Assessing executive performance during cognitive rehabilitation

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002 Stuss, D. and Levine, B. 2002. Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53: 401–433. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Impairment in executive functioning disrupts a person's ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a person's executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005 Peterson, D. 2005. International Classification of Functioning, Disability and Health: An introduction for rehabilitation psychologists. Rehabilitation Psychology, 50: 105–112. [Crossref], [Web of Science ®] , [Google Scholar]), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.     

Strategy instruction in Parkinson's disease: Influence on cognitive performance

Objectives

Though strategic deficits are extensively investigated in Parkinson's disease (PD), little is known about the effects of instruction for PD patients. Thus, we compared the ability to internally generate a cognitive strategy with the ability to use a strategy after elaborate strategy instruction.

Methods

Patients with PD (n = 14) and matched healthy controls (n = 22) were administered a Numerosity Judgement task in which they had to determine different numerosities of blocks presented in a square grid. In more complex task configurations, healthy participants tend to use a subtraction strategy. Participants in our study were confronted with a counting condition (A), a strategy initiation condition without instruction (B), and a strategy elaboration and strategy training condition (C).

Results

Patients and controls were comparable with respect to basic cognitive measures. PD patients and controls performed equivalently within the counting condition (A), but patients needed significantly more trials to initiate the subtraction strategy. With the exception of 1 PD patient, all patients were able to internally initiate the strategy (condition B). In condition C, both groups increased reaction times, but patients were significantly slower than controls. Moreover, only patients significantly increased error rates after strategy instruction.

Conclusion

As long as sufficient time is provided for solving the task, results do not show a general deficit in the ability to internally generate a cognitive strategy in PD. Failures in strategy utilization strongly depend on cognitive load (working memory, executive functions). This bears important implications for the neuropsychological rehabilitation of PD patients.     

The relation of the number of languages spoken to performance in different cognitive abilities in old age

Introduction: Findings on the association of speaking different languages with cognitive functioning in old age are inconsistent and inconclusive so far. Therefore, the present study set out to investigate the relation of the number of languages spoken to cognitive performance and its interplay with several other markers of cognitive reserve in a large sample of older adults. Method: Two thousand eight hundred and twelve older adults served as sample for the present study. Psychometric tests on verbal abilities, basic processing speed, and cognitive flexibility were administered. In addition, individuals were interviewed on their different languages spoken on a regular basis, educational attainment, occupation, and engaging in different activities throughout adulthood. Results: Higher number of languages regularly spoken was significantly associated with better performance in verbal abilities and processing speed, but unrelated to cognitive flexibility. Regression analyses showed that the number of languages spoken predicted cognitive performance over and above leisure activities/physical demand of job/gainful activity as respective additional predictor, but not over and above educational attainment/cognitive level of job as respective additional predictor. There was no significant moderation of the association of the number of languages spoken with cognitive performance in any model. Conclusions: Present data suggest that speaking different languages on a regular basis may additionally contribute to the build-up of cognitive reserve in old age. Yet, this may not be universal, but linked to verbal abilities and basic cognitive processing speed. Moreover, it may be dependent on other types of cognitive stimulation that individuals also engaged in during their life course.     

Transcranial electrical stimulation improves cognitive training effects in healthy elderly adults with low cognitive performance

ObjectiveTo investigate the efficacy of transcranial direct (tDCS) or alternating current stimulation (tACS) in boosting cognitive training efficiency in healthy older adults. We further explored whether such improvements depend on general cognitive performance or age.MethodsIn this randomized, sham-controlled study, 59 healthy elderly participants (mean age 71.7) were assigned to receive computer-based cognitive training (10 sessions, 50 min, twice weekly) combined with tDCS (2 mA), tACS (5 Hz), or sham stimulation over the left dorsolateral prefrontal cortex (20 minutes). Cognitive performance was assessed with the Montreal Cognitive Assessment (MoCA), and a cognitive composite score derived from a broad neuropsychological test battery before and immediately after the intervention as well as at 6 and 12 months follow-ups.ResultsPerformance in the cognitive composite score improved significantly in all groups but was not further modulated by neurostimulation. Additional analyses revealed that participants with a low initial MoCA score (<1SD) improved significantly more in the tDCS than in the sham group.ConclusionTDCS increased the efficacy of cognitive training, but only in participants with initially low general cognitive performance.SignificanceCognitive interventions including tDCS should address baseline performance as modulating factor of cognitive outcomes.     

Stability of performance on neuropsychological tests in patients with schizophrenia

This study evaluated the stability of performance on neuropsychological tests in a group of 14 schizophrenic patients. These patients were first tested as inpatients and later on as outpatients. The patients’ results are also compared with matched normal controls and with standardized norms. The patients’ test results were stable over time and no change in performance was found for the patients as a group, suggesting that these aspects of the patients’ functioning were of a trait quality. The patient group had significantly poorer results on a majority of the tests compared with the controls. The variation of the level of cognitive functioning among the patients, however, was great. In clinical practice today, neuropsychological examinations are often included in the diagnostic procedure, and their results also have impact on treatment planning. However, the possibility to generalize the findings is reduced as a consequence of the low number of patients in the study. Received: 7 May 1998 / Accepted: 6 October 1999     

Factors associated with psychiatric morbidity in men--a general practice survey

A survey of men aged from 20 to 59 years from a general practice list using the General Health Questionnaire and a questionnaire of social and domestic items yielded 1011 respondents. Several items were shown to be linked with psychological disturbance including ill health, ill health or psychiatric history in wife, poor relationship with wife, being unemployed, poor or divorced and lower social class. The results are compared with those of a similar sample of women.     

Factors associated with psychiatric morbidity in women--a general practice survey

1517 women between 20 and 59 years of age were screened for current psychiatric disturbance using the General Health Questionnaire, and 382 of the subjects were also interviewed. The women gave information on a variety of family, demographic and reproductive or gynaecological items. Items concerning personal relationships with mother, husband and father were significantly associated with high scores on the GHQ as were demographic items such as marital status, numbers of children and social class and gynaecological items such as sterilization and painful, heavy or irregular periods. The many cross associations between items included in the study need to be considered when interpreting the findings. In particular the highly significant association of relationship and demographic factors with psychiatric morbidity in women must be taken into account when investigating the impact of reproductive physiology and gynaecological procedures on mental health.     

Treatment factors associated with outcomes in children less than 3 years of age with CNS tumours

Introduction  This study aimed to document cognitive outcomes in children treated for brain tumours with surgery and/or chemotherapy before the age of 3 years and to investigate the relationship between treatment factors and cognitive outcome. Materials and methods  Participants were 31 children aged 7–14 years who had been diagnosed and treated for brain tumours under the age of 3 years. Neuropsychological assessment included tests of cognitive functioning (WASI), memory (CMS) and executive functioning (BADS-C). Results and discussion  IQ and memory functioning scores were within the normal range but executive function was significantly below the expected level. Lower socio-economic status, younger age at treatment, having undergone more than one surgical intervention, motor problems and speech and language difficulties were found to be related to cognitive functioning. Although this group of children have good outcomes in terms of IQ and memory they have significant difficulties with executive functioning. Conclusion  Further research in this area is needed to allow for development of appropriate support packages for those who are most at risk.     

老年脑白质疏松合并高血压对患者认知功能的影响

目的探讨老年脑白质疏松(LA)合并高血压对患者认知功能的影响。方法选取2014年1月~2015年1月期间于我院神经内科门诊就诊或病房收治的42例老年LA合并高血压患者为研究对象,归为老年LA伴高血压组,并选择同期40例无脑白质病变的单纯老年高血压患者归为老年高血压组,以及来我院体检的30例健康老年人作为老年健康对照组。以蒙特利尔认知评估量表(Mo CA)评估3组的认知功能。结果老年LA伴高血压组的视空间与执行功能、命名、注意力、抽象及延迟回忆的评分及总分均显著低于老年健康对照组,差异均有统计学意义(P0.05)。且视空间与执行功能、抽象的评分及总分均显著低于老年高血压组,差异有统计学意义(P0.05)。老年LA伴高血压组的认知功能损害发生率显著高于老年高血压组及对照组,差异均有统计学意义(P0.05)。结论与老年高血压和健康老人相比,老年LA合并高血压患者的认知功能明显减退,认知功能障碍率明显升高,故需要对这些老年患者定期检测认知功能,对认知功能障碍进行早期干预。     

Magnetic resonance imaging and cognitive functioning in multiple sclerosis

Summary The relationship between cognitive impairment in multiple sclerosis and brain lesions seen on magnetic resonance imaging (MRI) was studied. Three groups of 11 patients with multiple sclerosis, matched for the variables of disability, duration of illness, age and sex, were included. On the basis of neuropsychological testing, the groups were seen to differ in their level of cognitive impairment. The first group showed no cognitive impairment, the second group a moderate, and the third group a serious cognitive impairment. These differences between the groups were reflected by MRI, which revealed more abnormalities in the groups with cognitive impairment compared with the group with normal cognitive function. However, by MRI it was not possible to distinguish between the groups with moderate and that with serious cognitive impairment.     

绝经前单侧卵巢切除后老年女性认知功能的改变

目的本研究观察绝经前单侧卵巢切除伴有或无子宫切除的老年人认知功能的改变,探讨单侧卵巢切除对认知功能的远期影响。方法采用1∶1年龄及教育配比病例对照研究,选取绝经前行单侧卵巢切除及自然绝经的老年女性各50名,对其认知功能进行测定并比较两组的差异。结果绝经前单侧卵巢切除老年女性的词语学习记忆及延迟回忆分数均较对照组降低(P<0.05)。结论绝经前单侧卵巢切除可能对女性认知功能产生远期损害。     

Comparing cognitive functioning in schizophrenia and autism using WAIS-III

The main goal of this study was to investigate differences and similarities in general cognitive functioning between adults with schizophrenia and autism, because this has not been systematically investigated. We used a cross-sectional design to compare adults with schizophrenia (n = 27), with autism (n = 114) and a healthy control group (n = 30). Schizophrenia diagnoses were based on the Structured Clinical Interview for the DSM-IV Axis I (SCID-I) and behavioral symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Autism was diagnosed with a DSM-IV questionnaire for autism spectrum disorders and the Autistic Diagnostic Interview, revised version. The Wechsler Adult Intelligence Scale, third version (WAIS-III) was used to assess cognitive functions. All participants were between 18 and 65 years of age and had a minimum full scale intelligence of 80. Results showed that patients with schizophrenia scored significantly lower on processing speed than patients with autism and the healthy control group. Differences on other index scales were not found. In participants with schizophrenia a correlation was found between processing speed impairment and negative symptoms. Diagnosis could be predicted correctly with WAIS-III profile in 70.4% of the cases with schizophrenia compared to 56.7% of the healthy control group and 22.8% of the autism group.     

Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans

Abstract

Objectives: Impaired cognition and pre-frailty are associated with poor health outcomes. However, research has not examined the combined impact of cognitive impairment and pre-frailty on future frailty and mortality among older Mexican Americans.

Methods: Data for this analysis came from the 2006–2007 and 2010–2011 waves of the Hispanic EPESE. The final sample included 639 Mexican Americans aged ≥77 years who were non-frail or pre-frail in 2006–2007. Frailty measure included weight loss, exhaustion, weakness, and slow walking speed. Participants were classified as non-frail (0 criteria) and pre-frail (1 criterion) at baseline. Cognitive impairment was defined as <21 points on the MMSE. At baseline, participants were grouped as: cognitively intact non-frail, cognitively intact pre-frail, cognitively impaired non-frail, and cognitively impaired pre-frail. Logistic and hazard regression models were used to evaluate the odds of being frail in 2010–2011 and risk for 10-year mortality.

Results: Cognitively impaired pre-frail participants were more likely to become frail (OR?=?4.82, 95% CI?=?2.02–11.42) and deceased (HR?=?1.99, 95% CI?=?1.42–2.78). Cognitively impaired non-frail participants had significantly higher risk for mortality (HR?=?1.55, 95% CI?=?1.12–2.19) but not frailty (OR?=?1.29, 95% CI?=?0.50–3.11). Being cognitively intact and pre-frail at baseline was not significantly associated with being frail at follow-up (OR?=?1.62, 95% CI?=?0.83–3.19) or mortality (HR?=?1.29, 95% CI?=?0.97–1.71).

Conclusions: Comorbid cognitive impairment and pre-frailty is associated with future frailty and mortality in older Mexican Americans. Screening for cognitive impairment may be effective for identifying pre-frail Mexican Americans who are at the highest risk of frailty and mortality.     

The moderating effect of subjective age on the association between depressive symptoms and cognitive functioning in Korean older adults

Objectives: Depressive symptoms are greatly associated with cognitive impairment in older adults. Recent growing body of literature has reported that the subjective perception of one's own age (subjective age) predicts both cognitive performance and mental well-being in old age. This study aims to examine whether subjective age moderates the association between depressive symptoms and cognitive functioning in a representative sample of Korean older adults. To address this research question, we employed the Stereotype-Embodiment Theory as a theoretical guide.

Method: Data are from the 2016 Dementia Literacy Survey collected by Kyung Hee University, and 526 community-dwelling Korean older adults (ages 60–79) completed the questionnaire about depressive symptoms, cognitive functioning, and subjective age.

Results: According to the hierarchical regression analysis, both higher levels of depressive symptoms and older subjective age were associated with poorer cognitive functioning. Further analyses showed that subjective age attenuated the effect of depressive symptoms on cognitive functioning: when older adults have a higher level of depression, those with younger subjective age reported a higher level of cognitive functioning than those with older subjective age.

Conclusion: Based on the findings from this study, both theoretical and practical implications were discussed.     

Socio-cultural Factors Associated with the Initiation of Opium Use in Darab, Iran

This study aimed to identify socio-cultural factors facilitating initiation of opium use among drug users in Darab, Iran. A qualitative study using in-depth interviews was conducted. The study began in June 2006 and included 76 drug users, aged 20–43, of whom 95% (72) were male, and 5% (4) were female. The five most common factors facilitating initiation of drug use were revealed to be: lack of hobbies, treatment of general medical problems, modeling, peer networks, and cultural norms. Partner pressure was a common complaint among women in this study. Cultural factors perceived to facilitate initiation of drug use revealed in this study have not been fully addressed by current prevention and rehabilitation programs. Programs can be targeted at social and family levels to alter drug use culture.     

成年起病的癫痫患者认知损害的影响因素研究

目的评估患者性别、教育水平、发作频率、持续时间、抗癫痫药物和视频脑电图(VEEG)尖波出现对成年起病的癫痫患者认知能力的影响。方法 50例成年起病的癫痫患者接受VEEG检查后行简易精神状态量表(MMSE)和蒙特利尔认知评估量表(Mo CA)检查获得认知分数,按照上述6种因素分别分组,应用SPSS16.0软件进行差异统计学分析。结果 VEEG尖波出现明显降低癫痫患者两种量表得分(MMSE P0.01;Mo CA P0.05),而性别、发作频率和持续时间均不影响两种量表的得分(均P0.05)。丙戊酸钠治疗组两种量表的得分低于非丙戊酸钠(拉莫三嗪、奥卡西平、卡马西平和苯妥英钠)治疗组(MMSE P=0.097;Mo CA P=0.061)。研究还发现,较高教育程度癫痫人群Mo CA得分明显高于较低教育水平患者,Mo CA量表评分P0.05,而MMSE量表评分P0.05,提示Mo CA量表对于认知能力影响的评估更加敏感。结论 VEEG尖波出现提示成年发病癫痫患者的认知损害,丙戊酸钠治疗也可能损害癫痫患者的认知水平。另外,教育程度较高的成年发病癫痫患者认知能力较高。而癫痫发作频率、持续时间和患者性别不影响成年发病癫痫患者的认知水平。     

动脉瘤性蛛网膜下腔出血患者认知功能影响因素研究

目的研究动脉瘤性蛛网膜下腔出血（SAH）患者认知功能的动态变化及其影响因素。方法以简易智能量表评估入院时、出院时和出院后2个月患者的认知功能;以Hunt-Hess、GCS、手术方式、GOS、年龄、性别和入院时并发症为变量,研究其与SAH患者认知功能间的关系。结果 100例动脉瘤性SAH患者认知功能损害率入院时为37%,出院时60%,出院后2个月38%;出院时认知功能损害率高于入院时（χ2=10.590,P=0.001）和出院后2个月（χ2=9.684,P=0.002）;对出院时认知功能有显著影响的因素是Hunt-Hess、GOS和手术方式,对出院后2个月认知功能有显著影响的因素是GOS。结论动脉瘤性蛛网膜下腔出血患者存在一定程度的认知功能损害,并与一定的影响因素相关;血管内治疗有助于减轻认知功能的损害。     

Cerebellar brain volume accounts for variance in cognitive performance in older adults

Introduction

Frontal lobe atrophy is implicated in patterns of age-related cognitive decline. However, other brain areas, including the cerebellum, support the work of the frontal lobes and are also sensitive to the effects of ageing. A relationship between cerebellar brain volume and cognitive function in older adults is reported, but no study has separated variance associated with cerebellar gray matter volume and cerebellar white matter volume; and no study has examined whether or not brain volume in the cerebellum is related to cognitive function in older adults after statistical control for frontal lobe volume of gray and white matter.

Method

We used voxel based morphometry (VBM) and structural equation modelling (SEM) to analyse relations between general cognitive ability (G) and volume of GM and WM in frontal areas and cerebellum in a sample of 228 older adults (121 males and 107 females).

Results

Results indicate that GM volume in the cerebellum predicts G, even when total intracranial volume (TICV) and GM gray and WM volumes in frontal lobes are statistically controlled. However, results differ for males and females, with males showing a stronger relationship between brain volume in the cerebellum and G.

Conclusions

Results are discussed in light of neurological models of cognitive ageing and the significance of the cerebellum in models of cognitive functioning.