Trauma-related deficits in working memory

Introduction. The aim of the study was to evaluate trauma-related impairments of working memory in psychiatric outpatients, and the mediating role of processing speed, anxiety and depression in the cognitive decrements. Methods. This research applied a comprehensive assessment protocol including an evaluation of psychopathological and neuropsychological functioning in psychiatric outpatients. Patients with trauma history (n = 33) were compared to patients without such a history (n = 30). We collected information regarding age, gender, culture level, profession level, alcohol abuse, anxiety, and depression symptoms. Working memory and speed processing were assessed with standardised neuropsychological instruments. Data analysis was accomplished using parametric statistics, and a hierarchical multiple regression model was used to regress working memory performance scores against the trauma variable, anxiety-depression scores, and speed processing. Results. The groups differed by gender, not by age, education level, socioeconomic status and alcohol abuse. Analysis of cognitive data revealed specific trauma-related deficits in working memory. Moreover, the trauma-exposed subjects scored higher on anxiety/depression scales, and lower on processing speed tests. The regression revealed significant impairment in working memory partially mediated by speed processing, but not by anxiety or depression. Conclusions. These findings confirmed the trauma-related impairments in working memory and the paramount importance for these impairments of reduced processing speed rather than emotional factors.     

Neuropsychological functioning in HIV-positive African-American women with a history of drug use.

This preliminary investigation examined neuropsychological performance in a sample of human immunodeficiency virus (HIV)-positive and HIV-negative African-American women with a history of drug use. The study population was comprised of 10 HIV-negative, 9 asymptomatic HIV-positive, 13 symptomatic HIV-positive, and 10 acquired immunodeficiency virus (AIDS) patients. A neuropsychological battery designed to assess attention, psychomotor processing, verbal memory, and visual memory was administered to participants. No evidence of HIV-related cognitive impairment was found in patients in the early stages of HIV infection. Multivariate analyses of variance revealed significant deficits in psychomotor processing and verbal recall in persons with AIDS. These individuals showed greater difficulty in tasks requiring maintained attention and performed poorly on measures of immediate and delayed verbal recall. In contrast, HIV status was not related to visual memory, verbal recognition, or the number of errors made during a verbal recall task. The pattern of cognitive deficits observed in persons with AIDS resembles that commonly associated with subcortical pathology. The cognitive deficits observed were not related to depression or recentness of drug use.     

Neuropsychological characteristics of three subgroups of Flemish delinquent adolescents

Sixty-three adjudicated adolescents, aged 14-17 years, were followed for 2 years to examine the neuropsychological characteristics of subgroups of delinquents. Nonrecidivistic subjects (n = 29) and late recidivistic subjects (n = 22) differed from early recidivistic subjects (n = 12) on intelligence, self-control functioning, and memory. Late recidivistic subjects, compared with not recidivistic subjects, showed a lower verbal IQ. The differences remained when controlling for the level of substance abuse. This study suggests that neuropsychological assessment may help in differentiating delinquent adolescents, although more research is needed to unravel the mediating influences of substance abuse and early neuropsychological and academic problems.     

Morphometric and psychometric comparisons between non-substance-abusing patients with posttraumatic stress disorder and normal controls

BACKGROUND: Hippocampal decrease in size in response to posttraumatic stress disorder (PTSD) is still a subject of controversy. The aims of this study were to: (1) confirm previous hippocampus findings in PTSD patients compared to controls, using ethnically similar study groups where alcohol and drug abuse were non-existent; (2) test influence of disease duration as well as depression scores on possible morphological changes; (3) test whether the voxel-based morphometry (VBM) data confirm the group differences seen in the region of interest (ROI) analysis, and (4) test the associations between the cognitive test scores and the morphological changes. METHODS: VBM and ROI-based analysis were applied in 23 patients and 17 healthy controls. Culture-neutral cognitive tests were used. RESULTS: The ROI-based method showed significantly decreased gray matter volumes for global hippocampal volume, as in a separate analysis of left and right sides in the PTSD group. Total volume of the hippocampus was significantly decreased on the left side, as in the global assessment. A multiple regression VBM model showed significant voxel clusters for group affiliation in the right hippocampus, modelling lowering of gray matter associated with the PTSD group. Disease duration was shown to be negatively correlated to bilateral hippocampal volume and high depression score to bilateral gray matter parahippocampal volume. No significant correlations were found between hippocampal or parahippocampal volumes and cognitive functions. CONCLUSION: The present and previous studies showed that morphologic differences do not appear to be due to drug or alcohol abuse. The VBM data partially confirm the group differences seen in the ROI-based method in the medial temporal lobe. The fact that the significantly lower score on the short-term memory test in the PTSD group is not correlated to hippocampal volume may suggest a more general basis for such memory impairment.     

Cognitive complaints,depression, medical symptoms,and their association with neuropsychological functioning in HIV infection: a structural equation model analysis

The main objective of this study was to use structural equation modeling (SEM) to clarify the relationship between subjective cognitive complaints and neuropsychological functioning in 160 adults with HIV infection. Participants completed questionnaires assessing cognitive complaints, symptoms of depression, and HIV-related medical symptoms. Neuropsychological tests included measures of attention, verbal fluency, psychomotor skills, learning, memory, and executive skills. SEM was used to test models of the relationships among cognitive complaints, mood, and medical symptoms with neuropsychological functioning. The model indicated that although depressed mood (beta = 0.32, p < .01) and medical symptoms (beta = 0.31, p < .01) influenced cognitive complaints, cognitive complaints were independently associated with poorer neuropsychological performance (beta = 0.39, p < .01). Mood and medical symptoms were significantly correlated but were not significantly associated with neuropsychological skills.     

Blood pressure regulation, cognition, and depression in response to orthostatic challenge in African American children: an initial investigation

Poor blood pressure regulation (BPR) in response to orthostasis could contribute to cerebral hypoperfusion and cell damage. The authors of this study examined neuropsychological function and mood in relation to BPR following orthostatic challenge in African American children, aged 6 to 9 years. Participants (N = 33) laid supine for 5 minutes, before having their BP taken. Participants then stood and had BP measured again at 1, 3, and 5 minutes. After a rest, the authors administrated neuropsychological and depression tests while the participants were seated. The authors calculated the difference between supine and 1-minute standing systolic blood pressure (SBP) and pulse pressure (PP) scores. In response to orthostatic challenge, smaller increases in SBP were predictive of decreased verbal memory whereas smaller increases in PP were associated with increased depressive symptomatology and poor prospective memory. In conclusion, less effective BPR was associated with increased depression and poor performance on some neuropsychological tests.     

Verbal memory and aspects of attentional control in children and adolescents with anxiety disorders or depressive disorders

BACKGROUND: The aim was to examine basic performance on attention and memory tasks in treatment-naive children and adolescents with anxiety disorder or depressive disorder and in healthy subjects under drug-free conditions. METHODS: Basic neurocognitive performance on attention and verbal memory tasks was examined in children and adolescents with emotional disorders, between 6 and 17 years of age. A total of 34 children with an anxiety disorder, 31 children with a depressive disorder, and 33 healthy controls were assessed with a comprehensive neuropsychological test battery. All children were treatment-naive at the time of testing. Five different computerised attention tasks and the Rey Auditory-Verbal Learning Test were administered. RESULTS: A significant effect of diagnosis was found for verbal memory but not for attention. LIMITATIONS: The large age range and inclusion of different diagnoses resulted in rather inhomogeneous groups. CONCLUSION: The present study provided evidence for an undisturbed attentional performance in both patient groups and a dissociation in memory functioning between anxious and depressed children. Memory impairment was found to be specifically associated with childhood depression.     

Brain injury in battered women

The goals of the present study were to examine (a) whether battered women in a sample of both shelter and nonshelter women are sustaining brain injuries from their partners and (b) if so, whether such brain injuries are associated with partner abuse severity, cognitive functioning, or psychopathology. Ninety-nine battered women were assessed using neuropsychological, psychopathology, and abuse history measures. Almost three quarters of the sample sustained at least 1 partner-related brain injury and half sustained multiple partner-related brain injuries. Further, in a subset of women (n = 57), brain injury severity was negatively associated with measures of memory, learning, and cognitive flexibility and was positively associated with partner abuse severity, general distress, anhedonic depression, worry, anxious arousal, and posttraumatic stress disorder symptomatology.     

The neuropsychological phenotype of velocardiofacial syndrome (VCFS): relationship to psychopathology.

Children with velocardiofacial syndrome (VCFS; N=14) and a comparison group of siblings (N=8) underwent comprehensive neuropsychological assessment to examine the relationship between cognitive functioning and psychopathology. Significant group differences were obtained on tests of full scale and verbal intellectual functioning and perceptual-motor skills. With the exception of performance on tests of attention and executive functioning, children with VCFS displayed a profile consistent with nonverbal learning disability (NLD). However, within group comparisons revealed significantly poorer visuospatial intellectual and nonverbal memory functioning in sibling controls as well. No significant group differences were obtained on tests of motor speed, academic, language, attention, memory, or executive functioning, with significant variability in children with VCFS frequently accounting for the lack of robust differences. Parent-report measures revealed profiles consistent with ADHD. No clinically significant symptoms of psychosis, depression or anxiety were noted on either self- or parent-report measures. Wisconsin Card Sorting Test performance was found to be highly and negatively correlated with the Thought Problems subscale of the Child Behavior Checklist (CBCL) for VCFS children only, suggesting a possible at-risk indicator for later onset psychopathology.     

Cognitive functioning in a population-based sample of young adults with a history of non-psychotic unipolar depressive disorders without psychiatric comorbidity

BACKGROUND: There is evidence for cognitive dysfunction in unipolar depression among middle-aged and elderly patients, but cognitive functioning among depressed young adults has scarcely been systematically investigated. The aims of the present study were to examine cognitive functioning among depressed young adults identified from the general population and to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity and age at onset. METHODS: Performance in verbal and visual short-term memory, verbal long-term memory and learning, attention, processing speed, and executive functioning was compared between a population-based sample of 21-35-year-olds with a lifetime history of non-psychotic unipolar depressive disorders without psychiatric comorbidity (n=68) and healthy controls derived from the same population (n=70). RESULTS: Depressed young adults were not found to be impaired in any of the assessed cognitive functions, except for some suggestion of mildly compromised verbal learning. Nevertheless, younger age at depression onset was associated with more impaired executive functioning. LIMITATIONS: The results may slightly underestimate of the true association between depression and cognitive impairments in the young adult population due to possible dropout of participants. Additionally, the problem of multiple testing was not entirely corrected. CONCLUSION: The findings from this study indicate that a lifetime history of non-psychotic unipolar depressive disorders among young adults without psychiatric comorbidity may be associated only with minimal cognitive deficits, even when some residual depressive symptoms are prevalent. However, early-onset depression may represent a more severe form of the disorder, associated with more cognitive dysfunction.     

Discriminating neuropsychological sequelae of head injury from alcohol-ABUSE-induced deficits: A review and analysis

Alcohol abuse is linked strongly with neuropsychological deficits that may resemble deficits seen in head-injured individuals. Heavy daily drinking appears more damaging than episodic abusive consumption. Cognitive deficits associated with alcohol include abstraction, perceptuospatial, and problem- solving skills. Verbal abilities are spared. For alcoholics younger than 40, abstinence is associated with improved functioning. For those over 40, deficits may be permanent. Intelligence tests are unlikely to pick up alcohol-induced deficits. Points for neuropsychologists to consider in differentiating between head injury and alcohol-induced deficits include abstinence from drinking prior to testing, intactness of remote memory and verbal functions, and changes in tolerance for alcohol.     

A distinctive interaction between memory and chronic daytime somnolence in asymptomatic APOE e4 homozygotes

STUDY OBJECTIVES: To correlate memory measures with a trait measure of chronic daytime somnolence in cognitively normal individuals with different gene doses of the apolipoprotein E (APOE) e4 allele, a common Alzheimer's disease susceptibility gene. DESIGN: Cross-sectional, exploratory study of cognitive abilities in APOE e4 homozygotes (HMZ) (n=42), heterozygotes (HTZ), (n=42) and noncarriers (NC) (n=42) who are matched for age, gender, educational level, and family history of dementia. SETTING: Tertiary care academic medical center. PARTICIPANTS: Cognitively normal residents of Maricopa County, Arizona who are 30-70 years of age, genotyped for APOE, and have no history of a sleep disorder INTERVENTIONS: N/A. MEASUREMENTS: Epworth Sleepiness Scale (ESS) and a battery of neuropsychological tests RESULTS: Age, education, gender, and insomnia complaints did not significantly differ among groups. Despite normal baseline memory scores, memory declined with increasing ESS on all eight memory measures in the HMZ, two of eight in the HTZ, and one of eight in the NC. Differences between HMZ and NC on the slope of memory decline with increasing ESS reached statistical significance on two verbal memory measures, AVLT Long-Term Memory (p=0.048) and Percent Delayed Recall (p=0.035). CONCLUSIONS: Chronic daytime somnolence is associated with a distinctive decline in verbal memory in cognitively normal APOE e4 HMZ, a group at particularly high risk of Alzheimer's disease. Additional studies are needed to confirm these exploratory findings and to determine the effects of acute somnolence on cognition in these genetic subgroups.     

Hormone levels and cognitive function in postmenopausal midlife women

Gonadal hormones may influence cognitive function. Postmenopausal midlife women in the population-based Melbourne Women's Midlife Health Project cohort were administered a comprehensive battery of neuropsychological tests on two occasions 2 years apart. Participants (n = 148, mean age 60 years) had undergone natural menopause and were not using hormone therapy. Estrone, total and free estradiol, and total and free testosterone levels were measured at time of the first testing. Principal-component analysis identified four cognitive factors. In multiple linear regression analyses, better semantic memory performance was associated with higher total (p = 0.02) and free (p = 0.03) estradiol levels and a lower ratio of testosterone to estradiol (p = 0.007). There were trends for associations between better verbal episodic memory and lower total testosterone (p = 0.08) and lower testosterone/estradiol ratio (p = 0.06). Lower free testosterone levels were associated with greater 2-year improvement on verbal episodic memory (p = 0.04); higher testosterone/estradiol predicted greater semantic memory improvement (p = 0.03). In postmenopausal midlife women, endogenous estradiol and testosterone levels and the testosterone/estradiol ratio are associated with semantic memory and verbal episodic memory abilities.     

Cognitive profiles of mild cognitive impairment with and without vascular disease

This study examined whether the cognitive profile of subjects with mild cognitive impairment (MCI) with vascular disease differs from that of MCI subjects with no vascular disease. Consecutive MCI subjects with vascular disease (n=60) and matched MCI subjects with no vascular disease (n=60) were included in the study and were compared with healthy control subjects (n=60). The neuropsychological assessment comprised tests of speed and attention, episodic memory, visuospatial function, language, and executive function. Control subjects performed significantly better than did both MCI groups on the neuropsychological battery. MCI subjects with no vascular disease performed better overall than did MCI subjects with vascular disease, most clearly on tests of speed and attention, visuospatial function, and executive function. MCI subjects with and without vascular disease exhibited differences, both in terms of overall performance and of cognitive profiles. These differences can be largely explained by deficits in speed and attention and in executive function of the MCI subjects with vascular disease.     

Depression and neuropsychological test performance in acute spinal cord injury patients: lack of correlation.

Factors which have been causally related to neuropsychological deficits in acute spinal cord injury (SCI) patients include advanced age, limited educational level, acute traumatic brain injury, alcohol and/or substance abuse. Concomitant depression may impair motivation, prolong reaction time, and produce fatigue during neuropsychological testing, resulting in impaired performance. To test the hypothesis that abnormal neuropsychologic test results may be associated with depression, the Zung Self-Rating Depression Scale (ZUNG) and a comprehensive, predominantly motor-free neuropsychological test battery were administered to 66 acute SCI patients approximately 8 weeks following injury. Spinal cord injury groups were dichotomized based on their ZUNG scores. Comparison of neuropsychological test scores between SCI groups failed to demonstrate any impairment in neuropsychological performance, within the limits of the test battery administered, suggesting that cognitive performance in this sample of acute SCI patients may not be influenced by the presence of depression.     

Cognitive function in late versus early postmenopausal stage

OBJECTIVES: There are relatively few studies of cognitive performance in the first few postmenopausal years and insufficient data on whether there is differential decline in different cognitive abilities. The aim of the present analysis was to determine the nature of cognitive decline across a range of functions within a period of 5 years from early to late postmenopausal stage. METHODS: In a cross-sectional study, 189 postmenopausal women, who had experienced a natural menopause, were not taking hormonal medication and had not done so in the previous 12 months, were divided according to their postmenopausal stage into early (stage +1, < or =5 years since the last menstrual period, aged 55.4+/-0.3 years, n=80), or late (stage +2, >5 years since the last menstrual period, aged 59.8+/-0.4 years, n=109) postmenopausal stages. Participants completed a comprehensive battery of tests measuring attention, episodic and semantic memory, planning and mental flexibility. Participants also completed self-ratings of mood, sleepiness and menopausal symptoms. RESULTS: There were no differences between the groups in their performance in tests of attention, verbal fluency or memory. However, in the two tests of executive function (planning and mental flexibility) the women in the late postmenopausal stage performed significantly worse than the women in the early postmenopausal stage. These differences remained significant when effects of age and IQ were taken into account by analyses of covariance. There were no differences between the groups in their ratings of mood or of habitual sleepiness, or of feeling sleepy at the start of testing. However, by the end of testing the women in the late postmenopausal stage rated themselves as feeling sleepier than did the women in the early postmenopausal stage. The group differences in executive function remained significant when these differences in sleepiness were accounted for. CONCLUSIONS: Although there were no differences in attention, verbal fluency and memory, executive function was significantly poorer in the late postmenopausal stage women, suggesting that this aspect of cognition deteriorates more rapidly than other functions. This change was independent of change in age, suggesting that hormonal changes between the early and late postmenopausal stages may be responsible.     

Disturbances in selective information processing associated with the BDNF Val66Met polymorphism: evidence from cognition, the P300 and fronto-hippocampal systems

In this study, we examined whether the Met allele of the BDNF Val66Met polymorphism is associated with selective disruptions to task-relevant information processing. In 475 non-clinical participants for whom BDNF genotype status was determined we used the 'IntegNeuro' computerized battery of neuropsychological tests to assess cognitive performance, an auditory oddball task to elicit the P300 event-related potential (ERP) and, in smaller subsets of these subjects, high resolution structural MRI imaging to quantify fronto-hippocampal grey matter (n=161), and functional magnetic resonance imaging to assess fronto-hippocampal BOLD activation (n=37). Met/Met (MM) homozygotes had higher verbal recall errors, in the absence of differences in attention, executive function, verbal ability or sensori-motor function. Further, MM homozygotes demonstrated a slowed P300 ERP during the oddball task, with corresponding alterations in hippocampal and lateral prefrontal activation, and a localized reduction in hippocampal grey matter. These results are consistent with a subtle impact of the Met allele on fronto-hippocampal systems involved in selective information processing of stimulus context and memory updating within the normal population. The findings also indicate that heritable endophenotypes such as the P300 have value in elucidating genotype-phenotype relationships.     

Specificity of verbal learning impairment and recovery in a marijuana-dependent male: The effects of sustained marijuana abstinence

Introduction. We present the case of a young adult in treatment for marijuana dependence, with recurrent depression and a history of possible traumatic brain injury, complaining of concentration, memory, and initiation problems.

Methods. The patient was assessed longitudinally during treatment with a brief neuropsychological battery, as well as measures of marijuana use and mood.

Results. Testing at treatment baseline revealed performance that was generally in the high average range or higher on measures of reaction time and attention, with a selective impairment in verbal learning (borderline to extremely low range). Following 8 weeks of abstinence from marijuana, his verbal learning recovered to expected levels (high average range), with signs of improved learning strategy, efficiency, rate, and capacity. However, his reaction time and attention showed minimal evidence of change.

Conclusions. This finding is consistent with the literature that demonstrates that marijuana-associated neurocognitive impairments may be most pronounced in the domain of verbal learning and may remit with abstinence. The clinical implications of these case findings and recommendations for neuropsychological assessment of marijuana abusers are discussed.     

Neuropsychological correlates of diffusion tensor imaging in schizophrenia

Patients with schizophrenia (n = 41) and healthy comparison participants (n = 46) completed neuropsychological measures of intelligence, memory, and executive function. A subset of each group also completed magnetic resonance diffusion tensor imaging (DTI) studies (fractional anisotropy and cross-sectional area) of the uncinate fasciculus (UF) and cingulate bundle (CB). Patients with schizophrenia showed reduced levels of functioning across all neuropsychological measures. In addition, selective neuropsychological-DTI relationships emerged. Among patients but not controls, lower levels of declarative-episodic verbal memory correlated with reduced left UF, whereas executive function errors related to performance monitoring correlated with reduced left CB. The data suggested abnormal DTI patterns linking declarative-episodic verbal memory deficits to the left UF and executive function deficits to the left CB among patients with schizophrenia.     

Schizophrenic-like neurocognitive deficits in children and adolescents with 22q11 deletion syndrome.

22q11.2 Deletion Syndrome (22q11DS) is the most common genetic microdeletion syndrome affecting humans. The syndrome is associated with general cognitive impairments and specific deficits in visual-spatial ability, non-verbal reasoning, and planning skills. 22q11DS is also associated with behavioral and psychiatric abnormalities, including a markedly elevated risk for schizophrenia. Research findings indicate that people with schizophrenia, as well as those identified as schizoptypic, show specific cognitive deficits in the areas of sustained attention, executive functioning, and verbal working memory. The present study examined such schizophrenic-like cognitive deficits in children and adolescents with 22q11DS (n = 26) and controls (n = 25) using a cross-sectional design. As hypothesized, 22q11DS participants exhibited deficits in intelligence, achievement, sustained attention, executive functioning, and verbal working memory compared to controls. Furthermore, deficits in attention and executive functioning were more pronounced in the 22q11DS sample relative to general cognitive impairment. These findings suggest that the same pattern of neuropsychological impairment seen in patients with schizophrenia is present in non-psychotic children identified as at-risk for the development of schizophrenia based on a known genetic risk marker.