Premorbid neurocognitive functioning in schizophrenia spectrum disorder

A prospective study based on the U.S. National Collaborative Perinatal Project and using the Wechsler Intelligence Scale for Children (WISC) found lower test scores for the Coding subtest in preschizophrenic children than in their unaffected siblings. Using data on cognitive functioning in adolescence, the aim of the present prospective study was to examine whether low scores on Coding is associated with the risk of developing schizophrenia spectrum disorders. The 12 subtests of the WISC were administered to 311 children and adolescents with a mean age of 15.1 years (range: 8 to 20 years), and the diagnostic assessment (DSM-IIIR) was conducted by senior clinicians 25 years later. The group with schizophrenia spectrum disorder consisted of 84 individuals, and this group obtained significantly lower scores on Coding than nonschizophrenic controls. This difference could not be explained by differences in WISC IQ. Logistic regression analysis controlling for age at examination, gender, and social status yielded a significant, but relatively weak, association between low Coding test score and risk of schizophrenia spectrum disorder. For each unit increase in the Coding raw score, the adjusted odds ratio was 0.97 (95% CI 0.94-1.00) (p = .022), and the risk of schizophrenia spectrum disorder decreased by 3% (95% CI 6 to 0%). The Coding deficit on the WISC may indicate deficits in perceptual motor speed or in working memory processing speed in young individuals who later develop schizophrenia, schizotypal personality disorder, or other disorders within the schizophrenia spectrum.     

Recovery in schizophrenia: focus on neurocognitive functioning

Recovery encompasses symptom remission and functional elements such as cognition, social functioning and quality of life. Personal recovery is also important in illness management to help the person stay on track with treatment and focus on activities unrelated to taking medication that maintain mental health. In the present study we aimed to identify neurocognitive functioning in two clinically stable groups of patients with personal recovery and non-recovered patients. The results showered generalized cognitive deficits in both groups while the non-recovery group was more impaired in verbal and visual memory, acoustic and tactile gnosis and neurodynamics and executing functioning. Interestingly the recovery group demonstrated lack of programming of actions and sufficient error monitoring and self-correction whereas the non-recovery group was significantly more impaired in all executive domains. The obtained results could be beneficial in identifying a target for psychosocial treatments and specifically cognitive remediation for patients with schizophrenia to facilitate the process of recovery.     

Subclinical hypothyroidism and neurocognitive functioning in bipolar disorder

The aim of this study was to compare neurocognitive functioning between euthymic bipolar disorder (BD) patients with and without subclinical hypothyroidism (SCH). Patients with SCH had poorer performance than patients without SCH in measures of verbal memory, attention, language, and executive functions. These preliminary results suggest that SCH could have some impact on the neurocognitive performance of euthymic patients with BD and warrant further research in this field.     

地中海贫血患者的神经认知功能研究进展

地中海贫血可能引起个体的神经认知功能损害,现对近20年来关于0重型和中间型地中海贫血以及镰刀型p地中海贫血的神经心理、电生理、神经影像方面的研究报道做一回顾性综述,为地中海贫血的治疗以及心理认知机制研究提供新的思路。     

Diagnosing attention disorders with measures of neurocognitive functioning

The validity of the Differential Ability Scales (DAS; Elliott, 1990) in predicting attention disorders in school-aged children was examined. The participants were 40 children diagnosed with attention deficit/hyperactivity disorder (ADHD) and 40 normal children between 7 and 12 years of age. Comorbidity was controlled by excluding children with ADHD who had a concurrent DSM-IV diagnosis such as reading disability, learning disability, mood disorder, or behavioral disorder. In addition, groups did not differ significantly by sex, age, racial/ethnic identification, or parental educational level. A stepwise discriminant analysis indicated the DAS correctly classified 72.5% of the total sample when either the Sequential and Quantitative Reasoning subtest or the Recall of Digits subtest was used to predict group membership. In general, the DAS core subtests were found to be good measures of cognitive ability in children classified with ADHD and did not appear to be influenced by attention problems.     

Sickle cell disease and stroke in a pediatric population. Evidence-based diagnostic evaluation

Cerebrovascular complications are common in SCD and constitute a major source of concern to the pediatric hematologist. These complications can be either clinically overt or covert. The authors' review of the diagnostic tests does not offer absolute indications for neuroimaging because most of the evidence is based on studies that are not randomized controlled trials. Imaging guidelines for children have emerged based on the available level 2 and 3 literature, however, CT and MR imaging remain the initial tests of choice for stroke assessment, and TCD is the imaging tool of choice for stroke prevention. Based on guidelines handed down from the NIH, TCD has become a part of routine continuing care of children with SCD.     

Motor based assessment of neurocognitive functioning in resource-limited international settings

This study compared variance accounted for by neuropsychological tests in both a brief motor battery and in a comprehensive neuropsychological battery. 327 HIV+ subjects received a comprehensive cognitive battery and a shorter battery (Timed Gait, Grooved Pegboard, and Fingertapping). A significant correlation existed between the motor component tests and the more comprehensive battery (52% of variance). Adding Digit symbol and Trailmaking increased the amount of variance accounted for (73%). Motor battery sensitivity to impairment diagnosis was 0.79 and specificity was 0.76. A motor battery may have broader utility to diagnose and monitor HIV related neurocognitive disorders in international settings.     

Neuropsychological predictors of everyday memory and everyday functioning in patients with mild Alzheimer's disease

The contributions of executive function, naming, visuoperception, and delayed recall to everyday memory abilities and everyday living activities were examined in a sample (n = 24) of mildly impaired Alzheimer's disease (AD) patients. Everyday memory was rated independently by the patient and by a caregiver, and everyday functioning was rated by a caregiver. For patient-rated everyday memory, verbal recall accounted for 23% of the variance, while naming performance alone accounted for 56% of the variance in caregiver-rated everyday memory. Executive function was a unique and significant predictor of caregiver-rated functional daily living skills, accounting for 40% of the variance. Clinician's ratings of patient unawareness of deficit correlated with the discrepancy between caregiver and patient rating of memory. Caregiver reports of memory impairment appear to be influenced by naming abilities, indicating that language dysfunction may be misinterpreted as reflecting memory impairment. Helping caregivers distinguish between these two abilities may result in more accurate reporting of patients' impairments.     

Theory of mind and neurocognitive functioning in patients with bipolar disorder

Wolf F, Brüne M, Assion H‐J. Theory of mind and neurocognitive functioning in patients with bipolar disorder. Bipolar Disord 2010: 12: 657–666. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objectives: Studies into social cognition in psychiatric disorders have recently been expanded to address the question of whether or not theory of mind (ToM), i.e., the ability to represent one’s own and others’ mental states, is impaired in bipolar affective disorder (BPD). Results have been mixed so far, mainly due to possible confounding effects of neurocognition, as well as clinical factors such as acuity and current mood. Here, we explored ToM and its associations with neurocognitive functioning in BPD. Methods: A total of 33 patients with bipolar I disorder (of whom 12 were currently depressed, 10 manic, and 11 remitted) and 29 healthy controls were assessed using a test battery that was identical to the one that was used in previous studies in schizophrenia, comprising diverse neurocognitive tasks, including measures of intelligence, executive functioning, and ToM tasks. Results: The bipolar disorder patient group as a whole and all three clinical subgroups were impaired on all measures of ToM relative to controls, but did not differ from each other in most ToM scores. Patients’ poorer performance on executive tasks did not fully explain ToM differences between patients and controls, suggesting a partially selective ToM deficit in BPD. Conclusions: Patients with BPD are impaired in ToM, partially independent of other cognitive dysfunctions and current mood.     

Independence and overlap among neurocognitive correlates of community functioning in schizophrenia

Existing literature on the neurocognitive correlates of community functioning in schizophrenia has not adequately focused on the relationships among the correlated variables. In a sample of 40 outpatients with schizophrenia and related disorders, we studied two sets of variables that we expected to be related to broad ratings of community functioning: (1) the Wechsler Adult Intelligence Scale-III (WAIS-III) index scores for verbal comprehension, perceptual organization, working memory, and processing speed; and (2) positive, negative, disorganized and affective symptom variables. Of the WAIS-III index scores, working memory and processing speed entered a stepwise regression, together accounting for substantial variance in functional ratings (R(2)=0.37). However, only processing speed remained significantly associated with community functioning after controlling for the other indexes. In relation to community functioning, the remaining indexes appeared to be overlapping markers of general cognitive ability, rather than specific measures of discrete cognitive domains. Addition of positive and negative symptom variables in a further analysis greatly increased the explained functional variance (R(2)=0.65). Processing speed overlapped substantially with negative symptoms in predicting functioning, while the other WAIS-III indexes were independent of symptomatology. Results illustrate the importance of (1) knowing which neurocognitive variables have specific relationships to community functioning and which reflect the influence of more general cognitive ability in daily life, and (2) appreciating areas of overlap and independence among classes of correlates of functioning, such as neurocognitive and symptom variables. This improved understanding has implications for predictive models of community functioning, for cognitive rehabilitation and deficit compensation strategies, and for assessment practice.     

神经心理测验预测首发精神分裂症的近期预后

目的：筛选与首发精神分裂症近期预后有关的神经心理测查指标。方法：对１６４例首发精神分裂症患者随机给予氯丙嗪或氯氮平治疗,于治疗前分别作韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击测验、利手测验、动作功能测验、手功能协调测验、连线测验、连线测验Ｂ、威期康辛卡片分类测验（ＷＣＳＴ）及语言流畅性测验等１１项刘经心理测查各１次,并作ＢＰＲＳ、ＳＡＮＳ、功能总体评定量表（ＧＡＦ）各１次,治疗１２周     

Cognitive mechanisms,psychosocial functioning,and neurocognitive rehabilitation in schizophrenia

The aim of the present study is to test Brenner's model of cognitive functioning in schizophrenia. It is assumed that elementary cognitive disorders (attention and encoding) and complex cognitive disorders (recall, concept formation) reinforce each other. Cognitive disorders are supposed to cause detrimental effects on functional outcome. We used cognitive rehabilitation as a strategy to induce cognitive changes in 27 patients assigned to treatment groups following the cognitive modules of the Integrated Psychological Treatment (IPT). Ten schizophrenic patients without cognitive impairments worked as a control group. With only one minor conceptual change (replacing concept formation with executive function, a more comprehensive construct), we found that our data fitted with Brenner's model. A relationship has been found between neuropsychological improvements and higher levels of autonomy and social functioning. These findings have important implications not only for cognitive assessment but also for selecting targets in cognitive rehabilitation.     

Gender differences of neurocognitive functioning in patients with first-episode schizophrenia in China

AimsTo investigate the gender differences in neurocognitive functioning in patients with first-episode schizophrenia (FES) in China.MethodsA total of 449 Chinese patients with FES (210 males, 239 females) were included in this study. Participants’ psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Neurocognitive functioning was assessed by 10 neuropsychological tests from a battery. Neurocognitive test scores were converted to scale scores and t-scores using normative data from Chinese populations.ResultsMales were younger and less likely to be married, had an earlier age of illness onset and a longer duration of untreated psychosis (DUP), and scored higher on the PANSS negative, general and total scales than females. After controlling for potential confounders, females performed better than males in the verbal learning and memory domain (p=0.016). While most neurocognitive domains were correlated with PANSS negative scores for male patients with FES, for female patients with FES, negative associations were found between scores on the PANSS general subscales and neurocognitive domains. We also performed a case-control comparison with a group of patients with clinically stable schizophrenia (CSS) (n = 60) who were matched by age, sex and education years with patients with FES (n = 58). After controlling for potential confounders, no significant differences were found between patients with FES and patients with CSS in all neurocognitive domains. Female patients still performed better in the verbal learning and memory domain (t = 2.14, p = 0.034). No interaction effects of gender and disease were found.ConclusionsGender was an independent influence factor for the verbal learning and memory domain. Both female patients with first-episode schizophrenia and female patients with clinically stable schizophrenia performed better than male patients.     

Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design

IntroductionMetacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown.MethodsThe current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience).ResultsBipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general.ConclusionMaladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.     

The Palau Early Psychosis Study: neurocognitive functioning in high-risk adolescents

ObjectiveThe purpose of the present study was to evaluate both the independent and joint effects of genetic risk and clinical status on neurocognitive functioning in adolescents from a population isolate with an elevated risk for schizophrenia and strong familial aggregation of cases.MethodThe subjects were 310 non-help seeking, drug-naïve adolescents 14–19 years of age from the Republic of Palau. The sample comprised 98 Genetically High Risk (GHR) adolescents, 54 of whom were symptomatic, and 212 Genetically Low Risk (GLR) adolescents, including 113 Clinically High Risk (CHR) subjects who were symptomatic and 99 normal controls who were non-symptomatic. Neurocognitive testing was conducted after the clinical assessment and included Wechsler Memory Scale tests of logical, visual and working memory, the perceptual organization and processing speed subtests of the WISC-III, CPT-IP measures of sustained attention, and tests of fine and gross neuromotor function.ResultsGHR adolescents showed impairments in immediate logical memory, verbal working memory, CPT-IP performance, and fine motor skills. The only two cognitive components influenced by the presence of early psychosis symptoms were WISC-III perceptual organization and spatial working memory. Neurocognitive deficits did not increase with increasing levels of psychopathology. We found no significant interactive effects of genetic risk and clinical status on neurocognitive functioning.ConclusionsGenetic risk and clinical status exert independent effects on neurocognitive function in HR adolescents, and genetic risk has a broader impact than clinical status. Our results suggest that many of the neurocognitive impairments associated with early psychosis are genetically mediated and can occur in genetically vulnerable individuals regardless of their clinical status. However, visuospatial processing appears to be uniquely disrupted by emerging symptomatology.     

Humor appreciation deficit in schizophrenia: the relevance of basic neurocognitive functioning

The purpose in undertaking the present study was to investigate humor appreciation in patients with schizophrenia. Moreover, we sought to explore the potential relationship of humor appreciation with measures of psychopathology and cognitive functioning among the patients. Thirty-six patients with schizophrenia were compared with 31 normal controls matched for age, sex, and education on a computerized test comprising captionless cartoons: Penn's Humor Appreciation Test (PHAT). The patients were also evaluated on the symptom dimensions derived from the Positive and Negative Symptom Scale (positive symptoms, negative symptoms, cognitive symptoms, depression, and excitement), as well as a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and psychomotor speed. Patients with schizophrenia had significantly lower scores on the PHAT than normal controls. The patients' performance on the PHAT correlated with scores on Penn's Continuous Performance Test, the Stroop Color-Word Test, and the phonological subscale of the Greek Verbal Fluency Test. Our findings indicated impaired humor appreciation among patients with schizophrenia. The relationship found between the appreciation of captionless cartoons involved an incongruous detail and performance on a broad neuropsychological battery suggested that the deficit in humor appreciation in schizophrenia could be attributed to impairment in more basic neurocognitive domains, namely, selective and sustained attention as well as phonological word fluency.     

White matter predictors of cognitive functioning in older adults

Few studies have applied multiple imaging modalities to examine cognitive correlates of white matter. We examined the utility of T2-weighted magnetic resonance imaging (MRI) -derived white matter hyperintensities (WMH) and diffusion tensor imaging-derived fractional anisotropy (FA) to predict cognitive functioning among older adults. Quantitative MRI and neuropsychological evaluations were performed in 112 older participants from an ongoing study of the genetics of Alzheimer's disease (AD) in African Americans. Regional WMH volumes and FA were measured in multiple regions of interest. We examined the association of regional WMH and an FA summary score with cognitive test performance. Differences in WMH and FA were compared across diagnostic groups (i.e., normal controls, mild cognitive impairment, and probable AD). Increased WMH volume in frontal lobes was associated with poorer delayed memory performance. FA did not emerge as a significant predictor of cognition. White matter hyperintensity volume in the frontal and parietal lobes was increased in MCI participants and more so in AD patients relative to controls. These results highlight the importance of regionally distributed small vessel cerebrovascular disease in memory performance and AD among African American older adults. White matter microstructural changes, quantified with diffusion tensor imaging, appear to play a lesser role in our sample.     

Obstructive sleep apnea-hypopnea and neurocognitive functioning in the Sleep Heart Health Study

BACKGROUND AND PURPOSE: Obstructive sleep apnea-hypopnea (OSAH) is associated with sleep fragmentation and nocturnal hypoxemia. In clinical samples, patients with OSAH frequently are found to have deficits in neuropsychological function. However, the nature and severity of these abnormalities in non-clinical populations is less well defined. PATIENTS AND METHODS: One hundred and forty-one participants from the Tucson, AZ and New York, NY field centers of the Sleep Heart Health Study completed a battery of neuropsychological tests for 9-40 months (mean=24 months, SD=7 months) after an unattended home polysomnogram. Sixty-seven participants had OSAH (AHI>10) and 74 did not have OSAH (control (CTL), apnea-hypopnea index (AHI)<5). In addition to the individual tests, composite variables representing attention, executive function, MotorSpeed and processing speed were constructed from the neuropsychological test battery. RESULTS: There were no significant differences in any individual neuropsychological test or composite variable between the OSAH and CTL groups. However, when time spent with O(2) saturations less than 85% was dichotomized into those participants in the top quartile of the distribution and those in the lower three quartiles, motor speed was significantly impaired in those who were more hypoxemic. In addition, poorer motor speed (model adjusted R(2)=0.242, P<0.001) and processing speed performance (model adjusted R(2)=0.122, P<0.001) were associated with more severe oxygen desaturation even after controlling for degree of daytime sleepiness, age, gender and educational level. CONCLUSIONS: Mild to moderate OSAH has little impact on the selected measures of attention, executive function, motor speed and processing speed. However, hypoxemia adversely affects both motor and processing speed. These results suggest that in middle-aged to elderly adults the neuropsychological effects of clinically unrecognized mild to moderate OSAH are neither global nor large.     

Long-term efavirenz use is associated with worse neurocognitive functioning in HIV-infected patients

Neurocognitive (NC) complications continue to afflict a substantial proportion of HIV-infected people taking effective antiretroviral therapy (ART). One contributing mechanism for this is antiretroviral neurotoxicity. Efavirenz (EFV) is associated with short-term central nervous system (CNS) toxicity, but less is known about its long-term effects. Our objective was to compare NC functioning with long-term use of EFV to that of a comparator, lopinavir-ritonavir (LPV/r), in a cohort of well-characterized adults. Four hundred forty-five patients were selected from the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) cohort based on their use of either EFV (n?=?272, mean duration 17.9 months) or LPV/r (n?=?173, mean duration 16.4 months) and the lack of severe NC comorbidities. All patients had undergone standardized comprehensive NC testing. Univariable and multivariable analyses to predict NC outcomes were performed. Compared with LPV/r users, EFV users were more likely to be taking their first ART regimen (p?<?0.001), were less likely to have AIDS (p?<?0.001) or hepatitis C virus (HCV) coinfection (p?<?0.05), had higher CD4+ T cell nadirs (p?<?0.001), had lower peak (p?<?0.001) and current (p?<?0.001) plasma HIV RNA levels, and were less likely to have detectable HIV RNA in cerebrospinal fluid (CSF) (p?<?0.001). Overall, EFV users had worse speed of information processing (p?=?0.04), verbal fluency (p?=?0.03), and working memory (p?=?0.03). An interaction with HCV serostatus was present: Overall among HCV seronegatives (n?=?329), EFV users performed poorly, whereas among HCV seropositives (n?=?116), LPV/r users had overall worse performance. In the subgroup with undetectable plasma HIV RNA (n?=?269), EFV users had worse speed of information processing (p?=?0.02) and executive functioning (p?=?0.03). Substantial differences exist between EFV and LPV/r users in this observational cohort, possibly because of channeling by clinicians who may have prescribed LPV/r to more severely ill patients or as second-line therapy. Despite these differences, EFV users had worse functioning in several cognitive abilities. A potentially important interaction was identified that could indicate that the NC consequences of specific antiretroviral drugs may differ based on HCV coinfection. The complexity of these data is substantial, and findings would best be confirmed in a randomized clinical trial.