Assessment of neuropsychological performance in Mexico City youth using the Cambridge Neuropsychological Test Automated Battery (CANTAB)

Background: The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized tool used to measure cognitive function in diverse populations and is sensitive for assessing developmental changes in children. Although CANTAB has been used in several countries, its applicability in a Mexican child population is unknown. This study examined developmental trends on CANTAB in a large sample of urban Mexico City youth and tested the hypothesis that their performance would be similar to a large US normative sample.

Method: As part of a birth cohort, Early Life Exposures in Mexico to Environmental Toxicants, 826 children, ages 5–15 years, completed CANTAB. Subtests measured planning (Stockings of Cambridge; SOC), short-term memory (Delayed Matching to Sample; DMS), sustained attention (Rapid Visual Information Processing; RVP), ability to match visual stimuli (Match to Sample Visual Search; MTS), flexibility (Intra-extra Dimensional Set Shift; IED), and response inhibition (Stop Signal Task; SST). Determinants of performance on the CANTAB, including age, maternal/child IQ, and sex, were analyzed using Spearman correlation and Welch t tests. Equivalence testing compared performance with existing norms.

Results: Performance improved with age on all measures. Child IQ was mildly associated with measures of memory and attention but not executive functioning, consistent with US norms. Maternal IQ was not associated with any outcomes, and males performed better on IED. Mexican norms were comparable to US norms on almost all outcomes, with the exception of a short-term visual recognition memory task (DMS).

Conclusions: This study provides the largest normative data for CANTAB performance in a community sample of Mexican youth. Findings demonstrate the expected maturational effects of executive function, specifically in cognitive shifting and inhibition. Levels of executive function performance demonstrated by a Mexican sample were consistent with normative values reported in US youth. These findings, as well as expected associations with child IQ, indicate high applicability of CANTAB for Mexican youth in neurobehavioral studies.     

首次发病的强迫症患者认知功能的研究

目的:探讨首次发病的强迫症(OCD)患者认知功能的特点及相关影响因素。方法:采用逻辑记忆、视觉再生记忆、连线测验、数字广度、Stroop测验及威斯康星卡片分类测验分别对35例首次发病的OCD患者(OCD组)及30名健康对照者(HC组)进行神经心理学测评;应用Yale-Brown强迫量表(Y-BOCS)、抑郁自评量表(SDS)、状态-特质焦虑问卷(STAI)评定患者的病情及抑郁、焦虑程度。结果:OCD组的逻辑延迟记忆、视觉再生记忆、连线测验A、B时间、数字广度倒背、Stroop测验字色阅读时间、威斯康星卡片分类测验成绩较明显差于健康对照组(P均<0.05)。OCD患者的病程与其视觉延迟记忆、数字广度倒背分呈负相关(r=-0.39,P=0.024;r=-0.38,P=0.027),SDS分与Stroop测验字色阅读时间正相关(r=0.37,P<0.05),Y-BOCS分、SAI分及TAI分与各神经心理学指标的相关性无统计学意义(P均>0.05)。结论:首次发病的OCD患者存在记忆、注意和执行功能损害。     

The International Society for Bipolar Disorders–Battery for Assessment of Neurocognition (ISBD‐BANC)

Yatham LN, Torres IJ, Malhi GS, Frangou S, Glahn DC, Bearden CE, Burdick KE, Martínez‐Arán A, Dittmann S, Goldberg JF, Ozerdem A, Aydemir O, Chengappa KNR. The International Society for Bipolar Disorders–Battery for Assessment of Neurocognition (ISBD‐BANC).
Bipolar Disord 2010: 12: 351–363. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objectives: Although cognitive impairment is recognized as an important clinical feature of bipolar disorder, there is no standard cognitive battery that has been developed for use in bipolar disorder research. The aims of this paper were to identify the cognitive measures from the literature that show the greatest magnitude of impairment in bipolar disorder, to use this information to determine whether the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB), developed for use in schizophrenia, might be suitable for bipolar disorder research, and to propose a preliminary battery of cognitive tests for use in bipolar disorder research. Methods: The project was conducted under the auspices of the International Society for Bipolar Disorders and involved a committee that comprised researchers with international expertise in the cognitive aspects of bipolar disorder. In order to identify cognitive tasks that show the largest magnitude of impairment in bipolar disorder, we reviewed the literature on studies assessing cognitive functioning (including social cognition) in bipolar disorder. We further provided a brief review of the cognitive overlap between schizophrenia and bipolar disorder and evaluated the degree to which tasks included in the MCCB (or other identified tasks) might be suitable for use in bipolar disorder. Results: Based on evidence that cognitive deficits in bipolar disorder are similar in pattern but less severe than in schizophrenia, it was judged that most subtests comprising the MCCB appear appropriate for use in bipolar disorder. In addition to MCCB tests, other specific measures of more complex verbal learning (e.g., the California Verbal Learning Test) or executive function (Stroop Test, Trail Making Test–part B, Wisconsin Card Sorting Test) also show substantial impairment in bipolar disorder. Conclusions: Our analysis reveals that the MCCB represents a good starting point for assessing cognitive deficits in research studies of bipolar disorder, but that other tasks including more complex verbal learning measures and tests of executive function should also be considered in assessing cognitive compromise in bipolar disorder. Several promising cognitive tasks that require further study in bipolar disorder are also presented.     

Cognitive Assessment and Rehabilitation Pathway for Stroke (CARPS)

Abstract

Complex cognitive impairments are common after stroke and they can significantly impede individuals’ progress in rehabilitation. Treatment strategies that allow patients to compensate for such deficits are therefore an important part of multidisciplinary rehabilitation, as acknowledged by various clinical guidelines. In part due to the heterogeneity of poststroke cognitive impairments, the evidence base for treatments in this area is often unclear or inconsistent. There are no straightforward clinical tools or guidelines available to facilitate poststroke cognitive rehabilitation across cognitive domains. The present article proposes a cognitive assessment and rehabilitation pathway for stroke (CARPS), which aims to provide a structure to guide stroke rehabilitation teams in this difficult area of clinical practice. Practical treatment strategies are also discussed in some detail. Finally, the limitations of the proposed pathway are acknowledged, as is the importance of further research.     

Cognitive fMRI and soluble telencephalin assessment in patients with localization-related epilepsy

Objectives - The use of telencephalin as a possible marker for altered cortical function as demonstrated by functional MRI was investigated in a pilot study with 16 patients with localization-related epilepsy and secondarily generalized seizures. Materials and methods - Functional MRI of verbal working memory performance (Sternberg paradigm) and self-regulatory control processes (Stroop paradigm) was used to examine cortical activation in 16 patients with localization-related epilepsy and secondarily generalized seizures. Additionally, blood serum concentrations of soluble telencephalin (marker for neuronal damage) were determined. Results - In three patients (one temporal and two frontal focus), telencephalin was detected. All three patients had lower functional MRI activation in the frontotemporal region (P = 0.04), but not in other regions (P > 0.35) compared with patients without detectable telencephalin. Additionally, an association of levetiracetam and frontotemporal activation was observed. Conclusions - These preliminary data in a heterogeneous group suggest an association between decreased frontotemporal activation on fMRI and both detectable telencephalin serum levels and levetiracetam use. Future longitudinal studies with larger patient groups are required to confirm these observations. It is hypothesized that altered local function of the frontotemporal cortex in localization-related epilepsy might be better predicted by the biochemical marker telencephalin than epilepsy characteristics such as seizure focus.     

Cognitive functioning in the general population: Factor structure and association with mental disorders—The neuropsychological test battery of the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1‐MH)

The objective of this study is to obtain population level data about cognitive functions and their association with mental disorders. We here report factor analytic and psychometric findings of a neuropsychological test battery and examine the association of current and past mental disorders with cognitive function in a large nationwide population‐based sample of 18‐ to 79‐year‐old adults in Germany (n = 3,667) participating in the mental health module of the German Health Interview and Examination Survey for Adults 2008–2011. Confirmatory factor analysis confirmed verbal memory and executive function factors. Older age was strongly associated with lower verbal memory and executive function and with higher vocabulary scores. After adjustment for age, sex, and education, rather modest decrements were found for verbal memory (β = ?.118, p = .002) and executive functions (β = ?.191, p < .001) in participants with any current mental disorder (n = 442) compared to those without (n = 3,201). Small decrements in memory (β = ?.064, p = .031) and executive function (β = ?.111, p < .001) were found in participants with any mental disorder in the last 12 months but not in those with past (fully or partially remitted) mental disorders, compared to participants without a history of mental disorder. More fine‐grained analyses of these data will investigate the complex interplay between cognition, health behaviors, and specific mental and somatic diseases.     

蒙特利尔认知评估量表在帕金森病认知障碍患者中的应用价值

目的 分析蒙特利尔认知评估(MoCA)量表(中文版)在筛查帕金森病(PD)患者中认知障碍的应用价值.方法 使用RoSA编制的,根据年龄及教育程度调整的MMSE分界值筛出整体认知功能正常的213例PD患者,并进一步使用MoCA量表对其进行分组,MoCA评分≥26分的PD患者入PD认知正常组(PD-NC组),MoCA评分<26分的PD患者入PD认知损害组(PD-CI组).比较2组患者MoCA各分测验分数的差异及认知功能改变的特点,并应用单因素及多元Logistic回归分析PD患者认知损害的影响因素.结果 (1)PD组患者中52.6%(112/213)的患者MoCA评分<26分;(2)与PD-NC组比较,PD-CI组在MoCA视空间和执行、命名、注意力、语言、抽象、延迟回忆、定向分测验中得分诸项比较均有统计学意义;(3)Logistic回归分析结果显示,低文化程度是PD患者认知损害的影响因素(OR:0.72,95%CI0.64～0.81,P<0.05).结论 MMSE正常者中仍然存在相当比例的患者MoCA评分异常.因此,临床上建议使用MoCA对PD患者认知水平进行测试,在患者未达到PD痴呆时,应结合患者的教育水平及时发现并处理患者认知损害症状,使PD患者得到及时治疗并能提高生活质量.

Abstract：

Objective To examine the application of Montreal Cognitive Assessment (MoCA) in Parkinson' s disease (PD) patients with normal general cognitive function by Mini-Mental State Examination (MMSE) evaluation.Methods PD patients were examined with MMSE, and those having a normal ageand education-adjusted MMSE score were included in the further study of MoCA testing.The patients with MoCA score not less than 26 were selected into normal control PD-NC group, and the patients with less than 26 into cognitive impaired PD-CI group.Scores of MoCA subtests were used in PD-CI group and PD-NC group to characterize cognitive changes in PD patients with mild cognitive impairment (MCI).MoCA score in PD-CI group used as dependent variable, and sex, educational level, age, course of disease, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Self-rating depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Unified Parkinson' s Disease Rating Scale (UPDRS) were used as independent variable, the risk factors of CI in PD patients was analysed by Linear Regression Analysis.Results There are 52.6% (112/213) PD patients with MMSE ≥ 26 while their MoCA < 26.Significant differences were observed in subtests of MoCA in visuospatial, executive, naming, attention,language, abstract, delayed recall and orientation between PD-CI group and PD-NC group (all P <0.01).Univariate and multivariate regression analysis showed that educational level is the most significant factor in PD-CI (OR:0.72, 95% CI 0.64-0.81, P < 0.05).Conclusions There is a high proportion of PD patients whose MMSE test showed normal but MoCA test showed cognitive impairment.MoCA examination was used to detect cognitive function of PD patients.Furthermore we suggest consider the education level in PD patients when evaluate their cognitive function.     

亚综合征性抑郁患者认知功能初探

目的：探讨亚综合征性抑郁（SSD）患者的认知功能。方法：45例SSD患者,以31例抑郁症患者和28名正常人作为对照。SSD组和抑郁症组均使用抗抑郁剂治疗12个月以上。采用韦氏成人智力量表、临床记忆量表、威斯康星卡片分类测验（WCST）于治疗前后分别评定3组患者的认知状况;采用抑郁自评量表（SDS）评定抑郁症状的严重度。结果：治疗3个月,SSD组和抑郁症组的言语智商、操作智商、总智商、记忆商数均较治疗前明显提高（P〈0.05或P〈0.01）;WCST总应答数显著减少,分类数显著提高（P〈0.01）;两组SDS评分较治疗前显著下降（P〈0.01）。治疗12个月,两组上述认知指标进一步显著改善,SDS评分与对照组相比差异无显著性（P〉0.05）;但两组指向记忆、联想学习、WCST正确百分数、随机错误数与对照组相比仍未恢复正常（P〈0.01）。结论：SSD患者存在认知功能障碍,治疗后症状虽有缓解,但部分认知功能仍不能完全恢复。     

Cognitive and behavioral dysfunction in children with hypothalamic hamartoma and epilepsy

Hypothalamic hamartoma (HH) syndrome comprises the clinical triad of epilepsy, developmental retardation, and central precocious puberty. A predominant opinion has been that the acquired cognitive and behavioral disorders observed in children with this syndrome are a direct effect of their seizure activity. A review of the recent literature suggests that this opinion needs to be revised because it is only partially supported by the data. The size of the HH and its anatomic attachment/location, in addition to the seizure history, appear to contribute to the cognitive and behavioral disturbances in children with HH. Small sample sizes and the inability to use standard neuropsychological testing scales in more severely affected HH patients complicate the study of causality. The present literature, however, suggests that multiple factors contribute to the cognitive and behavioral problems of these children.     

The MATRICS Consensus Cognitive Battery (MCCB): clinical and cognitive correlates

The purpose of this study was to examine the cognitive and clinical correlates of the MATRICS Consensus Cognitive Battery (MCCB) which was originally developed to be an endpoint for cognitive enhancement clinical trials. In a sample of 117 people with schizophrenia and 77 healthy control participants we found the following: a) the MCCB was highly sensitive to the type and level of impairment typically observed in schizophrenia, b) the MCCB composite score was highly correlated with WASI Estimated Full Scale IQ score, c) that the MCCB domain scores were generally moderately-highly intercorrelated, d) that MCCB performance was minimally related to clinical symptom type and severity, and e) the MCCB is sensitive to employment status with better performance in employed vs. unemployed patients. These data support the validity of the MCCB as a sensitive measure of cognitive impairment in schizophrenia and suggest that MCCB performance is relevant for functional outcome. The data also suggest that the MCCB domain scores may offer limited resolution on discrete cognitive functions.     

Effects of topiramate versus other antiepileptic drugs on the cognitive function of patients With epilepsy

BACKGROUND： Only very large dose of topiramate has neurotoxicity, indicating that topiramate has low neurotoxicity and high safety. The residual rate of topiramate is affected by many cognitive-related adverse effects. Patients who take topiramate often accompany with thought slowness, difficulty in finding words, dyscalculia, blunt reaction, attention decreasing, memory deterioration, etc. OBJECTIVE： To compare the effects of topiramate with traditional anti-epileptic drugs （including carbamazepine and Valproic acid （VPA） on cognitive function of patients with epilepsy. DESIGN： Observational experiment, self-control and intergroup comparison. SETTING： Sichuan Academy of Medical Science. PARTICIPANTS： Eighty-seven inpatients and outpatients with newly diagnosed epilepsy who received preliminary diagnosis and follow-up in the Department of Neurology, Sichuan People＇s Hospital between January 2004 and June 2006 were involved in this survey. They were diagnosed according to disease history and electroencephalogram （EEG）. The onset type was diagnosed following the definition of epilepsy and epileptic syndrome in 1989 International Anti-epileptic League. The involved patients and their relatives were informed of detection and therapeutic regimen. The patients were assigned into two groups according to table of random digit： traditional antiepileptic drugs group （AEDs group, n =44） and topiramate （TPM） group （n =43）. METHODS： （1）Among the patients in AEDs group, carbamazepine was the first choice for 21 patients with partial seizures or partial secondarily generalized seizures, and VPA for 23 patients with generalized seizures. The initial dose of carbamazepine was 300 mg/d, and that of VPA was 500 mg/d. Patients in the TPM group took TPM with the initial dose of 25 mg/d, increased by 25 mg/d each week to target dose 150 mg/d within 8 weeks. （2） Curative effect was graded into 4 degrees： markedly effective, effective, ineffective and aggravated. Total effective rate was calculated. （3） Cognitive function of patients was tested before and 6 months after administration by using Wechsler Adult Intelligence Scale（WAIS） or Wechsler Intelligence Scale for Children （WISC, Chinese edition）, （Higher scores indicated better cognitive function）, Stroop color word interference, test of memory of past numbers, test of telling the names of fruits and vegetables within 1 minute （Shorter time for reading word, telling color and memory of past numbers demonstrated better cognitive function. Less errors in reading words, telling colors and memory of past numbers, numbering and telling the names of fruits and vegetables within 1 minute indicated better cognitive function）, etc. totally 22 items. （4） t test and paired t test were used for measurement data. MAIN OUTCOME MEASURES： Clinical curative effects and adverse reactions as well as neurological tests. RESULTS： Eighty-four pationts praticipated final analysis and 3 dropped out. （1） Inthe AEDS group and TPM group, total effective rate was 86% and 99%, respectively. （2） In the AEDs group, there were no significant changes in the scores of each test of WIS before and after treatment （P 〉 0.05）. In the TPM group, total IQ, word scores, verbal IQ and digit span scores were significantly decreased （ t =2.097 - 4.423, P 〈 0.05 - 0.01 ） .Following treatment, the time for reading word and telling color for patients in the AEDs group was prolonged in Stroop color interference test （ t = - 2.304, - 2.454, P 〈 0.05 ）, and time for reading word and memory of past numbers for patients in the topiramate group was significantly prolonged （ t = - 3.054, 2.272, P 〈 0.01, 0.05 ）. （3）There were no significant differences in scores of WIS before and after treatment in AEDs group and TPM group （P 〉 0.05）. Following treatment, verbal IQ, word scores, total IQ, digit span of patients in the TPM group were significantly lower than those in the AEDs group （t =2.052 - 3.297, P 〈 0.05- 0.01 ） .There were no significant differences in Stroop color word interference, memory of past numbers and telling the names of fruits and vegetables within 1 minute before and after treatment in AEDs group and TPM group （P 〉 0.05）. CONCLUSION： （1） Moderate and small doses of both TPM and AEDs may lead to mild cognitive function impairment of patients, mainly presenting delayed reaction and decreased sensitivity. （2）TPM mainly influences attention, language comprehension ability and fluency, while AEDs cause delayed reaction easily, but influence executive function mainly.     

儿童期精神分裂症患者认知功能研究

目的:探索儿童期精神分裂症患者认知功能情况。方法:对15名年龄≤16岁以妄想为主要症状的精神分裂症患者(患者组)及15名正常匹配儿童(对照组)进行认知功能测验(包括听觉词汇学习、数字广度、数字符号及瑞文标准推理测验)。结果:患者组在听觉词汇学习、数字广度、数字符号及瑞文标准推理测验成绩均较对照组差。其中,知觉辨别的效应值最大为-2.10,其次为比较推理-1.68、抽象推理-1.59、即刻记忆-1.50、数字符号-1.44、系列关系-0.85、数字广度(倒背、正背)分别为-0.77,-0.58、类同比较-0.30、延迟记忆保持率的效应值为0.32。结论:儿童期精神分裂症患者在智能、逻辑推理、记忆功能、注意功能、执行功能等方面均有不同程度的损害。     

抑郁症脑灰质结构和神经认知性别差异

目的:探讨抑郁症脑灰质体积和认知功能的性别差异。方法:38例抑郁症患者(男19例,女19例)及29名健康对照(男13名,女16名)均经常规及结构磁共振(MRI)扫描,同时联合反映脑区执行及记忆功能的神经心理学测量,t检验对性别组间数据进行统计分析。结果:①健康男性在右额上回皮质灰质体积较健康女性减小;女性抑郁症患者在右颞叶梭状回及右海马回皮质的灰质体积较男性患者减小(P<0.005,像素>10);②在字色干扰总时间上,健康男性成绩差于健康女性;而抑郁症女性瞬时记忆(数字倒背)项目分数低于男性(P<0.05);③字色干扰总时间的性别差异与右额上回皮质体积性别差异在健康受试中存在相关性(r=0.503,F=4.412,P=0.022);数字倒背的性别差异与右颞叶梭状回及右海马回皮质性别差异在抑郁症患者中未发现显著统计意义的相关(r=0.567,F=2.028,P=0.084)。结论:健康者及抑郁症患者在灰质体积及神经认知上均存在一定的性别差异。     

Cognitive profiles in Mild Cognitive Impairment (MCI) patients associated with Parkinson's disease and cognitive disorders

Background:

Mild cognitive impairment (MCI) is rapidly becoming one of the most common clinical manifestations affecting the elderly and represents an heterogeneous clinical syndrome that can be ascribed to different etiologies; the construct of MCI in Parkinson''s disease (PD) (MCI-PD) is more recent but the range of deficits is still variable. Early recognition and accurate classification of MCI-PD could offer opportunities for novel therapeutic interventions to improve the natural pathologic course.

Objective:

To investigate the clinical phenotype of amnestic mild cognitive impairment (aMCI) and in patients with PD and MCI (MCI-PD).

Materials and Methods:

Seventy-three patients with aMCI and in 38 patients with MCI-PD were enrolled. They all underwent Mini–mental State Examination (MMSE), the Rey auditory-verbal learning test and the immediate visual memory (IVM) item of the Mental Deterioration Battery, the Rey auditory-verbal learning test included the Rey-immediate (Rey-I), and the delayed recall of the word list (Rey test deferred, Rey-D). The Geriatric Depression Scale (GDS) was used for mood assessment.

Results:

The results of the Rey-I and Rey-D and of the IVM item showed statistically significant differences between the aMCI and the MCI-PD group. The mean Rey-I and Rey-D score was significantly lower as well as the IVM score was higher in patients with aMCI than in those with MCI-PD, aMCI patients showed greater impairment in long-term memory, whereas more aMCI than MCI-PD patients had preserved attention, computation, praxis, and conceptualization.

Conclusions:

Our findings demonstrate that the cognitive deficit profile is specific for each of the two disorders: Memory impairment was a typical feature in aMCI patients while MCI-PD patients suffered from executive functions and visuospatial attention deficits.     

Concurrent and predictive validity of the Allen Cognitive Levels Assessment

The present study examined the concurrent and predictive validity of the Allen Cognitive Levels (ACL) Assessment in a sample of 110 medicated patients with schizophrenia who received the ACL at discharge from a state psychiatric facility. Subsamples within this group of patients had received an Activities of Daily Living assessment (n=64) and a comprehensive neuropsychological test battery (n=48) at discharge, or a battery of community follow-up measures (n=30) 1–3.5 years following discharge as part of other investigations. Positive correlations were found between the ACL and concurrent measures of adaptive and cognitive function. With respect to cognitive variables, stepwise multiple regression analysis revealed that the majority of the variance in ACL scores was predicted by neuropsychological test scores assessing higher level cognitive processes, such as visual organization, manipulation of information in working memory, and ability to inhibit a response to a prepotent stimulus. Finally, results revealed positive relationships between the ACL obtained at discharge and community functioning at follow-up. The results of this study provide some evidence for the concurrent and predictive validity of the ACL for patients with schizophrenia and suggest that further study of this assessment tool would be important to pursue in future investigations.     

颈动脉粥样硬化患者认知功能与事件相关电位的改变及其关系

目的 探讨颈动脉粥样硬化(CAS)患者认知功能与事件相关电位(ERP)的改变及其关系.方法 对65例不同程度CAS患者进行简易精神状态检查量表(MMSE)和ERP P300检查及相关性分析;并与对照组进行比较.结果 与对照组比较,轻中度CAS组的注意计算、短程记忆、图形描画评分明显降低(均P＜0.05);P300潜伏期延长、波幅降低 (均P＜0.05);重度CAS组差异更明显(均P＜0.01).与轻中度颈动脉狭窄组比较,重度颈动脉狭窄组在时间定向力、地点定向力、注意计算、短程记忆、言语复述、语言表达、图形描画7个亚项评分方面有显著降低(均P＜0.05);P300潜伏期延长、波幅降低 (均P＜0.05).轻中度、重度CAS患者的MMSE评分与P300潜伏期呈负相关(r=-0.503,-0.589,均P＜0.05),轻中度、重度颈动脉狭窄患者的MMSE评分与P300潜伏期亦呈负相关(r=-0.497,-0.601,均P＜0.05).结论 CAS可导致认知功能障碍和ERP异常,其程度与颈动脉病变程度有关.     

Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder

Depp CA, Mausbach BT, Harmell AL, Savla GN, Bowie CR, Harvey PD, Patterson TL. Meta‐analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 2012: 14: 217–226. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta‐analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder. Methods: We conducted a comprehensive meta‐analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design. Results: The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self‐report than performance‐based tasks and real‐world milestones such as employment. None of the moderator analyses were significant. Conclusions: Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed to a greater extent according to functional measurement approach.     

Identifying mild cognitive impairment at baseline in the Ginkgo Evaluation of Memory (GEM) study

Objectives: To identify, characterize and compare the frequency of mild cognitive impairment (MCI) subtypes at baseline in a large, late-life cohort (n = 3063) recruited into a dementia prevention trial.

Method: A retrospective, data-algorithmic approach was used to classify participants as cognitively normal or MCI with corresponding subtype (e.g. amnestic vs. non-amnestic, single domain vs. multiple domain) based on a comprehensive battery of neuropsychological test scores, with and without Clinical Dementia Rating (CDR) global score included in the algorithm.

Results: Overall, 15.7% of cases (n = 480) were classified as MCI. Amnestic MCI was characterized as unilateral memory impairment (i.e. only verbal or only visual memory impaired) or bilateral memory impairment (i.e. both verbal and visual memory impaired). All forms of amnestic MCI were almost twice as frequent as non-amnestic MCI (10.0% vs. 5.7%). Removing the CDR = 0.5 (‘questionable dementia’) criterion resulted in a near doubling of the overall MCI frequency to 28.1%.

Conclusion: Combining CDR and cognitive test data to classify participants as MCI resulted in overall MCI and amnestic MCI frequencies consistent with other large community-based studies, most of which relied on the ‘gold standard’ of individual case review and diagnostic consensus. The present data-driven approach may prove to be an effective alternative for use in future large-scale dementia prevention trials.