Cortical thickness is linked to executive functioning in adulthood and aging

Executive functions that are dependent upon the frontal-parietal network decline considerably during the course of normal aging. To delineate neuroanatomical correlates of age-related executive impairment, we investigated the relation between cortical thickness and executive functioning in 73 younger (20-32 years) and 56 older (60-71 years) healthy adults. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). Cortical thickness was measured at each location of the cortical mantle using surface-based segmentation procedures on high-resolution T1-weighted magnetic resonance images. For regions involved in WCST performance, such as the lateral prefrontal and parietal cortices, we found that thicker cortex was related to higher accuracy. Follow-up ROI-based analyses revealed that these associations were stronger in older than in younger adults. Moreover, among older adults, high and low performers differed in cortical thickness within regions generally linked to WCST performance. Our results indicate that the structural cortical correlates of executive functioning largely overlap with previously identified functional patterns. We conclude that structural preservation of relevant brain regions is associated with higher levels of executive performance in old age, and underscore the need to consider the heterogeneity of brain aging in relation to cognitive functioning.     

Cognition and communication dysfunctions in early-onset schizophrenia: Effect of risperidone

Background

Cognitive impairment and formal thought disorder, also referred to as communication disturbances, are considered the core symptoms of schizophrenia, strongly affecting social functioning and long-term outcome. Several studies in adult patients suggest improvement of both functions after the treatment with atypical antipsychotic drugs. Such medications are also used as first line treatment in early-onset schizophrenia, however their efficacy in cognitive and communication domains in this population have not been systematically assessed.

Aim of the study

Evaluation of risperidone efficacy at psychopathological symptoms, cognitive impairment and formal thought disorder in adolescents with schizophrenia spectrum diagnosis.

Material and method

Psychopathological symptoms, cognitive functioning and formal thought disorder were evaluated in 32 hospitalized adolescent patients with schizophrenia spectrum diagnosis at the beginning of risperidone treatment and after clinical improvement and compared to the results of matched healthy control group.

Results

Risperidone treatment was associated with reduction of symptom severity and moderate improvement of formal thought disorder and some aspects of executive functions. Working memory and verbal fluency were not improved. There were few correlations between psychopathological symptoms and results of cognitive tests, mainly between negative symptoms and executive functions.

Discussion

In early-onset schizophrenia spectrum disorders atypical antipsychotic treatment is associated with alleviation of symptoms and only selective and moderate cognitive and communication improvement.     

Neurocognitive dysfunction in strategic and non-strategic gamblers

Objective

It has been theorized that there may be subtypes of pathological gambling, particularly in relation to the main type of gambling activities undertaken. Whether or not putative pathological gambling subtypes differ in terms of their clinical and cognitive profiles has received little attention.

Method

Subjects meeting DSM-IV criteria for pathological gambling were grouped into two categories of preferred forms of gambling — strategic (e.g., cards, dice, sports betting, stock market) and non-strategic (e.g., slots, video poker, pull tabs). Groups were compared on clinical characteristics (gambling severity, and time and money spent gambling), psychiatric comorbidity, and neurocognitive tests assessing motor impulsivity and cognitive flexibility.

Results

Seventy-seven subjects were included in this sample (45.5% females; mean age: 42.7 ± 14.9) which consisted of the following groups: strategic (n = 22; 28.6%) and non-strategic (n = 55; 71.4%). Non-strategic gamblers were significantly more likely to be older, female, and divorced. Money spent gambling did not differ significantly between groups although one measure of gambling severity reflected more severe problems for strategic gamblers. Strategic and non-strategic gamblers did not differ in terms of cognitive function; both groups showed impairments in cognitive flexibility and inhibitory control relative to matched healthy volunteers.

Conclusion

These preliminary results suggest that preferred form of gambling may be associated with specific clinical characteristics but are not dissociable in terms of cognitive inflexibility and motor impulsivity.     

A proton magnetic resonance spectroscopy study in schizoaffective disorder: Comparison of bipolar disorder and schziophrenia

The aim of this study was to compare schizoaffective disorder, bipolar disorder and schizophrenia based on (1)H-MRS metabolite values in dorsolateral prefrontal cortex and executive functions. The subjects comprised 15 patients with bipolar disorder type I (BD), 15 with schizophrenia (SCH), 15 with schizoaffective disorder (SAD) and 15 healthy controls. We performed proton magnetic resonance spectroscopy ((1)H-MRS) of the dorsolateral prefrontal cortex (DLPFC) bilaterally. Levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho) and creatine-containing compounds (Cr) were measured in the DLPFC using (1)H-MRS. We administered the Wisconsin Card Sorting Test (WCST) and the Stroop Test (ST) to evaluate executive functions. The SAD, BD and SCH patients had lower levels of NAA than the control group. The SAD and BD patients had low levels of Cho compared to the control group. The left DLPFC Cr levels in all of the patient groups and the right DLPFC Cr levels in the BD and SAD groups were lower than in the control group. The levels of NAA Cho and Cr were not related to executive functions and attention performance. Cr level were related to attention processes, only in SCH. Our results indicate that NAA levels are reduced in schizoaffective disorder, bipolar disorder and schizophrenia, but the reduction in the levels of NAA is not a distinctive feature among these three illnesses. Schizoaffective and bipolar disorders have similar features related to the levels of compounds containing Cho and Cr. This similarity may be related to these illnesses both having an affective basis.     

齐拉西酮与碳酸锂对躁狂发作患者疗效及认知功能的影响

目的 探讨齐拉西酮与碳酸锂对躁狂发作患者疗效及对认知功能的影响.方法 将127例躁狂发作患者随机分为两组,分别口服齐拉西酮、碳酸锂治疗,观察12周.于治疗前后采用Bech-Rafaelsen躁狂量表评定临床疗效,成套神经心理测查工具评定认知功能,副反应量表评定不良反应.结果 治疗4周末起两组Bech-Rafaelsen躁狂量表总分均较治疗前显著降低（P＜0.05或0.01）.研究组治疗4周末起、对照组治疗8周末起敲击测验、动作能力测验、手功能协调测验、威斯康星卡片分类测验完成类别数、智能检测等结果显示患者的认知功能均有显著改善（P＜0.05或0.01）,治疗12周末研究组显著优于对照组（P＜0.05或0.01）.研究组副反应量表评分及不良反应发生率显著低于对照组（P＜0.05或0.01）.结论 齐拉西酮与碳酸锂治疗躁狂发作疗效显著且相当,但齐拉西酮对认知功能改善更好,安全性更高.     

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目的探讨中国文化背景下汉族注意缺陷多动障碍(ADHD)儿童在威斯康星卡片分类测验(WCST)中的反应特征。方法对2003-04—2004-03在中山大学附属三院儿童发育行为中心确诊的汉族ADHD儿童57例和63例正常儿童,采用修订版WCST进行了测试分析。结果WCST的13个指标中ADHD组儿童有7个指标成绩都显著比正常对照组儿童差(P<0·05,P<0·01)。ADHD儿童与正常儿童在WCST中持续性错误数(RPE)分别为(26·84±10·87)与(22·83±10·35),P<0·05,总错误数(RE)分别为(57·58±18·06)与(49·33±18·55),P<0·05,持续性反应数(RP)分别为(30·39±13·88)与(25·49±12·68),P<0·05,完成总应答数(RA)分别为(127·60±1·77)与(122·86±11·04),P<0·01,完成分类数(CC)分别为(2·86±1·46)与(3·78±1·81),P<0·01,正确应答数百分比(RCP)分别为(54·96±14·00)与(60·50±13·38),P<0·05,概念化水平(RFP)分别为(40·80±17·61)与(47·77±17·72),P<0·05。控制年龄的偏相关分析显示症状、诊断都分别与WCST的多个指标相关,其中完成分类数(CC)与症状、诊断均相关。结论汉族ADHD儿童的认知功能、认知转移能力、抽象概括能力、概念形成的洞察力不足。推测汉族ADHD儿童可能存在额叶功能缺陷。WCST可以考虑作为ADHD临床诊断的参考测验,其中较稳定的指标是完成分类数。     

精神分裂症患者威斯康星测试的对照研究

目的：探讨精神分裂症患者认知障碍的情况。方法：对99例符合CCMD-3精神分裂症诊断标准的精神分裂症病人和38例正常人实施威斯康星卡片分类测试（WCST），并对其中28例经过8周抗精神病药物治疗的患者进行治疗前后对比，观察BPRS评分与WCST变化情况。结果：精神分裂症患者WCST的总测验次数，持续错误数和随机错误数与年龄、BPRS总分正相关（P〈0．01），正确数和分类数与年龄、BPRS评分成负相关（P〈0.05）；WCST两组间在性别及文化程度上差异无显著性，对28例患者治疗前后比较，显示WCST随病情的好转而改善。而治疗前后WCST的总测验次数，持续错误数，随机错误数的减分率与BPRS减分率正相关（P〈0．05）。结论：精神分裂症患者存在认知功能损害。     

海洛因依赖者认知功能损害的对照研究

目的　采用威斯康星 (Wisconsin)卡片分类测验评估海洛因依赖者与正常人群的认知差异。方法　对完成脱瘾治疗的 4 8例海洛因依赖者和 4 2例正常人进行Wisconsin卡片分类测验评定。结果　两组间总应答数、完成分类数、正确应答百分数、错误应答数、持续应答数、持续性错误数、概念化应答百分数和完成第一类所需应答数的比较显示 ,海洛因依赖组较正常人组差 (P <0 0 1)。相关因素分析显示 ,吸毒时间及日吸毒量与认知功能损害程度呈正相关 (r分别为 0 4 1～ 0 4 7和 0 35～ 0 4 2 ;P <0 0 5 )。结论　海洛因依赖者存在认知功能损害     

拉科酰胺对难治性癫痫患者认知功能和生活质量的影响

目的探讨拉科酰胺作为抗癫痫辅助用药对难治性癫痫患者认知功能和生活质量的影响。方法收集2013年6月至2015年6月我院年龄18~75岁的80例难治性癫痫患者,随机分为辅以拉科酰胺干预组(干预组)及安慰剂对照组(对照组),并对患者进行10个月随访。干预前后对患者认知功能及生活质量进行评估。结果干预组10个月后的MMSE(Mini-mental state examination,简易精神状态检查)评分及WCST(Wisconsin Card Sorting Test,威斯康辛卡片分类测验)结果均优于对照组,差异有统计学意义(P<0.05)。干预组治疗后患者QOLIE-31总分、对发作的担忧、认知功能及综合生活质量评分均较治疗前增高(P<0.05),且高于对照组(P<0.05)。结论拉科酰胺不引起癫痫患者认知功能减退,且能改善患者主诉的生活质量。     

A systematic review of evidence for the role of inflammatory biomarkers in bipolar patients

Bipolar disorder (BD) is a neuropsychiatric disorder that is characterized by a phasic course of affective episodes interspersed with a euthymic state. Epidemiological, clinical, genetic, post-mortem and preclinical studies have shown that inflammatory reactions and immune modulation play a pivotal role in the pathophysiology of BD. It is conceptualized that biomarkers of inflammation and immune responses should be employed to monitor the disease process in bipolar patients. The objective of this systematic review is to analyse the inflammatory markers involved in human studies and to explore each individual marker for its potential clinical application and summarize evidence regarding their role in BD. A systematic review of human studies to measure inflammatory markers was conducted, and the studies were identified by searching PubMed/MEDLINE, PsycINFO, EMBASE, and Web of Science databases for peer-reviewed journals that were published until September 2015. In this review, we included peripheral markers, genetic, post-mortem and cell studies with inflammatory biomarker analysis in BD. One hundred and two (102) papers met the inclusion criteria. The pro-inflammatory cytokines were elevated and the anti-inflammatory cytokines were reduced in BD patients, particularly during manic and depressive phases when compared to the controls. These changes tend to disappear in euthymia, indicating that inflammation may be associated with acute phases of BD. Even though there are promising findings in this field, further clinical studies using more established detection techniques are needed to clearly show the benefit of using inflammatory markers in the diagnosis, follow-up and prognosis of patients with BD.