Linking neurophysiological and neuropsychological measures for aphasia assessment.

OBJECTIVES: The objective of this study was to find the event-related brain potential (ERP) waveform features and parameters that maximize the correlation between the ERP components and behavioral performance on a neuropsychological test of language comprehension (PPVT-R) in order to develop an electrophysiological diagnostic technique that can be used in the assessment of aphasic patients. METHODS: ERPs were recorded during a computerized version of the Peabody Picture Vocabulary Test-Revised (PPVT-R, Form M). In the computerized version, a picture is presented followed by a congruent or incongruent spoken word. A derived measure was calculated from the ERP differentiation between congruent and incongruent words. The traditional PPVT-R (Form L) was also administered for comparison purposes. The participants included 10 left-sided stroke patients. RESULTS: The N400 was the primary component elicited to incongruent spoken words. Following optimization procedures, a statistical correlation (Pearson r=0.86) was found between the derived N400 measures and the neuropsychological test scores. Examination of the scatter plot confirmed that the relationship was linear. The derived N400 measure was defined primarily as the mean of the t-scores obtained from the incongruent and congruent waveform comparison, within the temporal interval that encompasses the N400. CONCLUSIONS: This novel quantification technique links ERPs with neuropsychological data at an unprecedented level. Given the high correlation, a regression line could reasonably be used to estimate a patient's language ability using only ERPs. However, before these findings can be accepted fully, these results need to be replicated in larger samples and across other paradigms.     

Longitudinal study of cognitive dysfunction in multiple sclerosis: neuropsychological,neuroradiological, and neurophysiological findings

OBJECTIVE: (1) To assess cognitive function and cerebral magnetic resonance imaging (MRI) involvement in relapsing-remitting multiple sclerosis; (2) to monitor disease evolution, cognitive dysfunction, and cerebral lesion burden over time (mean 8.5 year follow up period); (3) to study the relation between clinical, neuropsychological, and MRI data. On follow up assessment, visual and auditory oddball event related potentials (ERPs) were recorded as psychophysiological evaluation of cognitive status. Correlations between neuropsychological, MRI, and ERP data were also analysed. METHODS: Neuropsychological study assessed verbal and non-verbal IQ, deterioration index (DI) from WAIS subtests, conceptual reasoning, attention, verbal and visuospatial short-term and long term memory. MRI assessment detected presence of demyelinating lesions by using a semiquantitative method as well as cortical and subcortical atrophy over time. RESULTS: Attention, short-term and long term visuospatial memory were mildly impaired at baseline and remained unaltered longitudinally. At retesting a significant worsening of verbal long term memory (p=0.023), DI presence (p=0.041) and the increase of supratentorial and subtentorial MRI lesions load (p=0.001) emerged. Expanded disability status scale score correlated significantly with total lesion burden at both evaluations (p=0.043 and p=0.024 respectively). Temporal, occipital, and frontal horn lesions as well as cortical atrophy correlated significantly with attention and memory tests at baseline. Follow up assessment revealed significant correlation between cortical atrophy and attention as well as visuospatial short-term memory; spatial long term memory correlated significantly with lesions in body of lateral ventricle and frontal lobe. ERP study showed P300 latency abnormalities in 75% of patients, involving specifically more visual P300 (58.4 % of cases) than auditory wave (41.6 %). Visual P300 latency and amplitude correlated significantly with DI and auditory P300 latency with frontal horn and brain stem lesions. CONCLUSIONS: These findings revealed mild cognitive impairment in MS patients particularly consistent with slowing information processing over time. Increased MRI lesions do not correlate with the clinical course of the disease and cognitive deficit evolution. Thus, cognitive dysfunction could be related to disease peculiarity and not to the time course. Correlations between P300, neuropsychological, and MRI findings provide further information about ERP application to examine cognitive impairment in MS and probably to investigate their neural origin.     

Discriminating cognitive screening and cognitive testing from neuropsychological assessment: implications for professional practice

Objective: To provide clarification on the distinction between cognitive screening, cognitive testing, and neuropsychological assessment and highlight practical implications. Method: Non-systematic brief clinical review. Results: There is a present lack of explicit distinction between the various levels of measurement of cognitive functioning with regard to goals, indications for use, levels of complexity, and outcome. There is also a lack of guidance regarding the identification of who should be responsible for the administration and interpretation at each level. Conclusions: There is a growing awareness of the importance of cognitive health and disability, and of the importance of measurement of cognitive functions across the lifespan. For example, cognitive screening has been mandated by the Patient Protection and Affordable Care Act of 2010, and language contained within new psychiatric diagnostic criteria and healthcare regulatory changes reflect increased consideration of the importance of measurement of cognition. Changes such as these necessitate greater clarity on this important issue as it bears implications for professional practice, which ranges from education and training competencies, practice standards, and the way that neuropsychologists clarify and advocate for the value of specialty referrals for comprehensive assessment in a competitive and ever-changing healthcare market.     

Short-term course of neuropsychological abilities in middle-aged and older adults with bipolar disorder

Objectives:  There are few longitudinal studies of neurocognition in bipolar disorder, and the short-term course of cognitive deficits in later-life bipolar disorder is unknown.
Methods:  We administered a battery of neurocognitive tests, repeated 1–3 years after baseline, to 35 community-dwelling outpatients with bipolar disorder (mean age = 58), and compared their performance on a composite measure of cognitive functioning to that of demographically matched samples of normal comparison subjects (NCs; n = 35) and patients with schizophrenia (n = 35). Using regression analyses, we examined group differences in baseline performance, trajectory of change over time, and variability in performance across time. Within the bipolar group, we examined the impact of baseline severity and change in severity of psychiatric symptoms on intra-individual change in neurocognitive performance.
Results:  At baseline, the group with bipolar disorder differed in overall neurocognitive functioning from the NCs, but did not differ significantly from the schizophrenia group. The bipolar group did not differ from the NCs or schizophrenia group in the mean trajectory of change between time-points, but the bipolar patients showed more intra-individual variability over time than the NCs or schizophrenia group. In the bipolar group, change in neurocognitive function was not related to baseline or change in psychiatric symptom severity.
Conclusions:  Middle-aged and older community-dwelling adults with bipolar disorder have greater short-term variability in level of neurocognitive functioning relative to NCs or people with schizophrenia. The developmental course of and risk factors for cognitive deficits in bipolar disorder should be examined in future longitudinal studies.     

Tension type headache: a neuropsychological and neurophysiological study

Characteristic personality profiles of patients suffering from either migraine headache (MH) or tension type headache (TTH) have been described in the light of Minnesota Multiphasic Personality Inventory (MMPI). In the present study we evaluated personality profile changes following modifications of the painful symtoms after treatment, through the administration of the MMPI to MH and TTH patients. In TTH patients with no clinical improvement the depression scale scores were higher after 6 months of treatment, whereas in MH patients similar scores were observed before and after therapy, thus suggesting a primary role of depression in the onset of pain in the latter patients. Computerized EMG recording of the neck muscle activity showed different patterns of muscle contraction in resting condition and during stress or maximal muscular activity in patients suffering from TTH as compared to MH patients and normal subjects.

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Somario Il Minnesota Multiphasic Personality Inventory (MMPI) ha permesso di tracciare profili di personalità caratteristici di pazienti affetti da emicrania (migraine headache, MH) o cefalea di tipo tensivo (tension type headache, TTH). Nel presente studio abbiamo valutato le modificazioni dei profili di personalità da noi ottenuti nei suddetti pazienti in relazione alla presenza o meno di miglioramento clinico valutato dopo sei mesi di terapia. Nei pazienti con TTH in cui la terapia non ha indotto alcun miglioramento clinico, il punteggio ottenuto nella scale della depressione è risultato più alto rispetto a quello ottenuto prima della terapia. Al contrario, in pazienti con MH il punteggio della depressione non si è modificato dopo terapia. Questi dati suggeriscono che la depressione ha un ruolo di primaria importanza nello svilupparsi della sintomatologia algica nei pazienti con MH.La registrazione elettromiografica dell'attività dei muscoli nucali a riposo non ha messo in evidenza differenze significative tra i due gruppi di pazienti, mentre in condizioni di sforzo muscolare massimo o durante uno stimolo stressante nei pazienti con TTH era evidente una attività muscolare significativamente maggiore rispetto a pazienti con MH.

     

Mild cognitive impairment after lacunar infarction: voxel-based morphometry and neuropsychological assessment

BACKGROUND: The aim of the present study was to investigate whether there were differences in neuroradiological features, including white-matter lesions and gray-matter volumes, between patients with lacunar infarction with and without mild cognitive impairment of the vascular type (MCI-V). METHODS: A total of 40 patients with lacunar infarction were studied within 1 month after stroke. RESULTS: MCI-V was found in 22 patients, who in comparison with patients without cognitive impairment were significantly older and had fewer years of formal education. MRI subcortical hyperintensities especially in the basal ganglia (putamen and thalamus) were significantly more frequent in the MCI-V group. In the voxel-based morphometric study, patients with MCI-V showed more atrophy bilaterally in the middle temporal gyrus, right and left frontal and posterior bilateral occipitoparietal regions including the posterior cingulate as well as in the cerebellum. A region of interest analysis restricted to the parahippocampi and hippocampi showed further reduced bilateral parahippocampal gyrus and right hippocampus volume reductions in this group of patients. Finally, the amount of white-matter lesions among MCI-V showed negative correlations with gray-matter volume in frontal and temporal areas as well as with the thalamus and mesencephalon. CONCLUSIONS: The present findings provide support for an anatomical substrate of the MCI entity in patients with lacunar infarction. Both gray- and white-matter changes seem to contribute to the cognitive impairment of such patients.     

Comparison of informant reports and neuropsychological assessment in mild cognitive impairment

The aim of this retrospective study was to investigate the accuracy of informant reports on cognitive status in mild cognitive impairment (MCI) by comparing the subjective evaluation made by patients' relatives with the objective results of neuropsychological assessment. We enrolled 119 MCI outpatients and their relatives. Cognitive impairment was assessed by a battery of standardized neuropsychological tests. Informant reports on cognitive functioning were obtained by means of a structured interview. Subjective and objective evaluations of cognitive status were rated according to the same scoring system in order to enable comparison. All but one relative reported cognitive dysfunctions at the interview, but the kind of cognitive profile emerging from their reports was quite different from the one highlighted by neuropsychological assessment. A subjective evaluation of cognitive status based on informant reports could therefore be useful to identify patients with MCI but is unable to define MCI subtypes.     

Writing epilepsy: a neurophysiological, neuropsychological and neuroimaging study

Writing epilepsy is a rare reflex syndrome in which seizures are triggered by writing. We describe a 33-year-old, right-handed man, with a history of juvenile absence epilepsy in remission and a family history of epilepsy, in whom myoclonic jerks precipitated exclusively by writing started at the age of 30. Intensive video/EEG monitoring during neuropsychological tests revealed, at about 1 minute after starting to write, a dystonic posture, followed by myoclonic jerks involving the right hand that shortly after became generalized. Concomitantly, the ictal EEG documented generalized hypersynchronous polyspike-wave discharges, maximal over the right parietocentral area. SPECT revealed an ictal hyperperfusion and interictal hypoperfusion over right parietofrontal regions, and fMRI showed extensive and intense left frontal, supplementary motor area activation, induced by writing. This case study provides some evidence supporting the hypothesis that the mechanism underlying writing-triggered seizures may be a generalized seizure process, with a focal cortical trigger zone, presumed to be the left frontal lobe as suggested by clinical and fMRI data. A relevant role played by the right hemisphere (right parietofrontal region) is postulated in the full-blown expression of reflex epileptogenesis, as supported by EEG and SPECT findings.     

Conceptual and Perceptual Set-shifting executive abilities in young adults with Asperger's syndrome

Neuropsychological models of frontal lobe functioning have led to a greater appreciation of the dissociations among various aspects of executive functions. Theories of executive function have been proposed to account, at least in part, for the unique social and emotional difficulties experienced by individuals with Asperger's syndrome (AS). Given the paucity of research regarding the neural correlates of executive function in AS, this investigation research involves an examination of a well-established measure of executive, fronto-striatal function in young adults with AS. Findings provide preliminary evidence to support a specific type of executive dysfunction and in particular, extradimensional or conceptual set-shifting difficulties in individuals with AS that implicates prefrontal cortex and frontal-striatal function.     

Subjective cognitive complaints versus objective neuropsychological performance in older adults with epilepsy

Memory complaints are common among older adults with epilepsy (OAE), though discrepancy between subjective complaints and objective performance often exists. This study examined how accurately OAE and their informants reported on the participant's cognitive difficulties by comparing ratings of everyday cognition to objective performance. Thirty-seven OAE and 27 older adult controls completed a brief battery of neuropsychological tests, the Beck Depression Inventory, and the Cognitive Difficulties Scale (CDS). Each participant had an informant who completed the CDS. Older adults with epilepsy performed worse than controls on cognitive testing and reported more subjective cognitive complaints. Neither participant- nor informant-reported cognitive complaints were related to performance on any of the neuropsychological tests for either the group with epilepsy or control group, but both were related to greater depressive symptoms. Results suggest that subjective report of cognitive problems by both OAE and their informants may not reliably reflect the extent to which these problems exist.     

An eye-tracking controlled neuropsychological battery for cognitive assessment in neurological diseases

Neurological Sciences - Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal–motor impairment; to date, an...     

Indications and expectations for neuropsychological assessment in epilepsy surgery in children and adults

In our first paper in this series (Epilepsia 2015; 56(5): 674–681), we published recommendations for the indications and expectations for neuropsychological assessment in routine epilepsy care. This partner paper provides a comprehensive overview of the more specialist role of neuropsychological assessment in the pre and postoperative evaluation of epilepsy surgery patients. The paper is in two parts. The first part presents the framework for the mandatory role of neuropsychologists in the presurgical evaluation of epilepsy surgery candidates. A preoperative neuropsychological assessment should be comprised of standardised measures of cognitive function in addition to wider measures of behavioural and psychosocial function. The results from the presurgical assessment are used to: (1) establish a baseline against which change can be measured following surgery; (2) provide a collaborative contribution to seizure characterization, lateralization and localization; (3) provide evidence‐based predictions of cognitive risk associated with the proposed surgery; and (4) provide the evidence base for comprehensive preoperative counselling, including exploration of patient expectations of surgical treatment. The second part examines the critical role of the neuropsychologist in the evaluation of postoperative outcomes. Neuropsychological changes following surgery are dynamic and a comprehensive, long‐term assessment of these changes following surgery should form an integral part of the postoperative follow‐up. The special considerations with respect to pre and postoperative assessment when working with paediatric populations and those with an intellectual disability are also discussed. The paper provides a summary checklist for neuropsychological involvement throughout the epilepsy surgery process, based on the recommendations discussed.     

Socioeconomic and cognitive roots of trait anxiety in young adults

In 54 participants (41% women) from the Czech arm of the European Longitudinal Study of Pregnancy and Childhood, a national birth cohort with prospectively collected data from their birth until young adulthood, we aimed to study the association between early-life socioeconomic deprivation (ELSD), cognitive ability in adolescence, trait anxiety and resting state functional connectivity of the lateral prefrontal cortex (LPFC) in young adulthood. We found that ELSD was associated with lower cognitive ability in adolescence (at age 13) as well as higher trait anxiety in young adulthood (at age 23/24). Higher cognitive ability in adolescence predicted lower trait anxiety in young adulthood. Resting state functional connectivity between the right LPFC and a cluster of voxels including left precentral gyrus, left postcentral gyrus and superior frontal gyrus mediated the relationship between lower cognitive ability in adolescence and higher trait anxiety in young adulthood. These findings indicate that lower cognitive ability and higher trait anxiety may be both consequences of socioeconomic deprivation in early life. The recruitment of the right LPFC may be the underlying mechanism, through which higher cognitive ability may ameliorate trait anxiety.     

Confirmatory factor analysis in neurophysiological and neuropsychological dimensions of schizophrenia

This study applied confirmatory factor analysis (CFA) to examine the construct of smooth pursuit eye movements (SPEM) and the Wisconsin Card Sorting Test (WCST) in schizophrenia. Participants were assigned to two groups: Group 1 included 27 probands chosen from families with schizophrenia in first-degree relatives, and Group 2 included 54 schizophrenics who had no families with schizophrenia spectrum disorders. There were no differences in the eye tracking pursuit and the WCST between the sporadic and familial schizophrenics. Gender impacted the catch-up saccades (CUS) and anticipatory saccades (AS) indices of the SPEM, and the conceptual level responses (CLR) index of the WCST. Education impacted the CLR and perseverative errors of the WCST. Although there were no correlation between the SPEM and the WCST, but the two instruments showed good content validity, which might be useful in the subtyping of schizophrenia.     

A musical assessment of psychiatric states in adults

In music therapy, joint musical improvisation of therapist and subject provides the framework for a spontaneous and intimate, non-verbal interaction. This study shows that such an interaction can be used to reveal the subject's capacity for emotional contact with another person, the nature of this contact and how well it is sustained. We examine the musical interaction in first music therapy sessions using a model of analysis specially developed for this study. A comparison between 15 schizophrenics, 15 depressed patients and 15 clinically normal controls revealed significant differences. The findings, which take into account subjects' musical background and perceptual functioning, have implications for the diagnostic use of music therapy in adult psychiatry.