Anja Mäurer
- Vivantes Ida-Wolff-Krankenhaus, Berlin, Germany
| | | | - Catharina Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Franziska Mathies
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Peters
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Binoy S, Woody R, Ivry RB, Saban W. Feasibility and Efficacy of Online Neuropsychological Assessment. Sensors (Basel) 2023; 23:5160. [PMID: 37299887 PMCID: PMC10255316 DOI: 10.3390/s23115160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Neuropsychological testing has intrinsic challenges, including the recruitment of patients and their participation in research projects. To create a method capable of collecting multiple datapoints (across domains and participants) while imposing low demands on the patients, we have developed PONT (Protocol for Online Neuropsychological Testing). Using this platform, we recruited neurotypical controls, individuals with Parkinson's disease, and individuals with cerebellar ataxia and tested their cognitive status, motor symptoms, emotional well-being, social support, and personality traits. For each domain, we compared each group to previously published values from studies using more traditional methods. The results show that online testing using PONT is feasible, efficient, and produces results that are in line with results obtained from in-person testing. As such, we envision PONT as a promising bridge to more comprehensive, generalizable, and valid neuropsychological testing.
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Affiliation(s)
- Sharon Binoy
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
- Department of Molecular and Cell Biology, University of California, Berkeley, CA 94720, USA
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
| | - Rachel Woody
- Department of Molecular and Cell Biology, University of California, Berkeley, CA 94720, USA
| | - Richard B. Ivry
- Department of Psychology, University of California, Berkeley, CA 94720, USA
| | - William Saban
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Lanssens A, Tuts N, Welkenhuyzen L, Thielen H, Gillebert CR. The sustained attention to response task: Validation of a non-numerical parallel form. Appl Neuropsychol Adult 2023:1-17. [PMID: 37210673 DOI: 10.1080/23279095.2023.2213792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Many activities in daily life rely on the ability to continuously keep attention on task requirements. Patients with acquired brain injury often suffer from deficits in sustained attention that impact quality of life and complicate rehabilitation. The sustained attention to response task (SART) is a commonly used go/no-go task in the assessment of sustained attention. However, its feasibility for patients with acquired brain injury could be questioned considering deficits in alphanumerical processing following brain damage. We investigated whether a SART with sinusoidal gratings instead of digits can be used to assess sustained attention. The Gratings SART and Digits SART were administered in a random and fixed sequence to 48 cognitively healthy participants. Performance of the neurotypical individuals on the random and fixed Gratings SART was only moderately different from and correlated with performance on the random and fixed Digits SART. As a proof of concept, the SARTs were also administered to 11 cases with acquired brain injury. Performance in the random and fixed variants of both the Gratings SART and Digits SART was sensitive to cognitive impairments of cases with acquired brain injury. In conclusion, the SART with sinusoidal gratings holds promise as a tool to (re-)assess sustained attention in clinical practice. Further research is critical to investigate whether its performance accurately predicts sustained attention in daily life since we failed to find a significant correlation between performance on any of the SARTs and a self-reported measure of sustained attention.
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Affiliation(s)
- Armien Lanssens
- Department of Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Nora Tuts
- Department of Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lies Welkenhuyzen
- Department of Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Centre for Translational Psychological Research, Hospital East-Limburg, Limburg, Belgium
| | - Hella Thielen
- Department of Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Celine R Gillebert
- Department of Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Centre for Translational Psychological Research, Hospital East-Limburg, Limburg, Belgium
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Mukherjee S, Choi SE, Lee ML, Scollard P, Trittschuh EH, Mez J, Saykin AJ, Gibbons LE, Sanders RE, Zaman AF, Teylan MA, Kukull WA, Barnes LL, Bennett DA, Lacroix AZ, Larson EB, Cuccaro M, Mercado S, Dumitrescu L, Hohman TJ, Crane PK. Cognitive domain harmonization and cocalibration in studies of older adults. Neuropsychology 2023; 37:409-423. [PMID: 35925737 PMCID: PMC9898463 DOI: 10.1037/neu0000835] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Studies use different instruments to measure cognitirating cognitive tests permit direct comparisons of individuals across studies and pooling data for joint analyses. METHOD We began our legacy item bank with data from the Adult Changes in Thought study (n = 5,546), the Alzheimer's Disease Neuroimaging Initiative (n = 3,016), the Rush Memory and Aging Project (n = 2,163), and the Religious on such as the Mini-Mental State Examination, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Wechsler Memory Scale, and the Boston Naming Test. CocalibOrders Study (n = 1,456). Our workflow begins with categorizing items administered in each study as indicators of memory, executive functioning, language, visuospatial functioning, or none of these domains. We use confirmatory factor analysis models with data from the most recent visit on the pooled sample across these four studies for cocalibration and derive item parameters for all items. Using these item parameters, we then estimate factor scores along with corresponding standard errors for each domain for each study. We added additional studies to our pipeline as available and focused on thorough consideration of candidate anchor items with identical content and administration methods across studies. RESULTS Prestatistical harmonization steps such qualitative and quantitative assessment of granular cognitive items and evaluating factor structure are important steps when trying to cocalibrate cognitive scores across studies. We have cocalibrated cognitive data and derived scores for four domains for 76,723 individuals across 10 studies. CONCLUSIONS We have implemented a large-scale effort to harmonize and cocalibrate cognitive domain scores across multiple studies of cognitive aging. Scores on the same metric facilitate meta-analyses of cognitive outcomes across studies or the joint analysis of individual data across studies. Our systematic approach allows for cocalibration of additional studies as they become available and our growing item bank enables robust investigation of cognition in the context of aging and dementia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Seo-Eun Choi
- Department of Medicine, The University of Washington
| | | | | | - Emily H. Trittschuh
- Department of Psychiatry and Behavioral Sciences, The University of Washington
- VA Puget Sound Health Care System, Seattle, Washington, United States
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine
| | - Andrew J. Saykin
- Department of Radiology and Imaging Services, Indiana Alzheimer’s Disease Research Center, Indiana University
| | | | | | - Andrew F. Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine
| | - Merilee A. Teylan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington
| | - Walter A. Kukull
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington
- Department of Epidemiology, The University of Washington
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States
| | | | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Michael Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine
| | - Shannon Mercado
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Logan Dumitrescu
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Timothy J. Hohman
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Paul K. Crane
- Department of Medicine, The University of Washington
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Rosso G, Portaluppi C, Teobaldi E, Di Salvo G, Maina G. Assessing Adult ADHD Through Objective Neuropsychological Measures: A Critical Overview. J Atten Disord 2023; 27:786-794. [PMID: 37039121 DOI: 10.1177/10870547231167564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This review examines the role of neuropsychological tests in the diagnostic assessment of adult ADHD, focusing on their ability to discriminate individuals with ADHD from those with other psychiatric conditions. METHOD PubMed, Embase, and PsycINFO were searched for eligible peer-reviewed studies from inception to September 2022. RESULTS Ten studies were included. Among the objective measures analyzed, Continuous Performance Tests were the only capable to reliably distinguish individuals with ADHD from other psychiatric patients, in a combined approach with clinical interview instruments. The other objective tests showed mixed and inconsistent results. CONCLUSION This finding suggest that further studies are needed to develop objective measures more tailored to the core symptoms of ADHD, in order to improve the discriminatory ability of the tests and help the clinicians in the complex differential diagnosis between ADHD and other psychiatric disorders.
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Affiliation(s)
- Gianluca Rosso
- University of Turin, Turin, Italy
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | | | - Gabriele Di Salvo
- University of Turin, Turin, Italy
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
- Regional Coordination Centre for adult ADHD, Orbassano, Turin, Italy
| | - Giuseppe Maina
- University of Turin, Turin, Italy
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
- Regional Coordination Centre for adult ADHD, Orbassano, Turin, Italy
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Szymkowicz SM, Ryan C, Elson DM, Kang H, Taylor WD. Cognitive phenotypes in late-life depression. Int Psychogeriatr 2023; 35:193-205. [PMID: 35766159 PMCID: PMC9797624 DOI: 10.1017/s1041610222000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify cognitive phenotypes in late-life depression (LLD) and describe relationships with sociodemographic and clinical characteristics. DESIGN Observational cohort study. SETTING Baseline data from participants recruited via clinical referrals and community advertisements who enrolled in two separate studies. PARTICIPANTS Non-demented adults with LLD (n = 120; mean age = 66.73 ± 5.35 years) and non-depressed elders (n = 56; mean age = 67.95 ± 6.34 years). MEASUREMENTS All completed a neuropsychological battery, and individual cognitive test scores were standardized across the entire sample without correcting for demographics. Five empirically derived cognitive domain composites were created, and cluster analytic approaches (hierarchical, k-means) were independently conducted to classify cognitive patterns in the depressed cohort only. Baseline sociodemographic and clinical characteristics were then compared across groups. RESULTS A three-cluster solution best reflected the data, including "High Normal" (n = 47), "Reduced Normal" (n = 35), and "Low Executive Function" (n = 37) groups. The "High Normal" group was younger, more educated, predominantly Caucasian, and had fewer vascular risk factors and higher Mini-Mental Status Examination compared to "Low Executive Function" group. No differences were observed on other sociodemographic or clinical characteristics. Exploration of the "High Normal" group found two subgroups that only differed in attention/working memory performance and length of the current depressive episode. CONCLUSIONS Three cognitive phenotypes in LLD were identified that slightly differed in sociodemographic and disease-specific variables, but not in the quality of specific symptoms reported. Future work on these cognitive phenotypes will examine relationships to treatment response, vulnerability to cognitive decline, and neuroimaging markers to help disentangle the heterogeneity seen in this patient population.
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Affiliation(s)
- Sarah M. Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claire Ryan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Damian M. Elson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
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McIntosh RC, Clark US, Cherner M, Cysique LA, Heaton RK, Levin J, Remien RH, Thames A, Moore DJ, Rubin LH. The Evolution of Assessing Central Nervous System Complications in Human Immunodeficiency Virus: Where Do We Go From Here? J Infect Dis 2023; 227:S30-S37. [PMID: 36930636 PMCID: PMC10022716 DOI: 10.1093/infdis/jiac316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
In this fifth decade of the human immunodeficiency virus (HIV) epidemic, central nervous system (CNS) complications including cognitive impairment and mental health remain a burden for people with HIV (PWH) on antiretroviral therapy. Despite the persistence of these complications, which often co-occur, the underlying pathophysiology remains elusive and consequently treatments remain limited. To continue to grow our understanding of the underlying mechanisms of CNS complications among PWH, there is a need to reexamine our current approaches, which are now more than 2 decades old. At the 2021 National Institutes of Health-sponsored meeting on Biotypes of CNS Complications in PWH, the Neurobehavioral Working Group addressed the following: (1) challenges inherent to determining CNS complications; (2) heterogeneity in CNS complications; and (3) problems and solutions for examining integrated biotypes. The review below provides a summary of the main points presented and discussed by the Neurobehavioral Working Group at the meeting.
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Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Lucette A Cysique
- Department of Psychology, University of New South Wales, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, New York, USA
| | - Robert H Remien
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Leah H Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, Epidemiology, and Molecular and Comparative Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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Mancı E, Herold F, Günay E, Güdücü Ç, Müller NG, Bediz CŞ. The Influence of Acute Sprint Interval Training on the Cognitive Performance of Male Basketball Players: An Investigation of Expertise-Related Differences. Int J Environ Res Public Health 2023; 20:4719. [PMID: 36981625 PMCID: PMC10048824 DOI: 10.3390/ijerph20064719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Highly developed cognitive abilities are an important prerequisite for reaching elite athletic levels. This study aimed to investigate the effect of an acute sprint interval training (SIT) session on the cognitive performance of amateur and elite players. Eighteen amateur and ten elite male basketball players were included in this study. They were asked to perform an acute SIT consisting of the Wingate Test (i.e., four bouts of 30 s all-out sprints) on a cycle ergometer, interspersed with 4 min of active recovery. Before and after the acute SIT, three cognitive tests (i.e., Change Detection Test, Timewall Test, Mackworth Clock Test) were performed. Exercise-induced changes in cognitive performance and between-group differences were analyzed. We did not observe significant between-group differences in the performance of any cognitive test at the pretest, but elite basketball players outperformed the amateur players in specific measures of the Change Detection Test and Timewall Test after the acute SIT (p < 0.05). In addition, for the Clock Test, only the elite basketball players' performance improved from pre- to posttest. The current study's findings suggest that male elite basketball players, compared to amateur basketball players, can preserve their cognitive performance after an acute bout of SIT.
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Affiliation(s)
- Egemen Mancı
- Faculty of Sport Science, Dokuz Eylül University, Izmir 35320, Turkey
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany
| | - Erkan Günay
- Faculty of Sport Science, Celal Bayar University, Manisa 45140, Turkey
| | - Çağdaş Güdücü
- Department of Biophysics, Dokuz Eylül University, Izmir 35320, Turkey
| | - Notger G. Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany
| | - Cem Ş. Bediz
- Department of Physiology, University of Kyrenia, Kyrenia 99138, Cyprus
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Duff K, Dixon AM, Embree L, Hoffman JM. Change on the Repeatable Battery for the Assessment of Neuropsychological Status and its relationship to brain amyloid. J Clin Exp Neuropsychol 2023; 45:105-117. [PMID: 37224404 PMCID: PMC10330480 DOI: 10.1080/13803395.2023.2216920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated with commonly used biomarkers of Alzheimer's disease (AD), including brain amyloid plaque density. However, less is known about if changes in the RBANS across time are also related to brain amyloid deposition. The current study sought to expand on prior work by examining the relationship between changes over time on the RBANS and amyloid deposition via positron emission tomography (PET). METHOD One-hundred twenty-six older adults with intact or impaired cognition and daily functioning underwent repeat assessment with the RBANS across nearly 16 months, as well as had a baseline amyloid PET scan. RESULTS In the entire sample, amyloid deposition was significantly related to change on all five Indexes and the Total Scale score of the RBANS, with greater amyloid being associated with worsening cognition. This pattern was also observed in 11 of 12 subtests. CONCLUSIONS Whereas prior studies have identified a relationship between baseline RBANS and amyloid status, the current findings support that changes in the RBANS are also indicative of AD brain pathology, even if these findings are mediated by cognitive status. Although replication in a more diverse sample is needed, these results continue to support the use of the RBANS in AD clinical trials.
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Affiliation(s)
- Kevin Duff
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University
- Center for Alzheimer’s Care, Imaging and Research, Department of Neurology, University of Utah
| | - Ava M. Dixon
- Center for Alzheimer’s Care, Imaging and Research, Department of Neurology, University of Utah
| | - Lindsay Embree
- Center for Alzheimer’s Care, Imaging and Research, Department of Neurology, University of Utah
| | - John M. Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute
- Department of Radiology and Imaging Sciences, University of Utah
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Rao SM, Galioto R, Sokolowski M, Pierce M, Penn L, Sturtevant A, Skugor B, Anstead B, Leverenz JB, Schindler D, Blum D, Alberts JL, Posk L. Cleveland Clinic Cognitive Battery (C3B): Normative, Reliability, and Validation Studies of a Self-Administered Computerized Tool for Screening Cognitive Dysfunction in Primary Care. J Alzheimers Dis 2023; 92:1051-1066. [PMID: 36847000 PMCID: PMC10116145 DOI: 10.3233/jad-220929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND The self-administered iPad-based Cleveland Clinic Cognitive Battery (C3B) was designed specifically for the efficient screening of cognitive functioning of older adults in a primary care setting. OBJECTIVE 1) Generate regression-based norms from healthy participants to enable demographic corrections to facilitate clinical interpretation; 2) estimate test-retest reliability and practice effects; 3) examine ability to discriminate mild cognitive impairment (MCI) from healthy aging; 4) d etermine validity of screening in a distracting clinical environment; and 5) determine completion rates and patient satisfaction in a primary care setting. METHODS Study 1 (S1) recruited a stratified sample of 428 healthy adults, ages 18-89, to generate regression-based equations. S2 assessed 2-week test-retest reliability and practice effects in 30 healthy elders. S3 recruited 30 MCI patients and 30 demographically-matched healthy controls. In S4, 30 healthy elders self-administered the C3B in a distracting environment and in a quiet private room in counterbalanced order. In a demonstration project, 470 consecutive primary care patients were administered the C3B as part of routine clinical care (S5). RESULTS C3B performance was primarily influenced by age, education, and race (S1), had acceptably high test-retest reliability and minimal practice effects (S2), discriminated MCI from healthy controls (S3), was not negatively impacted by a distracting clinical environment (S4), had high completion rates (>92%) and positive ratings from primary care patients (S5). CONCLUSION The C3B is a computerized cognitive screening tool that is reliable, validated, self-administered, and is conducive to integration into a busy primary care clinical workflow for detecting MCI, early Alzheimer's disease, and other related dementias.
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Affiliation(s)
- Stephen M Rao
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Galioto
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Megan Sokolowski
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madelyn Pierce
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Penn
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Sturtevant
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blazenka Skugor
- Twinsburg Family Health and Surgery Center, Internal Medicine and Geriatrics Department, Twinsburg, OH, USA
| | - Brent Anstead
- Family Medicine, Hillcrest Hospital, Cleveland Clinic, Mayfield Heights, OH, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Qr8 Health, Inc., Cleveland, OH, USA
| | | | - Jay L Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lori Posk
- Health and Wellness Center, Cleveland Clinic, Vero Beach, FL, USA
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Pérez-Parra JE, Restrepo-de-Mejía F. The Trail Making Test (part B) is associated with working memory: A concurrent validity study. Appl Neuropsychol Adult 2023:1-9. [PMID: 36706083 DOI: 10.1080/23279095.2023.2171793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The Test Making Test (TMT) was originally created as a distributed attention test. Part B (TMT-B) has been proposed as representative of executive functions as effective problem solving and working memory. This study aimed to explore the validity of the TMT-B as an indicator of working memory in adults. A cross-sectional study was conducted by using linear correlation coefficients between the TMT-B and neuropsychological and electrophysiological tests of working memory. Fifty-six individuals participated, all of which had normal cognitive functioning and were aged between 19 and 55 years old. Results show a significant correlation among the TMT-B scores with all subtests, the overall score of the Corsi Block-Tapping Test, the Working Memory Index of the WAIS-IV (Wechsler Adult Intelligence Scale) (p ≤ .05) and the auditory Event Related Potentials (p < .01) with the N200 and P300 latencies and amplitudes. These findings are preliminary evidence of the validity of the TMT-B for the evaluation of working memory in adults. Additional studies are required to assess the differential validity of the TMT-B in the evaluation of working memory, through comparative correlational analyzes with the results of various neuropsychological tests that assess other cognitive functions.
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Affiliation(s)
- Julio Ernesto Pérez-Parra
- Doctoral Program in Cognitive Sciences, Universidad Autónoma de Manizales, Manizales, Colombia
- Department of Human Movement, Universidad Autónoma de Manizales, Manizales, Colombia
| | - Francia Restrepo-de-Mejía
- Doctoral Program in Cognitive Sciences, Universidad Autónoma de Manizales, Manizales, Colombia
- Department of Basic Biological Sciences, Universidad Autónoma de Manizales, Manizales, Colombia
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Iacono S, Di Stefano V, Costa V, Schirò G, Lupica A, Maggio B, Norata D, Pignolo A, Brighina F, Monastero R. Frequency and Correlates of Mild Cognitive Impairment in Myasthenia Gravis. Brain Sci 2023; 13. [PMID: 36831713 DOI: 10.3390/brainsci13020170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Antibodies against acetylcholine receptors (AChRs) can also target nicotinic AChRs that are present throughout the central nervous system, thus leading to cognitive dysfunctions in patients with myasthenia gravis (MG). However, the presence of cognitive impairment in MG is controversial, and the factors that may influence this risk are almost completely unknown. In this study, the frequency of mild cognitive impairment (MCI) in MG, as well as the clinical, immunological, and behavioral correlates of MCI in MG were evaluated. METHODS A total of 52 patients with MG underwent a comprehensive assessment including motor and functional scales, serological testing, and neuropsychological and behavioral evaluation. RESULTS The frequency of MCI was 53.8%, and the most impaired cognitive domains were, in order, visuoconstructive/visuospatial skills, memory, and attention. After multivariate analysis, only pyridostigmine use was inversely associated with the presence of MCI, while a trend toward a positive association between MCI and disease severity and arms/legs hyposthenia was found. Correlation analyses showed that daily doses of prednisone and azathioprine significantly correlated with depressive symptomatology, while disease severity significantly correlated with depressive symptomatology and sleep disturbance. CONCLUSIONS The presence of MCI is rather frequent in MG and is characterized by multidomain amnestic impairment. Such preliminary data need further confirmation on larger case series.
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Rosales-Lagarde A, Cubero-Rego L, Menéndez-Conde F, Rodríguez-Torres EE, Itzá-Ortiz B, Martínez-Alcalá C, Vázquez-Tagle G, Vázquez-Mendoza E, Eraña Díaz ML. Dissociation of Arousal Index Between REM and NREM Sleep in Elderly Adults with Cognitive Impairment, No Dementia: A Pilot Study. J Alzheimers Dis 2023; 95:477-491. [PMID: 37574730 DOI: 10.3233/jad-230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Sleep disruption in elderly has been associated with an increased risk of cognitive impairment and its transition into Alzheimer's disease (AD). High arousal indices (AIs) during sleep may serve as an early-stage biomarker of cognitive impairment non-dementia (CIND). OBJECTIVE Using full-night polysomnography (PSG), we investigated whether CIND is related to different AIs between NREM and REM sleep stages. METHODS Fourteen older adults voluntarily participated in this population-based study that included Mini-Mental State Examination, Neuropsi battery, Katz Index of Independence in Activities of Daily Living, and single-night PSG. Subjects were divided into two groups (n = 7 each) according to their results in Neuropsi memory and attention subtests: cognitively unimpaired (CU), with normal results; and CIND, with -2.5 standard deviations in memory and/or attention subtests. AIs per hour of sleep during N1, N2, N3, and REM stages were obtained and correlated with Neuropsi total score (NTS). RESULTS AI (REM) was significantly higher in CU group than in CIND group. For the total sample, a positive correlation between AI (REM) and NTS was found (r = 0.68, p = 0.006), which remained significant when controlling for the effect of age and education. In CIND group, the AI (N2) was significantly higher than the AI (REM) . CONCLUSION In CIND older adults, this attenuation of normal arousal mechanisms in REM sleep are dissociated from the relative excess of arousals observed in stage N2. We propose as probable etiology an early hypoactivity at the locus coeruleus noradrenergic system, associated to its early pathological damage, present in the AD continuum.
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Affiliation(s)
- Alejandra Rosales-Lagarde
- CONACyT Chairs, National Council of Science and Technology, Mexico
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico
| | - Lourdes Cubero-Rego
- Neurodevelopmental Research Unit, Institute of Neurobiology, National Autonomous University of Mexico, Campus Juriquilla-Queretaro, Querétaro, México
| | | | | | - Benjamín Itzá-Ortiz
- Mathematics Research Center, Autonomous University of the State of Hidalgo, Mexico
| | - Claudia Martínez-Alcalá
- CONACyT Chairs, National Council of Science and Technology, Mexico
- Institute of Health Sciences, Autonomous University of the State of Hidalgo, Mexico
| | | | | | - Marta L Eraña Díaz
- Center for Research in Engineering and Applied Sciences, Autonomous University of the State of Morelos, Mexico
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Walker WC, O'Neil ME, Ou Z, Pogoda TK, Belanger HG, Scheibel RS, Presson AP, Miles SR, Wilde EA, Tate DF, Troyanskaya M, Pugh MJ, Jak A, Cifu DX. Can mild traumatic brain injury alter cognition chronically? A LIMBIC-CENC multicenter study. Neuropsychology 2023; 37:1-19. [PMID: 36174184 PMCID: PMC10117581 DOI: 10.1037/neu0000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE While outcome from mild traumatic brain injury (mTBI) is generally favorable, concern remains over potential negative long-term effects, including impaired cognition. This study examined the link between cognitive performance and remote mTBIs within the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) multicenter, observational study of Veterans and service members (SMs) with combat exposure. METHOD Baseline data of the participants passing all cognitive performance validity tests (n = 1,310) were used to conduct a cross-sectional analysis. Using multivariable regression models that adjusted for covariates, including age and estimated preexposure intellectual function, positive mTBI history groups, 1-2 lifetime mTBIs (nonrepetitive, n = 614), and 3 + lifetime mTBIs (repetitive; n = 440) were compared to TBI negative controls (n = 256) on each of the seven cognitive domains computed by averaging Z scores of prespecified component tests. Significance levels were adjusted for multiple comparisons. RESULTS Neither of the mTBI positive groups differed from the mTBI negative control group on any of the cognitive domains in multivariable analyses. Findings were also consistently negative across sensitivity analyses (e.g., mTBIs as a continuous variable, number of blast-related mTBIs, or years since the first and last mTBI). CONCLUSIONS Our findings demonstrate that the average veteran or SM who experienced one or more mTBIs does not have postacute objective cognitive deficits due to mTBIs alone. A holistic health care approach including comorbidity assessment is indicated for patients reporting chronic cognitive difficulties after mTBI(s), and strategies for addressing misattribution may be beneficial. Future study is recommended with longitudinal designs to assess within-subjects decline from potential neurodegeneration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research
| | | | | | | | | | | | - David F Tate
- Department of Physical Medicine and Rehabilitation
| | | | - Mary Jo Pugh
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System
| | - Amy Jak
- VA San Diego Healthcare System
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation
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Karjadi C, Xue C, Cordella C, Kiran S, Paschalidis IC, Au R, Kolachalama VB. Fusion of Low-Level Descriptors of Digital Voice Recordings for Dementia Assessment. J Alzheimers Dis 2023; 96:507-514. [PMID: 37840494 PMCID: PMC10657667 DOI: 10.3233/jad-230560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/17/2023]
Abstract
Digital voice recordings can offer affordable, accessible ways to evaluate behavior and function. We assessed how combining different low-level voice descriptors can evaluate cognitive status. Using voice recordings from neuropsychological exams at the Framingham Heart Study, we developed a machine learning framework fusing spectral, prosodic, and sound quality measures early in the training cycle. The model's area under the receiver operating characteristic curve was 0.832 (±0.034) in differentiating persons with dementia from those who had normal cognition. This offers a data-driven framework for analyzing minimally processed voice recordings for cognitive assessment, highlighting the value of digital technologies in disease detection and intervention.
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Affiliation(s)
- Cody Karjadi
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Chonghua Xue
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Swathi Kiran
- Sargent College, Boston University, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Ioannis Ch. Paschalidis
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
- Departments of Electrical & Computer Engineering, Systems Engineering and Biomedical Engineering, Boston University, Boston, MA, USA
| | - Rhoda Au
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University, Boston, MA, USA
- Department of Computer Science, Boston University, Boston, MA, USA
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Howard RS, Goldberg TE, Luo J, Munoz C, Schneider LS. Reliability of the NACC Telephone-administered Neuropsychological Battery (T-cog) and Montreal Cognitive Assessment for participants in the USC ADRC. Alzheimers Dement (Amst) 2023; 15:e12406. [PMID: 36911358 PMCID: PMC9994164 DOI: 10.1002/dad2.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 03/10/2023]
Abstract
Introduction Restrictions during the COVID-19 pandemic necessitated remote administration of neuropsychological testing. We assessed the test-retest reliability for a telephone-administered cognitive battery, recommended for use in the National Institute on Aging Alzheimer's Disease Research Center (ADRC). Methods 64 participants in the University of Southern California ADRC clinical core underwent repeat telephone evaluation using the T-cog Neuropsychological Battery. Reliability was measured by intraclass correlation coefficient (ICC) for continuous variables and weighted Kappa coefficient for categorical variables. Mean scores for Montreal Cognitive Assessment (MoCA) total and Craft Story 21 Immediate and Delayed Recall were compared using paired t tests. Results Mean age was 74.8 (8.3 standard deviation); 73.4% were female. ICCs ranged from 0.52 to 0.84, indicating moderate test-retest reliability except for number span backward, which showed poor reliability. Weighted Kappa for MoCA items ranged from -0.016 to 0.734; however, relatively good observed agreement was seen across all items (70.3% to 98.4%). Although MoCA total scores did not significantly change, Craft Story 21 Immediate and Delayed Recall mean scores increased between first and second administrations (P < 0.0001). Discussion Test-retest reliability for the T-cog Neuropsychological Battery is adequate. The variation seen in testing is similar to results seen from face-to-face testing, with Craft Story 21 recall showing modest and expected practice effects. Highlights Moderate test-retest reliability is seen in most measures of the National Alzheimer's Coordinating Center Neuropsychological Test Battery and the Montreal Cognitive Assessment (MoCA).Intraclass correlation coefficients ranged from 0.52 to 0.84, except for number Span backward.Weighted Kappa for MoCA items varied, but good observed agreement was seen.MoCA total mean score did not change significantly between administrations.Craft Story 21 Immediate and Delayed Recall means increased on repeat testing (P < 0.0001).
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Affiliation(s)
| | - Terry E. Goldberg
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - James Luo
- Keck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Cynthia Munoz
- Keck School of Medicine of USCLos AngelesCaliforniaUSA
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Simons MU, Nelson LD, McCrea MA, Balsis S, Hoelzle JB, Magnus BE. Linking Rivermead Post Concussion Symptoms Questionnaire (RPQ) and Sport Concussion Assessment Tool (SCAT) scores with item response theory. J Int Neuropsychol Soc 2022;:1-8. [PMID: 36325632 DOI: 10.1017/S1355617722000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite the public health burden of traumatic brain injury (TBI) across broader society, most TBI studies have been isolated to a distinct subpopulation. The TBI research literature is fragmented further because often studies of distinct populations have used different assessment procedures and instruments. Addressing calls to harmonize the literature will require tools to link data collected from different instruments that measure the same construct, such as civilian mild traumatic brain injury (mTBI) and sports concussion symptom inventories. METHOD We used item response theory (IRT) to link scores from the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and the Sport Concussion Assessment Tool (SCAT) symptom checklist, widely used instruments for assessing civilian and sport-related mTBI symptoms, respectively. The sample included data from n = 397 patients who suffered a sports-related concussion, civilian mTBI, orthopedic injury control, or non-athlete control and completed the SCAT and/or RPQ. RESULTS The results of several analyses supported sufficient unidimensionality to treat the RPQ + SCAT combined item set as measuring a single construct. Fixed-parameter IRT was used to create a cross-walk table that maps RPQ total scores to SCAT symptom severity scores. Linked and observed scores were highly correlated (r = .92). Standard errors of the IRT scores were slightly higher for civilian mTBI patients and orthopedic controls, particularly for RPQ scores linked from the SCAT. CONCLUSION By linking the RPQ to the SCAT we facilitated efforts to effectively combine samples and harmonize data relating to mTBI.
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Cullum CM, Galusha JM, Wadsworth HE, Wilmoth K, Hynan LS, Lacritz LH, LoBue C, Argueta-Ortiz F. Southwestern Assessment of Processing Speed (SWAPS): A new brief test with demographically-corrected norms in an ethnically and educationally diverse population. Clin Neuropsychol 2022; 36:2260-2277. [PMID: 34554056 DOI: 10.1080/13854046.2021.1970229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective. Neuropsychological measures of processing speed have long been used as sensitive indices of cognitive functioning. Most of these commonly used tests are proprietary, and there is a need for brief, freely available tools that can be used in diverse clinical and research settings. The Southwestern Assessment of Processing Speed (SWAPS) is a 60-second digit-symbol transcription task developed as a brief alternative to commercially available coding tests. Demographically-corrected normative data are presented along with reliability and sensitivity/specificity values in older adults with and without cognitive impairment.Method. SWAPS data from 915 healthy aging individuals (NC) and 858 subjects with clinical diagnoses of mild cognitive impairment (MCI; n = 430) and Alzheimer's disease clinical syndrome (ADCS; n = 428) were obtained from the Texas Alzheimer's Research and Care Consortium (TARCC). TARCC participants represent ethnically and educationally diverse community-dwelling individuals age 50+.Results. SWAPS scores showed the expected associations with age, sex, and education, and the interaction between age and education were significant predictors of SWAPS scores. Test-retest reliability in NC was good, and the SWAPS distinguished impaired and non-impaired groups with adequate to excellent sensitivity and specificity for the primary analyses, with optimal cut-off points provided. Raw score- to uncorrected normalized T-scores and demographically-corrected SWAPS T-scores using regression-based norms are presented along with scoring programs for the calculation of each.Conclusions. The SWAPS is a brief, free, easily administered test with demographically-corrected regression-based norms and promising utility for detection of cognitive impairment and efficient assessment of processing speed.
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Affiliation(s)
- C Munro Cullum
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeanine M Galusha
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hannah E Wadsworth
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kristin Wilmoth
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laura H Lacritz
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Francisco Argueta-Ortiz
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ratcliff R, McKoon G. Can neuropsychological testing be improved with model-based approaches? Trends Cogn Sci 2022; 26:899-901. [PMID: 36153231 DOI: 10.1016/j.tics.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023]
Abstract
There has been little impact of cognitive psychology and modeling on neuropsychological testing for over 50 years. There is also a disconnect between those tests and the constructs they are said to measure. We discuss studies at the interface between testing and modeling that illustrate the opportunity for advances.
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Abstract
The Color Trails Test (CTT) is a pencil-and-paper (P&P) neuropsychological test. The CTT is divided into two parts that assess sustained visual attention (Trails A) and divided attention (Trails B). The CTT can also be performed in a virtual reality setting (VR-CTT) introducing a wider spatial range of targets. In cases of multiple assessments, repeating the same CTT configuration can bias the results due to fatigue and learning effects. The aim of this study is to create five different short versions of the VR-CTT. The different forms were created by rotating or flipping the original targets spatial layout on one of the axes and by ending it at ball #13. Healthy young participants (N = 15) performed the shortened VR-CTT forms (in a counterbalanced order), the P&P CTT and the original VR-CTT. We found no difference between the completion times of the five forms (p > 0.2), and a significant difference between Trails A and B across all forms (p < 0.04). Additionally, there was no evidence of a learning effect between trials (p > 0.4). Moreover, the shortened VR-CTT forms showed correlations with the P&P CTT (p < 0.05) and with the original VR-CTT (p < 0.06). These findings suggest that all five forms have an equal level of difficulty and that the different forms managed to mitigate the learning effects reported for repeated testing of the same spatial layout. This opens the possibility of applying the shortened VR-CTT forms for research settings and sets the basis for developing it into a clinical diagnostics tool.
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Affiliation(s)
- Noam Galor
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Meytal Wilf
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Sicard V, Stephenson DD, Hergert DC, Dodd AB, Robertson-Benta CR, Reddy SP, Yeates KO, Cromer JA, Meier TB, Campbell RA, Phillips JP, Sapien RE, Mayer AR. Investigating the diagnostic accuracy of a paper-and-pencil and a computerized cognitive test battery for pediatric mild traumatic brain injury. Neuropsychology 2022; 36:565-577. [PMID: 35377682 PMCID: PMC9900695 DOI: 10.1037/neu0000803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This study assessed classification accuracy of paper-and-pencil and computerized cognitive batteries at subacute (SA; 1-11 days) and early chronic (EC; ∼4 months) phases of pediatric mild traumatic brain injury (pmTBI). Two statistical approaches focused on single-subject performance (individual task scores, total impairments) were used to maximize clinical utility. METHOD Two hundred thirty-five pmTBI and 169 healthy controls (HC) participants aged 8-18 were enrolled, with a subset (190 pmTBI; 160 HC) returning for the EC visit. The paper-and-pencil battery included several neuropsychological tests selected from recommended common data elements, whereas computerized testing was performed with the Cogstate Brief Battery. Hierarchical logistic regressions (base model: Parental education and premorbid reading abilities; full model: Base model and cognitive testing variables) were used to examine sensitivity/specificity, with diagnosis as the dependent variable. RESULTS Number Sequencing and Cogstate One-Card Learning accuracy significantly predicted SA diagnosis (full model accuracy = 71.6%-71.7%, sensitivity = 80.6%-80.8%, specificity = 59.1%-59.6%), while only immediate recall was significant at EC visit (accuracy = 68.5%, sensitivity = 74.6%, specificity = 61.5%). Other measures (Letter Fluency, Cogstate Detection, and One-Card Learning accuracy) demonstrated higher proportions of impairment for pmTBI subacutely (pmTBI: 11.5%-19.8%; HC: 3.7%-6.1%) but did not improve classification accuracy. Evidence of multiple impairments across the entire testing battery significantly predicted diagnosis at both visits (full model accuracy = 66.2%-68.6%, sensitivity = 71.2%-78.9%, specificity = 54.3%-61.5%). CONCLUSIONS Current results suggest similar modest diagnostic accuracy for computerized and paper-and-pencil batteries across multiple pmTBI phases. Moreover, findings suggest the total number of impairments may be more clinically useful than any single test or cognitive domain in terms of diagnostic accuracy at both assessment points. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Veronik Sicard
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - David D. Stephenson
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Danielle C. Hergert
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Andrew B. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | | | | | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jason A. Cromer
- Child Study Center, Yale University, New Haven, CT, USA
- Cogstate Ltd, New Haven, CT, USA
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard A. Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - John P. Phillips
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Robert E. Sapien
- Department of Emergency Medicine University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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Benge JF, Artz J, Kiselica A. The ecological validity of the Uniform Data Set 3.0 neuropsychological battery in individuals with mild cognitive impairment and dementia. Clin Neuropsychol 2022; 36:1453-1470. [PMID: 33103615 PMCID: PMC8071839 DOI: 10.1080/13854046.2020.1837246] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Ecological validity refers to the ability of neuropsychological measures to predict real world performance. Questions remain as to the ecological validity of commonly used measures, particularly regarding their relationships to global versus specific activities of daily living among those with neurodegenerative disease. We explored these issues through the lens of the Uniform Data Set 3.0 Neuropsychological battery (UDS3NB) in individuals with mild cognitive impairment and dementia. Method: UDS3NB and informant rated Functional Activities Questionnaire scales were evaluated from 2,253 individuals with mild cognitive impairment and dementia. Ordinal regression equations were used to explore the relationships of demographic and cognitive variables with overall and specific instrumental activities of daily living. Results: Delayed recall for visual and verbal material, and performance on trail making tests were consistent predictors of global and specific functions. Specific skills (i.e. naming or figure copy) showed differential relationships with specific activities, while phonemic fluency was not related to any particular activity. Conclusions: Measures in the UDS3NB predicted activities of daily living in individuals with MCI and dementia, providing initial support for the ecological validity of these tests. Specifically, measures that tap core deficits of Alzheimer's disease, such as delayed recall and sequencing/shifting, are consistent predictors of performance in daily tasks.
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Affiliation(s)
- Jared F. Benge
- Department of Neurology, Baylor Scott and White Health, Temple, TX
- Plummer Movement Disorder Center, BSWH Health, Temple, TX
- Texas A&M College of Medicine, Temple, TX
| | | | - Andrew Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO
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Hirsch O, Fuermaier ABM, Tucha O, Albrecht B, Chavanon ML, Christiansen H. Symptom and performance validity in samples of adults at clinical evaluation of ADHD: a replication study using machine learning algorithms. J Clin Exp Neuropsychol 2022; 44:171-184. [PMID: 35906728 DOI: 10.1080/13803395.2022.2105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Research has shown non-trivial base rates of noncredible symptom report and performance in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. The goal of this study is to estimate and replicate base rates of symptom and performance validity test failure in the clinical evaluation of adult ADHD and derive prediction models based on routine clinical measures. METHODS This study reuses data of a previous publication of 196 adults seeking ADHD assessment and replicates the findings on an independent sample of 700 adults recruited in the same referral context. Measures of symptom and performance validity (one SVT, two PVTs) were applied to estimate base rates. Prediction models were developed using machine learning. RESULTS Both samples showed substantial rates of noncredible symptom report (one SVT failure: 35.7% - 36.6%), noncredible test performance (one PVT failure: 32.1% - 49.3%; two PVT failures: 18.9% - 27.3%), or both (each one SVT and PVT failure: 13.3% - 22.4%; one SVT and two PVT failures: 9.7% - 13.7%). Machine learning algorithms resulted in generally moderate to weak prediction models, with advantages of the reused sample compared to the independent replication sample. Associations between measures of symptom and performance validity were negligible to small. CONCLUSIONS This study highlights the necessity to include measures of symptom and performance validity in the clinical evaluation of adult ADHD. Further, this study demonstrates the difficulty to characterize the group failing symptom or performance validity assessment.
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Affiliation(s)
- Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, Germany
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany.,Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
| | - Björn Albrecht
- Department of Psychology, Clinical Child and Adolescent Psychology/Philipps University Marburg, Marburg, Germany
| | - Mira-Lynn Chavanon
- Department of Psychology, Clinical Child and Adolescent Psychology/Philipps University Marburg, Marburg, Germany
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology/Philipps University Marburg, Marburg, Germany
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Murphy P, Williams F, Davagnanam I, Chan E, Murphy E, Hughes D, Quattrocchi G, Werring DJ, Lachman RH, Cipolotti L. Cognitive dysfunction and white matter hyperintensities in Fabry disease. J Inherit Metab Dis 2022; 45:782-795. [PMID: 34994980 DOI: 10.1002/jimd.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/02/2021] [Accepted: 12/30/2021] [Indexed: 11/08/2022]
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder with multi-system involvement including cerebrovascular disease. Patients with FD also have a high risk of ischaemic stroke and TIA. White matter hyperintensities are common, but their clinical impact on cognition remains uncertain. Previous studies have examined the neuropsychological profile of FD, but have been inconclusive in part due to methodological limitations including small sample sizes. We sought to address these limitations in a case-control study of 26 patients with Fabry disease with mild to moderate disease symptoms matched with 18 healthy controls for age and premorbid intellectual level. We obtained detailed neuropsychological data and MRI neuroimaging data on the severity of white matter changes. Mood was accounted for as a possible confounder. Our results showed significant compromise of executive functions and information processing speed for the FD group. Error analyses suggested that the compromise of executive functions could not be entirely accounted for by slowed information processing speed. We demonstrated significant correlations between cognitive decline and the overall volume of white matter hyperintensities in the FD group. Our results point to significant compromise of cognition in FD even without stroke or mood difficulties. This suggests that neuropsychological assessment and rehabilitation should be routinely offered to patients with FD.
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Affiliation(s)
- Patrick Murphy
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Fay Williams
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- West Kent and Medway Neuropsychiatry Service, Kent, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Derralynn Hughes
- Institute of Immunity & Transplantation, Royal Free Hospital, London, UK
| | - Gabriella Quattrocchi
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, London, UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Robin H Lachman
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
OBJECTIVE To test the hypothesis that striatal dopamine function influences motivational alterations in Parkinson disease (PD), we compared vesicular monoamine transporter 2 (VMAT2) and dopamine transporter (DaT) imaging data in PD patients with impulse control disorders (ICDs), apathy, or neither. METHODS We extracted striatal binding ratios (SBR) from VMAT2 PET imaging (18F-AV133) and DaTscans from the Parkinson's Progression Markers Initiative (PPMI) multicenter observational study. Apathy and ICDs were assessed using the Movement Disorders Society-revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP), respectively. We used analysis of variance (ANOVA) and log-linear mixed-effects (LME) regression to model SBRs with neurobehavioral metrics. RESULTS Among 23 participants (mean age 62.7 years, mean disease duration 1.8 years) with VMAT2 imaging data, 5 had apathy, 5 had an ICD, and 13 had neither. ANOVA indicated strong groupwise differences in VMAT2 binding in right anterior putamen [F(2,20) = 16.2, p < 0.0001), right posterior putamen [F(2,20) = 16.9, p < 0.0001), and right caudate [F(2,20) = 6.8, p = 0.006)]. Post-hoc tests and repeated-measures analysis with LME regression also supported right striatal VMAT2 elevation in the ICD group and reduction in the apathy group relative to the group with neither ICD nor apathy. DaT did not exhibit similar correlations, but normalizing VMAT2 with DaT SBR strengthened bidirectional correlations with ICD (high VMAT2/DaT) and apathy (low VMAT2/DaT) in all striatal regions bilaterally. CONCLUSIONS Our findings constitute preliminary evidence that striatal presynaptic dopaminergic function helps describe the neurobiological basis of motivational dysregulation in PD, from high in ICDs to low in apathy.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A Mills
- Department of Neurology, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kate Perepezko
- Department of Mental Health, 25802Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health, Baltimore, MD, USA
| | - Gregory M Pontone
- Department of Psychiatry, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
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