Concurrent validity of the Test of Nonverbal Intelligence with referred suburban and Canadian native children

The relationship between the Test of Nonverbal Intelligence (TONI) and the WISC-R was investigated for cultural differences. The samples consisted of 30 suburban and 22 Native children who were referred for learning difficulties. The results indicated the suburban group was higher than the Native group on Verbal IQ, but not Performance IQ, Full Scale IQ, or the TONI Quotient. The correlation coefficient between the TONI Quotient and PIQ was as expected in the Native group, but unexpectedly low in the suburban group. Implications of these findings for the testing of both referred majority and Native group members are discussed.     

Utility of a seven-subtest version of the WAIS-R among an Alzheimer's disease sample.

Recent health care sector changes have created a need for shorter, more focused neuropsychological assessments. The WAIS-R provides useful information on patients' general cognitive abilities, but poses problems in that it is time-consuming and may contribute to fatigue, especially among geriatric patients with dementia. This study evaluated Ward's (1990) 7-subtest version of the WAIS-R among 32 patients with presumptive Alzheimer's disease. Among all patients, the abbreviated test underestimated full WAIS-R scores by an average of 2.0, 0.2, and 1.8 points for the Verbal Intelligence Quotient (VIQ), Performance Intelligent Quotient (PIQ), and Full-Scale Intelligence Quotient (FSIQ). This general finding held true regardless of whether scores were generated using the standard WAIS-R method (for patients age 75 and younger) or using age corrections (i.e., Mayo Older Americans' Normative Studies [MOANS]) for older patients. Most patients scored within the mean standard errors of measurement defined in the WAIS-R manual for VIQ, PIQ, and FSIQ. In general, the 7-subtest and full versions of the WAIS-R yielded similar findings among this closely screened sample, but further testing among a more typical sample of patients with multiple risk factors for dementing conditions is needed.     

首发脑卒中患者认知功能障碍与抑郁和脑损伤部位的关系

目的 :探讨急性期脑卒中病人的认知功能障碍与抑郁和脑损伤部位的关系。方法 :选择 62例单一首发病灶的脑卒中病人作为研究对象 ,用修订韦氏成人智力量表四合一简式 ,汉密顿抑郁量表和神经功能缺损评定等方法进行检测。结果 :1 前部卒中病人FIQ (总智商 ) ,VIQ (语言智商 )和V (词汇 )分显著低于后部 (P <0 0 5or 0 0 1) ;2 抑郁组智力各分非常显著低于正常组 (P <0 0 1) ,非抑郁组PIQ (操作智商 ) ,PA (图排 )和PC (填图 )分显著低于正常组 (P <0 0 5or 0 0 1,抑郁组和非抑郁组智力比较未发现差异 (P >0 0 5 ) ;3 多元逐步回归分析发现智力与抑郁 ,年龄和受教育程度有关。结论 :前部卒中和抑郁的病人更易产生认知功能障碍     

Neurocognitive Outcome in Survivors of Childhood Acute Lymphoblastic Leukemia: Experience at a Tertiary Care Hospital in Korea

This study was conducted to investigate long-term neurocognitive outcomes and to determine associated risk factors in a cohort of Korean survivors of childhood acute lymphoblastic leukemia (ALL). Forty-two survivors of ALL were compared with 42 healthy controls on measures of a neurocognitive test battery. We analysed potential risk factors (cranial irradiation, sex, age at diagnosis, elapsed time from diagnosis, and ALL risk group) on neurocognitive outcomes. ALL patients had lower, but non-significant full-scale intelligence quotient (FSIQ, 107.2±12.2 vs. 111.7±10.2), verbal intelligence quotient (VIQ, 107.7±13.6 vs. 112.2±11.4), and performance intelligence quotient (PIQ, 106.3±14.2 vs. 110.1±10.7) scores than healthy controls. However, patients treated with cranial irradiation performed significantly lower on FSIQ (102.2±8.1), VIQ (103.3±11.7), and PIQ (101.4±13.2) compared to non-irradiated patients and healthy controls. ALL patients also had poor attention, concentration, and executive functions. Among ALL survivors, cranial irradiation was a risk factor for poor FSIQ, being male was a risk factor for poor PIQ, and younger age was a risk factor for poor attention. Therefore, the delayed cognitive effects of ALL treatment and its impact on quality of life require continuing monitoring and management.

Graphical Abstract

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Cognitive and Academic Late Effects Among Children Previously Treated for Acute Lymphocytic Leukemia Receiving Chemotherapy as CNS Prophylaxis

Objective: Examine cognitive and academic late effects amongchildren and adolescents who had received central nervous system(CNS) prophylactic chemotherapy alone for acute lymphocyticleukemia (ALL); none had received whole brain radiation therapy(RT). Method: Subjects included 47 children and adolescents from 5to 22 years of age who were treated on the same protocol andhad been off treatment from 2 to 7 years at the time of assessment. Results: As a group the survivors displayed generally averageperformance on measures of cognitive and academic abilities,although they differed from normative means on tests of nonverbalskills. Girls performed more poorly than the normative sampleon nonverbal tasks, while no differences were found for boys.Age at diagnosis and time off treatment were not significantlyassociated with cognitive and academic functioning for survivorsof this particular chemotherapy-only protocol. Conclusions: Data were interpreted to support generally modestpotential late effects in specific areas for children and adolescentssurviving ALL. These findings suggest a need for monitoringnonverbal cognitive skills for childhood survivors of ALL, particularlyfor girls.     

Intellectual, neuropsychological, and academic functioning in long-term survivors of leukemia

OBJECTIVE: To assess the effects of treatment for acute lymphoblastic leukemia (ALL) on children's cognitive functioning. METHOD: Participants were long-term survivors of ALL treated with cranial irradiation and central nervous system (CNS) chemotherapy (n = 20), or CNS chemotherapy only (n = 21), healthy children (n = 21), and children with chronic asthma (n = 21). The groups were compared on measures of intellectual, neuropsychological, and academic functioning. RESULTS: CNS chemotherapy, with and without cranial irradiation, was associated with significantly lower levels of intellectual and academic functioning. Children with chronic asthma obtained lower scores than healthy controls, but these differences were not significant. Tests of neuropsychological functioning did not consistently separate the groups. CONCLUSIONS: CNS chemotherapy and, to a lesser extent, chronic illness both contribute to the poorer performance of long-term survivors of ALL on measures of intellectual and academic functioning.     

Verbal cognitive functioning and learning in girls treated for acute lymphoblastic leukemia by chemotherapy with or without cranial irradiation

Neuropsychological problems have frequently been reported following treatment of Acute Lymphoblastic Leukemia (ALL), however, partly because of the heterogeneity of the previously studied samples, the specific nature of these deficits is still a matter of debate. These problems, however, appear to be related more to the combination of cranial radiation therapy (CRT) and intrathecal chemotherapy (ITC) than to ITC alone. In this study, we evaluated a homogenous group of l9 girls between the ages of 7 and 11 years, 30 months after the completion of treatment. Nine received cranial radiation and chemotherapy and 10 were treated with chemotherapy alone. The patients were compared to 10 normal healthy controls. Neuropsychological tests included the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), the California Verbal Learning Test-Children's Version (CVLT-C), and the Calculation and Passage Comprehension subtests of the Woodcock-Johnson Psycho-Educational Battery-Revised. Results confirmed the presence of a verbal learning deficit in ALL girls treated with the combination of ITC and CRT. The ITC and CRT group scored significantly lower than the healthy controls on the Passage Comprehension subtest and on 5 of the 6 verbal subtests of the WISC-III. Furthermore, compared to nonirradiated patients and healthy normal controls, the ITC and CRT group was impaired on the Freedom from Distractibility index of the WISC-III, indicating an auditory-verbal attention deficit. On the CVLT-C, the ITC and CRT group was particularly impaired on the second half of the learning trials compared to the other two groups, showing a plateau in their performance. The ITC group was not different from the healthy control group, suggesting a less detrimental effect of the ITC alone on verbal abilities. Globally, these results indicate a deficit affecting auditory attention and verbal learning in girls who receive ITC and CRT, which may suggest the necessity for special educational assistance for these children.     

Predictive validity of WAIS-R VIQ-PIQ splits in persons with major depression.

We selected a sample of patients with depression (N = 70) and used Bayesian analyses to examine the diagnostic predictive validity of the Wechsler Adult Intelligence Scale-Revised Verbal IQ (VIQ) minus Performance IQ (PIQ) difference score for depression. The patients showed average VIQ-PIQ differences in the expected direction (i.e., VIQ > PIQ). However, based on sensitivity, specificity, and positive predictive value statistics, we concluded that the VIQ-PIQ split has very low predictive validity in persons with depression.     

Conventional intelligence measurements and neuropsychological concepts of adaptive abilities.

The concept of intelligence and its representation by the Intelligence Quotient have been difficult to define and the subject of criticism for various reasons. Matarazzo and Kaufman have reviewed intelligence measurements and brain functions, but a biologically based explication of intelligence has not been explicitly proposed since the theories presented more than 40 years ago by Halstead and Hebb. The present study explored the overlap and differential sensitivity of intelligence measures (VIQ, PIQ, and FSIQ) and neuropsychological measures (Impairment Index and Category Test) to cerebral damage and educational attainment. The results indicated that neuropsychological measures may serve to broaden the concept of intelligence and that a brain-related criterion may contribute to a fuller understanding of its nature.     

A comparison of the WISC-R and the WAIS-R with special education students

The results from Wechsler Adult Intelligence Scale-R (WAIS-R) and Wechsler Intelligence Scale for Children-R (WISC-R) with a sample of exceptional adolescents (N = 28) were compared over a 3-year period to determine whether the subjects can be expected to obtain similar subtest scores and similar VIQ, PIQ, and FSIQ scores. Results indicated that the sample scored higher on the WAIS-R Verbal and WAIS-R Full Scale than on the WISC-R Verbal and Full Scale. The findings are discussed in terms of the clinical application, especially as they relate to retesting exceptional children and youth with the WAIS-R.     

Comparison of various WISC-R summary scores for a psychiatric sample

Compared two sets of summary scores for the Wechsler Intelligence Scale for Children-Revised (WISC-R). The traditional scores used to summarize information about WISC-R performance (i.e., Verbal IQ (VIQ), Performance IQ (PIQ) and discrepancy between VIQ and PIQ) were compared to scores based on the three factors identified by Kaufman (1975) (i.e., Verbal Comprehension (VC), Perceptual Organization (PO) and Freedom from Distractibility (FD). Ss were 260 psychiatric outpatients who were administered the WISC-R during a 4-year period. The independent variables were sex and DSM II diagnosis. There were significant main effects for diagnosis for the VC and FD scales. There was a significant interaction for VIQ and nonsignificant results for the VIQ-PIQ discrepancy score. The groups did not differ in perceptual organization skills as assessed by PO and PIQ. Delinquents performed particularly poorly on the VC scale; hyperactive children had the highest VC score and relatively low scores on the FD factor; learning disabled children had low VC and FD scores. These findings suggest that the scores based on Kaufman's factors provided important clinical summary information that was not available from the traditional scores.     

Veränderungen der Blut-Liquorschranke für Serumproteine bei Kindern mit akuter lymphatischer Leukämie

Summary The blood-CSF barrier inhibits permeation of most chemotherapeutic agents into the central nervous system (CNS). The influence of systemic chemotherapy and prohylactic CNS irradiation on the permeability of the blood-CSF barrier was studied in 49 children treated for acute lymphoblastic leukemia (ALL) or non-Hodgkin's lymphoma.To study the permeability of the blood-CSF barrier under treatment according to BFM-ALL protocols, nephelometric determinations of albumin, immunoglobulin G (IgG), and alpha-2-macroglobulin in serum and CSF and total protein in CSF were performed at several time intervals during chemotherapy and prophylactic cranial irradiation.During systemic induction chemotherapy, no significant changes of blood-CSF barrier could be observed. In contrast, in the course of prophylactic CNS irradiation and intrathecal methotrexate application, a significant elevation of albumin, alpha-2-macroglobulin and total protein in CSF, and a significant decrease of blood: CSF ratios for albumin and alpha-2-macroglobulin were observed. IgG did not change significantly.After prophylactic CNS treatment and during maintenance chemotherapy protein concentrations and blood:CSF ratios gradually returned to normal range. This normalization was accelerated by cortisone treatment during the reinduction period.

     

Motor and perceptual timing deficits among survivors of childhood leukemia

OBJECTIVE: There is growing evidence of cerebellar-frontal system change in children treated for leukemia with chemotherapy alone (Lesnik et al., 1998). METHODS: We compared 22 long-term survivors of acute lymphoblastic leukemia (ALL), aged 8-18, to 22 age- and gender-matched controls on tasks emphasizing cerebellar-frontal functioning including judgment of time duration and motor timing. Groups were also compared on a judgment of pitch task, used as a control measure. Children with ALL were at least 5 years from diagnosis, treated with intrathecal chemotherapy (methotrexate in all, hydrocortisone and cytarabine in 20/22), but not radiation therapy, and free from recurrence of disease. RESULTS: After controlling for IQ, the ALL group had poorer performance than controls on judgment of long duration and motor timing, but not judgment of pitch. CONCLUSIONS: Treatment with intrathecal and infusional chemotherapy for childhood ALL may be associated with skill deficits comparable to those seen in individuals with cerebellar-frontal abnormalities.     

老年帕金森病患者事件相关电位检测与认知功能障碍的临床研究

目的：探讨老年帕金森病（PD）患者事件相关电位（ERP）与认知功能障碍的关系,并对其相关因素进行分析。方法：PD患者45例,根据年龄分组,≥60岁为PD老年组,〈60岁为PD非老年组。对所有入选患者进行ERP检测和韦氏成人智力量表中国修订版（WAIS-RC）检查,测定患者的ERP的N2、P3波潜伏期、波幅和患者的语言智商（VIQ）、操作智商（PIQ）、全智商（FIQ）等。结果：老年组PD患者ERP的N2、P3波潜伏期的异常率为73％,非老年组PD患者相应为33％,二者比较差异有极显著意义（P〈0．001）;老年组PD患者WAIS-RC测试异常率为60％,非老年组PD患者为20％,二者比较差异有统计学意义（P〈0．05）。患者的病程、受教育年限、运动功能障碍程度与ERP异常无相关性（P〉0．05）;病程与患者的VIQ、PIQ、FIQ无相关性（P〉0．05）;运动功能障碍程度与VIQ、PIQ、FIQ呈负相关（P〈0．05）;受教育年限与VIQ、PIQ、FIQ呈正相关（P〈0．05）。结论：老年组PD患者的认知功能障碍异常率明显高于非老年组PD患者。PD患者的认知功能障碍（VIQ、PIQ、FIQ）不仅与年龄有关,而且与运动功能障碍程度、受教育年限相关。ERP的检测对认知功能障碍测试比WAIS-RC更敏感,且不受患者的病程、受教育年限、运动功能障碍程度的影响,能客观反映出PD患者认知功能的损害。     

Cognitive status of children treated with central nervous system prophylactic chemotherapy for acute lymphocytic leukemia.

Treatment-related cognitive impairments have been reported for survivors of childhood leukemia following prophylactic central nervous system (CNS) treatment with craniospinal radiation. We examined the neurocognitive status of 46 children with acute lymphocytic leukemia (ALL) to assess the impact of a regimen consisting of systemic chemotherapy and prophylactic CNS chemotherapy. By comparing three groups of ALL children (i.e., patients whose diagnosis was recent, patients 1 year postdiagnosis currently receiving CNS prophylactic chemotherapy, and off-therapy patients who had been treated with chemotherapy for 3 years) and their healthy siblings on measures of sequential and simultaneous processing, we were able to examine the effects of CNS prophylactic and systemic chemotherapy at various points during treatment. Results indicate that the children who had received a 3-year course of chemotherapy (off-therapy patients) were more impaired on tasks involving right-hemisphere simultaneous processing than were sibling controls or ALL children whose diagnosis was recent and whose treatment had just begun. Age at diagnosis did not interact with the effects of chemotherapy. These findings support the need for continued evaluation of cognitive functioning in ALL, children receiving CNS prophylactic chemotherapy to identify potential harmful neurocognitive sequelae of treatment.     

Molecular,clinical and neuropsychological study in 31 patients with Kabuki syndrome and KMT2D mutations

Kabuki syndrome (KS—OMIM 147920) is a rare developmental disease characterized by the association of multiple congenital anomalies and intellectual disability. This study aimed to investigate intellectual performance in children with KS and link the performance to several clinical features and molecular data. We recruited 31 children with KMT2D mutations who were 6 to 16 years old. They all completed the Weschler Intelligence Scale for Children, fourth edition. We calculated all indexes: the Full Scale Intellectual Quotient (FSIQ), Verbal Comprehension Index (VCI), Perceptive Reasoning Index (PRI), Processing Speed Index (PSI), and Working Memory Index (WMI). In addition, molecular data and several clinical symptoms were studied. FSIQ and VCI scores were 10 points lower for patients with a truncating mutation than other types of mutations. In addition, scores for FSIQ, VCI and PRI were lower for children with visual impairment than normal vision. We also identified a discrepancy in indexes characterized by high WMI and VCI and low PRI and PSI. We emphasize the importance of early identification and intensive care of visual disorders in patients with KS and recommend individual assessment of intellectual profile.     

Behavioral Adkjustmnet and Social Functioning of Long-Term, Survivors of Childhood Leukemia: Parent and Teacher Reports

Obtained parent and teacher reports of behavior and social competencefor children who were survivors of acute lymphoblastic leukemia(ALL). At followup, children were 5–18 years of age, 48months postdiagnosis, in first continuous remission, and ofchemotherapy. Each child had been randomized to receive either1,800 cGY whole brain radiation therapy (WBRT) plus intrathecalmethotrexate (IT MTX), or IT MTX alone as central nervous systemprophylaxis, and one of four chemotherapy regimenss that variedin treatment intensity. Scores on standardized measures (CBCL-P/Tand PIC) were generally similar to instrument, norms. Parents,but not teachers, reported heightened child somatic concerns.There was no effect of WBRT or chemotherapy regimen on ratingsof behavioral adjustment. Results indicate minimal psychosocialmorbidity among long-term survivors of ALL and suggest thatthe stressful life envents associated with cancer and its treatmentdo not cause significant behavioral or emotional diffculties.     

White Matter Microstructure and Information Processing at the Completion of Chemotherapy-Only Treatment for Pediatric Acute Lymphoblastic Leukemia

Little is known about white matter microstructure and its role in information processing abilities of children treated for acute lymphoblastic leukemia (ALL) early posttreatment. Twenty-one survivors of ALL and 18 controls (7–16 years) underwent neurocognitive assessment. A subsample underwent diffusion-weighted magnetic resonance imaging. The ALL group performed poorer on measures of processing capacity, and had widespread areas of decreased fractional anisotropy and increased radial diffusivity. Significant group by white matter microstructure interactions was found when predicting processing speed. Findings provide evidence for an atypical brain–behavior relationship early posttreatment for childhood ALL. Replication in a larger sample is required.     

Cognitive profiles of children with early onset of unilateral lesions

The level and pattern of Wechsler Intelligence Scale for Children‐Revised (WISC‐R) performance for 18 left‐lesioned (LL) and 13 right‐lesioned (RL) children with clearly defined unilateral involvement and no ongoing seizure disorders were compared to normal controls matched by age, sex, race, and social class. Verbal IQ (VIQ), Performance IQ (PIQ), and Full Scale IQ (FIQ) were well within normal limits for all groups, although RL children scored significantly lower than right controls. No significant differences between VIQ, PIQ, and FIQ were found within the LL or RL or control groups; thus VIQ and PIQ discrepancy was not found to relate to lesion laterally. When WISC‐R subtests were recategorized according to Kaufman's factors, the Freedom from Distractibility factor was impaired in both LL and RL children, whereas RL children were also deficient on the Perceptual Organization factor. Level and pattern of cognitive performance are discussed in relation to age of lesion onset and site of lesion within a hemisphere.     

Cingulum fiber diffusivity and CSF T-tau in patients with subjective and mild cognitive impairment

Diffusion tensor imaging (DTI) and CSF biomarkers are useful diagnostic tools to differentiate patients with mild cognitive impairment (MCI) from normal controls, and may help predict conversion to dementia. Total Tau protein (T-tau) and DTI parameters are both markers for axonal damage, thus it is of interest to determine if DTI parameters are associated with elevated CSF T-tau levels in patients with cognitive impairment. For this purpose, patients with subjective cognitive impairment (SCI) and MCI were recruited from a university based memory clinic.Regions of interest were used to determine fractional anisotropy (FA), radial diffusivity (DR) and axial diffusivity (DA) in known white matter tracts in patients with MCI (n = 39) and SCI (n = 8) and 26 cognitively healthy controls. Significant lower FA and higher DR values were observed in patients with pathological vs. patients with normal CSF T-tau levels and vs. controls in left posterior cingulum fibers. T-tau values were negatively correlated with FA and positively correlated with DR values in the posterior cingulum fibers.Cingulum fiber diffusivity was related to T-tau pathology in SCI/MCI patients and altered DR may suggest that loss of myelin contributes to early white matter changes in patients at risk of developing Alzheimer's disease (AD).