Intelligence or years of education: which is better correlated with memory function in normal elderly Japanese subjects?

Background: We compared differences in intelligence and memory function between normal elderly Japanese subjects with more years of education and those with fewer years of education. We also investigated clinical and neuropsychological factors that are strongly correlated with memory function. Methods: There were 118 normal elderly subjects who underwent the Mini‐Mental State Examination, Wechsler Adult Intelligence Scale, 3rd edition (WAIS‐III), and Wechsler Memory Scale Revised. Subjects with at least 13 years of education were categorized as the H group, and those with 12 years of education or less were categorized as the L group. Results: Age and Mini‐Mental State Examination scores were not significantly different between the two groups. On the WAIS‐III, there were significant differences between the two groups in Verbal IQ and Full Scale IQ. On the Wechsler Memory Scale Revised, there were significant differences between the two groups in Visual Memory, General Memory, and Delayed Recall. Correlation coefficients between memory function and the other factors demonstrated significant but weak correlations between years of education and General Memory (R = 0.22) and between years of education and Delayed Recall (R = 0.20). Strong correlations were found between Verbal IQ and Verbal Memory (R = 0.45), between Verbal IQ and General Memory (R = 0.49), between Full Scale IQ and General Memory (R = 0.50) and between Full Scale IQ and Delayed Recall (R = 0.48). Conclusions: In normal elderly Japanese subjects, years of education weakly correlated with memory function while Verbal IQ, Full Scale IQ and Verbal Comprehension on WAIS‐III had stronger correlations with memory function. Verbal IQ and Verbal Comprehension on WAIS‐III were found to be insusceptible to the cognitive decline characteristic of Alzheimer's disease or amnestic mild cognitive impairment. Therefore, verbal intelligence, as measured by Verbal IQ and Verbal Comprehension, may be the most useful factor for inferring premorbid memory function in Alzheimer's disease or amnestic mild cognitive impairment patients.     

Central nervous system abnormalities in asymptomatic young patients with Sbeta-thalassemia

Twenty-one children and young adults with sickle/beta-thalassemia without overt stroke were examined with magnetic resonance imaging and angiography (MRA), transcranial Doppler (TCD), visual (VEP) and median nerve somatosensory (SEP)-evoked potential recordings, and neuropsychological testing (Wechsler Intelligence Scale [WISC-III]). Eight (38%) had silent infarction in the parietooccipital cortex, deep white matter, or basal ganglia, including two of three with previous seizures. Of 17 undergoing TCD, none had maximum middle cerebral artery (MCA) velocities greater than 126cm/sec, but 9 were abnormal, with low velocities and difficulty in tracking the MCA and/or asymmetry. Three patients had abnormal MRA, one of whom also had silent infarction. One patient had pathological VEP recordings, whereas all SEP recordings were normal. WISC-III was performed in all 11 children, 4 with silent infarction: all but 1 had IQ scores greater than 85 (mean, 97.7; standard deviation, 14.2). We conclude that Greek children and young adults with Sbeta-thalassemia and no history of clinical stroke have TCD abnormalities and silent infarction similar to those reported in children and adolescents with sickle cell anemia, but cognitive function is not necessarily compromised. International collaboration is needed to establish the risk factors for central nervous system sequelae in patients with sickle cell disease, including Sbeta-thalassemia, leading to evidence-based prevention.     

Cognitive profile in childhood myotonic dystrophy type 1: Is there a global impairment?

The objective of this study was to assess the cognitive profile in the childhood-onset form of myotonic dystrophy (DM1). We carried out a general cognitive abilities study on 36 patients (6-18 years). Results of Full Scale IQ , VIQ (Verbal IQ) and PIQ (Performance IQ) measures are discussed in terms of global cognitive impairment depending on the (CTG)n repeat size and the transmitting parent's sex. The results highlighted a negative correlation between the CTG repeat size and cognitive function: (1) 55% of the subjects (20/34) presented large CTG expansion (mean=761) correlated with significant extensive cognitive deficits (mean Full Scale IQ=56) in both intelligence scales (verbal and non-verbal); most of them exhibited DM1 maternal transmission. (2) In the case of smaller expansion (mean=527), 38% of the subjects exhibited a subnormal intelligence (mean Full Scale IQ=86) but performed poorly on subtests evaluating attention/memory function and presented a severe deficit in visuospatial and/or visuo-constructive skills. Most of these children had paternal transmission but a few had an affected mother.     

Cognitive deficits in children with sickle cell disease

We tested a hypothesis that children with sickle cell disease who are completely normal by magnetic resonance imaging can still be cognitively impaired, as predicted by a model of diffuse brain injury. Fifty-four patients with hemoglobin SS (average age 10.9 years +/- 2.9 years SD) were examined with the Wechsler Intelligence Scale for Children-III (WISC-III) and were randomly matched by age, race, and gender with healthy children from the Wechsler normative database. Patients were also imaged at 1.5 Tesla with standard imaging sequences. Among 30 patients who were normal by magnetic resonance imaging, there were substantial deficits in Wechsler Full-Scale IQ, Verbal IQ, and Performance IQ (all P < .01) compared with African-American controls. The patient Wechsler Full-Scale IQ was 12.9 points lower than that of controls and decreased as a function of age (probability = .014). The findings suggest that there is diffuse brain injury in patients and that patient deficits increase with age.     

Lesion burden and cognitive morbidity in children with sickle cell disease

The effect of increased tissue injury in children with sickle cell disease and silent cerebral infarcts is not known. We determined the relationship between the extent of injury and IQ scores in children with silent cerebral infarcts. Participants were 27 children with sickle cell disease who had received magnetic resonance imaging (MRI). Children were divided into three groups: group 1, small lesion volume (n = 9, < 6.8 cm3); group 2, large lesion volume (n = 9; > 6.8 cm3); and group 3, no cerebral infarcts (n = 9). The Wechsler Full-Scale IQ was significantly lower for group 2 (mean = 76.1) when compared with group 1 (mean = 87.7) or group 3 (mean = 89.9). In children with silent cerebral infarcts, large tissue loss is associated with lower Wechsler Full-Scale IQ and small tissue loss is associated with no apparent change in IQ compared with children with no cerebral infarcts. The progressive accumulation of silent infarcts may lead to poorer intellectual functioning.     

The use of word-reading to estimate "premorbid" ability in cognitive domains other than intelligence.

Diagnostic neuropsychological assessment requires the clinician to estimate a patient's premorbid abilities. Word reading tests, such as the National Adult Reading Test-Revised (NART-R), provide reasonably accurate estimates of premorbid IQ, but their capacity to benchmark other premorbid cognitive abilities remains unclear. In this extension of an earlier report, we administered the NART-R, an abbreviated Wechsler Adult Intelligence Scale (WAIS-R or WAIS-III), and 26 other cognitive measures to 322 reasonably healthy adults. While NART-R performance correlated robustly (rs > or = .72) with concurrent Verbal and Full Scale IQ, its correlation with all other cognitive measures was significantly lower. Thus, while it is appealing to use word reading as a proxy for premorbid functioning in other cognitive domains, the NART-R has limited utility for this because it does not predict current performance on other cognitive tests as well as it predicts IQ in healthy adults.     

Decreased corpus callosum size in sickle cell disease: relationship with cerebral infarcts and cognitive functioning.

We assessed midsagittal corpus callosum size in sickle cell disease (SCD) and its relationship to lesion volume, lesion location, and cognitive functioning. Twenty-eight children with SCD and 16 demographic controls completed magnetic resonance imaging (MRI) and neuropsychological testing. Corpus callosum (CC) size was smaller for children with silent infarcts (n = 8) or overt stroke (n = 8) than for those without visible infarcts (n = 12) or control participants. Lesion volume was a robust predictor of IQ and other cognitive scores; total CC size did not typically add explanatory power for these measures. The size of the rostral body of the CC, however, independently predicted measures of distractibility, speeded production, and working memory. Posterior CC size was also decreased among many of the children with SCD, even in the absence of visible infarcts in this region. Brain morphology appears to provide additional information about SCD-related effects on the brain above and beyond visible infarcts.     

Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale (WAIS-RC) in a brain-damaged sample

We factor analyzed the Chinese revision of the Wechsler Adult Intelligence Scale (WAIS-RC) in a sample of 59 individuals with medically diagnosed brain damage. The Chinese subjects consisted of 42 males and 17 females with means for Verbal. Performance, and Full Scale IQ of 83.88 (SD = 22.11), 75.49 (SD = 20.63), and 78.42 (SD = 21.97), respectively. Clear support was found for a general intelligence factor (g) and the Full Scale IQ. Similarly, the two-factor solution provided support for Wechsler's (1981) Verbal and Performance IQ designations. The three-factor solution revealed the familiar Verbal-Comprehension and Perceptual-Organization factors. However, the Freedom From Distractibility factor was less clearly defined. Comparisons of Chinese and American factor structures for neurologically impaired persons demonstrated high coefficients of congruence, ranging from .93 to .98. Overall, the findings demonstrated substantial congruence cross culturally for Chinese and American brain-damaged samples and suggest that the WAIS-RC measures essentially the same constructs as the WAIS-R.     

Radiographic predictors of neurocognitive functioning in pediatric Sickle Cell disease

We compared magnetic resonance imaging (MRI), magnetic resonance angiography, and transcranial Doppler ultrasonography as predictors of specific neurocognitive functions in children with sickle cell disease. Participants were 27 children with sickle cell anemia (hemoglobin SS) who were participants in the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and had no documented history of stroke. Children's MRIs were classified as normal or silent infarct, and their magnetic resonance angiograms were classified as normal or abnormal. The highest time-averaged mean flow velocity on transcranial Doppler ultrasonographic examination of the major cerebral arteries was analyzed. Age and hematocrit also were analyzed as predictor variables. The battery of neurocognitive tests included measures of intellectual functioning, academic achievement, attention, memory, visual-motor integration, and executive functions. MRI, magnetic resonance angiography, transcranial Doppler ultrasonography, age, and hematocrit were analyzed as predictors of participants' performance on the various measures of neurocognitive functioning. Age and hematocrit were robust predictors of a number of global and specific neurocognitive functions. When age and hematocrit were controlled, transcranial Doppler ultrasonography was a significantly unique predictor of verbal memory. We found an association between low hemoglobin and neurocognitive impairment. We also found that abnormalities on transcranial Doppler ultrasonography can herald subtle neurocognitive deficits. (J Child Neurol 2006;21:37-44).     

Reduced severity of strokes in patients with silent brain infarctions

Background: Silent brain infarctions (SBIs), leukoaraiosis (LA), and microbleeds (MBs) are ischaemic silent radiologic abnormalities that act as predictors of subsequent strokes. This study investigated the independent effect of silent radiologic abnormalities on initial stroke severity and short‐term outcome. Methods: A consecutive series of patients who had their first ischaemic stroke within 72 h of symptom onset were included. Demographic and clinical characteristics were collected on admission, and magnetic resonance imaging was performed to evaluate the ischaemic lesion, SBI, LA, and MB. Factors potentially associated with lower initial stroke severity (admission NIH Stroke Scale 0–5) and good short‐term outcome (discharge NIH Stroke Scale 0–5, modified Rankin Scale 0–1) were validated by multivariate analysis. Results: Silent brain infarctions were noted in 82 (45%) of the 182 patients. Although there were no statistically significant differences in stroke subtypes and lesion location, univariate analysis revealed that patients with SBI had reduced stroke severity (P = 0.005) and infarction volume (P = 0.001). After adjusting for covariates, the presence of SBI was independently associated with lower stroke severity and good short‐term outcome when the NIH Stroke Scale was used as dependent variable (OR 3.368, 95% CI 1.361–8.332, P = 0.009; OR 3.459, 95% CI 1.227–9.755, P = 0.019, respectively). However, the presence of SBI lost significance when the discharge‐modified Rankin Scale was used as dependent variable (P = 0.058). Conclusion: Amongst silent radiologic abnormalities, SBI was the only predictor of reduced stroke severity and infarct volume. Silent brain infarction deserves more attention in evaluating stroke severity.     

Development and preliminary validation of a Satz-Mogel short form of the WAIS-III in a sample of persons with substance abuse disorders.

We developed a Satz-Mogel short form of the WAIS-III and evaluated its accuracy for predicting IQs of 50 men with substance abuse disorders. Means for age, education, and Full Scale IQ were 44.20 years (SD = 7.23), 12.82years (SD = 1.53), and 98.06 (SD = 11.93). Correlations between the forms were significant for the 11 subtests (all rs> or =.79) and three IQs (all rs> or =.93). Short form estimated Verbal, Performance, and Full scale IQs were within +/-6 points of the WAIS-III 92% 80% and 90% of the time. The abbreviation may be used to estimate general intelligence, but interpretation of short-form-based IQ discrepancies should be avoided. The short form detected reliable WAIS-III Verbal-Performance IQ discrepancies only 67% of the time.     

Subtle brain abnormalities in children with sickle cell disease: relationship to blood hematocrit

Our objective was to test a hypothesis that subtle brain abnormality can be present in pediatric sickle cell disease (SCD) patients who are clinically free of stroke. We prospectively compared 50 patients with 52 healthy age-similar controls, using quantitative magnetic resonance imaging. A previously validated precise and accurate inversion-recovery method was used to measure T1 in a slice at the basal ganglia. We also used the Wechsler test to measure intelligence quotient (IQ) in a randomly selected subset of 27 patients. Brain T1 was significantly lower in patients in every gray matter structure evaluated but in none of the white matter structures. Regression suggests that T1 in caudate, nucleus pulvinares, and cerebral cortex was abnormal by age 4 years. Psychometric testing showed that 33% of patients were functioning in the range of mild mental deficiency (IQ, 50-70), compared with a published prevalence of 1.45% in inner-city black children. Thus, in our patients, SCD was associated with a 23-fold increase in the risk of mild mental deficiency. Full-scale IQ of SCD patients was a function of hematocrit (Hct), and when Hct was used to stratify patients, those with an Hct of less than 27% had significantly lower psychometric test scores, and significantly lower gray matter T1, than those with an Hct of 27 or more. Both cognitive deficits and subtle T1 abnormalities were associated with a low Hct, and both could be present when conventional magnetic resonance imaging findings were normal. Our findings suggest that chronic hypoxia of brain tissue can occur in SCD patients free of clinical stroke.     

Need for cognitive rehabilitation for children with sickle cell disease and strokes

Stroke is a significant cause of morbidity among children with sickle cell disease (SCD). Approximately 30% of children with sickle cell anemia will have either an overt stroke or silent infarct (an injury to the brain that does not have any focal neurological findings or a history of focal neurological deficits). Despite the strong association between stroke and cognitive deficits and poor educational attainment, few interventions have been developed to address this vulnerable population of children. A cognitive rehabilitation program was piloted to improve the memory and educational achievement of children with sickle cell disease and stroke. While the intervention was feasible, additional research is needed to establish efficacy. Ongoing studies are designed to improve the cognitive impairment for children with SCD and stroke. The health and educational systems will need to work as partners to improve the cognitive and educational outcomes of these children after they suffer from stroke.     

Surgical versus medical treatment for severe epilepsy: consequences for intellectual functioning in children and adults. A follow-up study.

We compared the effects of medical and combined surgical and medical treatment of refractory epilepsy on intellectual functioning in a group of children (n=13) and a group of adults (n=15).The patients were tested with the age-appropriate versions of Wechsler's intelligence scales twice prior to and once after epilepsy surgery. There were no significant differences between the groups in preoperative epilepsy-related variables, including age at onset. The IQ scores were submitted to two-way analyses of variance (ANOVA). We also evaluated individual changes in IQ scores.Adult patients maintained stable levels of performance after drug treatment as well as following surgery, while children declined in Full Scale IQ after both kinds of treatment. Children also declined in Performance IQ, but not in Verbal IQ after drug treatment, and in Verbal IQ, but not in Performance IQ after surgery. Three of six children who underwent a significant decline in Full Scale IQ before surgery did not show any further decline postoperatively.We have proposed a developmental model to account for the different findings in children and adults, and conclude tentatively that refractory, long-standing epilepsy may interfere with intellectual development both during drug treatment and following combined surgical and medical treatment in children, while the impact of long-standing refractory epilepsy of similar severity as in children is not strong enough to reduce intellectual performance in adults, irrespective of treatment modality.     

后循环缺血性卒中与认知障碍相关性研究

目的 探究后循环缺血性卒中与认知障碍发生的关系。 方法 连续选取2013年11月至2014年11月浙江大学医学院附属第一医院及嘉兴市第二医院收治的急 性后循环缺血性卒中患者67例,收集患者人口学、影像学及认知功能评价资料,并通过磁共振成像 统计梗死部位;通过简明精神状态量表、阿尔兹海默病评定量表认知分量表、临床痴呆量表评估认 知功能;根据认知诊断标准同时结合认知功能评价结果,将患者分为认知功能正常组、血管性轻度 认知障碍组、血管性痴呆组。 结果 67例患者中,认知功能正常32例（47.8%）、血管性轻度认知障碍20例（29.9%）,血 管性痴呆15例（2 2.4%）。通过校正年龄、性别、汉密尔顿抑郁评分等因素后,多因素回归分 析显示：颞枕叶缺血性卒中［比值比（odd ratio,OR）75.89,95%可信区间（confidence interval, C I ）3.92～1 470.06）］增加认知障碍发生风险,脑桥缺血性卒中患者发生认知障碍的风险比 非脑桥缺血性卒中降低90%（OR 0.10,95%CI 0.02～0.60）;进一步分析显示,颞枕叶缺血性卒 中（OR 542.24,95%CI 7.85～37 481.44）增加轻度认知障碍发生风险;小脑缺血性卒中（OR 12.49, 95%CI 1.03～151.58）增加血管性痴呆发生风险。 结论 50%以上后循环缺血性卒中患者发生认知障碍;其中颞枕叶及小脑缺血性卒中增加认知障碍 发生风险,脑桥缺血性卒中与认知障碍发生无显著相关性。     

Accuracy of the seven subtest WAIS-R short form in chronic schizophrenia.

The accuracy of the WAIS-R seven subtest short form (Ward, L.C., 1990. Prediction of Verbal, Performance and Full Scale IQs from seven subtests of the WAIS-R. J. Clin. Psychol. 46, 436-440) was examined for predicting IQs of 73 inpatients diagnosed with schizophrenia. Results indicated that 93% of the estimated Full Scale IQs were within +/-5 points of their actual scores. Using Wechsler's (1981) seven category intelligence classification, the level of agreement on the Full Scale IQ was 84% for the standard WAIS-R and the seven subtest short form. This abbreviated Wechsler Scale may be used with schizophrenic patients when only general estimates of intellectual functioning are required.     

Practice effects on the WAIS-III across 3- and 6-month intervals

Fifty-one participants (age M = 24.6; education M = 14.4 years) were administered the Wechsler Adult Intelligence Scale - Third Edition (WAIS-III) at baseline and at an interval of either 3 or 6 months later. Full Scale IQ (FSIQ), Verbal IQ (VIQ), Performance IQ (PIQ), Verbal Comprehension Index (VCI), Perceptual Organization Index (POI), and Processing Speed Index (PSI) scores improved significantly across time, whereas no significant change occurred on the Working Memory Index. Specifically, test scores increased approximately 3, 11, 6, 4, 8, and 7 points, respectively on the VIQ, PIQ, FSIQ, VCI, POI, and PSI for both groups. Notably, the degree of improvement was similar regardless of whether the inter-test interval was 3 or 6 months. These findings suggest that prior exposure to the WAIS-III yields considerable increases in test scores. Reliable change indices indicated that large confidence intervals might be expected. As such, users of the WAIS-III should interpret reevaluations across these intervals cautiously.     

Practice Effects on the WAIS-III Across 3- and 6-Month Intervals

Fifty-one participants (age M = 24.6; education M = 14.4 years) were administered the Wechsler Adult Intelligence Scale – Third Edition (WAIS-III) at baseline and at an interval of either 3 or 6 months later. Full Scale IQ (FSIQ), Verbal IQ (VIQ), Performance IQ (PIQ), Verbal Comprehension Index (VCI), Perceptual Organization Index (POI), and Processing Speed Index (PSI) scores improved significantly across time, whereas no significant change occurred on the Working Memory Index. Specifically, test scores increased approximately 3, 11, 6, 4, 8, and 7 points, respectively on the VIQ, PIQ, FSIQ, VCI, POI, and PSI for both groups. Notably, the degree of improvement was similar regardless of whether the inter-test interval was 3 or 6 months. These findings suggest that prior exposure to the WAIS-III yields considerable increases in test scores. Reliable change indices indicated that large confidence intervals might be expected. As such, users of the WAIS-III should interpret reevaluations across these intervals cautiously.     

Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings

BACKGROUND: There are few long-term follow-up studies of patients with lacunar infarcts (LIs). The purpose of this 5-year follow-up study was to assess functional and cognitive outcome in relation to MRI findings. METHODS: 81 patients with a first-ever LI were followed for 5 years with respect to mortality, stroke recurrence, functional and cognitive outcome. T(2)-weighted MRI was performed at baseline and at 5 years. The presence of basal ganglia lesions and white matter lesions was scored according to the European Task Force rating scale. Functional outcome was assessed with the Oxford Handicap Scale (OHP). Cognition was assessed with the Mini Mental State Examination (MMSE). RESULTS: The 5-year mortality was 19%. Predictors for death were age (OR = 1.07, 95% CI 1.03-1.11), ischemic heart disease (OR = 2.1, 95% CI 1.1-4.1) and impairment score (OR = 1.16, 95% CI 1.02-1.32). 30% of the patients had a recurrent stroke. Predictors for recurrent stroke were diabetes mellitus (OR = 1.7, 95% CI 1.2-7.4) and amount of white matter lesions (OR = 1.7, 95% CI 1.2-2.7). 36% of the patients were functionally dependent (defined as OHP >2). Predictors for functional dependency were impairment score (OR = 1.71, 95% CI 1.12-2.59), MMSE (OR = 0.55, 95% CI 0.33-0.91) and stroke recurrence (OR = 84, 95% CI 9.4-745). 16% of the patients had cognitive impairment (defined as MMSE <24). Stroke recurrence and white matter score, but not basal ganglia score, were correlated to cognitive impairment. CONCLUSIONS: Many LI patients have a good functional outcome at 5 years. For older patients, for patients with an initial severe stroke, and with additional vascular risk factors, however, the prognosis is more severe, with an increased risk for mortality, stroke recurrence, and physical and cognitive decline.     

Wisc/Wisc-r comparisons in a learning-disabled population: Equivalence of summary IQ measures

Abstract

Learning-disabled children referred for neuropsychological evaluation were administered either the WISC or WISC-R in order to determine the comparability of the two tests. The results indicated no significant differences between WISC and WISC-R with respect to Verbal IQ, Performance IQ, and Full Scale IQ. Examination of groups of children exhibiting various patterns of Reading, Spelling, and Arithmetic performances on the Wide Range Achievement Test also yielded nonsignificant differences between WISC and WISC-R Verbal, Performance, and Full Scale IQs. These results suggest that the summary IQ scores of these two tests are equivalent for this population.