Can executive cognitive measures differentiate between patients with spinal- and bulbar-onset amyotrophic lateral sclerosis?

Although executive functions in sporadic non-demented amyotrophic lateral sclerosis (ALS) patients are mostly affected, it remains unclear whether executive measures can differentiate between patients with bulbar and spinal ALS forms. Thirty spinal and 18 bulbar-onset ALS patients (ALS-s and ALS-b, respectively) as well as 47 demographically related healthy controls were examined in executive processes (Trail Making Test-part B [TMT-(B-A)]; Stroop Neuropsychological Screening Test [SNST]; Similarities subtest of the Wechsler Adult Intelligence Scale [WAIS Similarities]; Wisconsin Card Sorting Test [WCST]). ALS subgroups were similar with regard to demographic characteristics and disease duration; yet, ALS-b showed greater disease severity compared with ALS-s patients (p = .006). Both ALS-s and ALS-b patients were significantly inferior to healthy controls on TMT-(B-A) (p < .001), SNST (p = .009 and p = .02, respectively) and WAIS Similarities (p = .031 and p = .021, respectively), whereas ALS-s performed significantly worse than controls on the WCST perseverative responses (p = .005). However, neuropsychological measures did not significantly differ between ALS subgroups (p > .05). Despite the fact that ALS-b patients may present greater disease severity, specific executive impairments that are present early in the course of ALS seems to be independent of the site of onset.     

Gray matter reduction associated with psychopathology and cognitive dysfunction in unipolar depression: a voxel-based morphometry study

BACKGROUND: Functional neuroimaging studies on both cognitive processing and psychopathology in patients with major depression have reported several functionally aberrant brain areas within limbic-cortical circuits. However, less is known about the relationship between psychopathology, cognitive deficits and regional volume alterations in this patient population. METHODS: By means of voxel-based morphometry (VBM) and a standardized neuropsychological test battery, we examined 15 patients meeting DSM-IV criteria for major depression disorder and 14 healthy controls in order to investigate the relationship between affective symptoms, cognitive deficits and structural abnormalities. RESULTS: Patients with depression showed reduced gray matter concentration (GMC) in the left inferior temporal cortex (BA 20), the right orbitofrontal (BA 11) and the dorsolateral prefrontal cortex (BA 46). Reduced gray matter volume (GMV) was found in the left hippocampal gyrus, the cingulate gyrus (BA 24/32) and the thalamus. Structure-cognition correlation analyses revealed that decreased GMC of the right medial and inferior frontal gyrus was associated with both depressive psychopathology and worse executive performance as measured by the Wisconsin Card Sorting Test (WCST). Furthermore, depressive psychopathology and worse performance during the WCST were associated with decreased GMV of the hippocampus. Decreased GMV of the cingulate cortex was associated with worse executive performance. LIMITATIONS: Moderate illness severity, medication effects, and the relatively small patient sample size should be taken into consideration when reviewing the implications of these results. CONCLUSIONS: The volumetric results indicate that regional abnormalities in gray matter volume and concentration may be associated with both psychopathological changes and cognitive deficits in depression.     

The influence of acculturation on the Wisconsin Card Sorting Test by Mexican Americans.

This study examined the speculation that the Wisconsin Card Sorting Test (WCST) might be a relatively culture-free neuropsychological test. The relationship between level of acculturation and performance on the Spanish version of the WCST was investigated, using a sample of Mexican American adults (N=52). When the sample was divided into two groups based on level of acculturation as measured by the Acculturation Rating Scale for Mexican Americans--2nd Edition, within-group contrasts demonstrated that higher levels of acculturation significantly improved performance on the WCST. The performance of this sample was compared to select Spanish norms, finding no clinically significant differences. Contrasts with English norms for the WCST yielded significant differences on a majority of the WCST measures, demonstrating that the English norms are inappropriate for use with this population. This study concludes that the WCST is not a culture-free neuropsychological test.     

强迫性障碍患者的执行功能研究

目的:探讨影响强迫性障碍患者执行功能的因素。方法:纳入强迫性障碍患者60例,采用威斯康星卡片、连线测验、河内塔测验、Stroop测验,言语流畅性测验等神经心理学测验评定执行功能。同时使用社会功能缺陷量表评定社会功能水平,耶鲁布朗量表评定疾病严重程度,汉米尔顿量焦虑抑郁量表评定合并的焦虑抑郁程度。结果:强迫怀疑的出现与模式转换的威斯康星卡片分类测验的概念认知下降相关(r=-0.388,P<0.01),强迫检查的出现与计划的河内塔测验开始时间长短成正比(r=0.295,P<0.05),强迫仪式动作的出现与抑制的Stroop测验的时间延长和错误数目增加成正比(r=0.278、0.300,P<0.05),强迫询问与流利性的说出数目多少成负相关(r=-0.261,P<0.05)。合并的焦虑抑郁情绪与模式转换的威斯康星卡片分类测验和连线测验的操作时间成正比,与计划的河内塔测验总时间成正比(r=0.297,0.359,P<0.05)。结论:不同强迫症状与执行功能的不同层面相关,合并的焦虑抑郁情绪程度与模式转换、计划能力的下降有关。     

A twin study of cognitive function in chronic fatigue syndrome: the effects of sudden illness onset

Variable reports of neuropsychological deficits in individuals with chronic fatigue syndrome (CFS) may, in part, be attributable to methodological limitations. In this study, these limitations were addressed by controlling for genetic and environmental influences and by assessing the effects of comorbid depression and mode of illness onset. Specifically, the researchers conducted a co-twin control study of 22 pairs of monozygotic twins, in which 1 twin met strict criteria for CFS and the co-twin was healthy. Twins underwent a structured psychiatric interview and comprehensive neuropsychological assessment evaluating 6 cognitive domains. Results indicated that twin groups had similar intellectual and visual memory functioning, but fatigued twins exhibited decreases in motor functions (p = .05), speed of information processing (p = .02), verbal memory (p = .02), and executive functioning (p = .01). Major depression did not affect neuropsychological functioning among fatigued twins, although twins with sudden illness onset demonstrated slowed information processing compared with those with gradual onset (p = .01). Sudden onset CFS was associated with reduced speed of information processing. If confirmed, these findings suggest the need to distinguish illness onset in future CFS studies and may have implications for treatment, cognitive rehabilitation, and disability determination.     

Reduced frontal perfusion in depressed postmenopausal women: a SPECT study with WCST

OBJECTIVES: To investigate frontal cerebral blood flow (CBF) in depressed postmenopausal women and its relation to cognitive function and the severity of depressive symptoms. METHODS: Regional CBF of 20 unmedicated depressed postmenopausal women was measured using Tc-99m HMPAO SPECT, both at rest and during frontal activation using the Wisconsin card sorting test (WCST). Frontal CBF was semi-quantified by comparing the radioactivity in the prefrontal region to the cerebellum (F/C ratio). We measured the severity of the symptoms of depression using the hospital anxiety and depression scale (HADS) and cognitive function using the mini-mental status examination (MMSE). RESULTS: At rest, there was no difference in frontal CBF between patients with moderate or severe (HADS> or =11) and patients with mild depressive symptoms (HADS<11). During the WCST, however, the HADS> or =11 group did not score as well as the HADS<11 group (P=0.03). The changes in F/C ratios were inversely correlated with HADS scores (r=-0.43, P=0.05) and positively correlated with MMSE scores (r=0.58, P=0.004). After adjusting for age, F/C ratios were significantly correlated with MMSE (P=0.002), but not with HADS scores. CONCLUSIONS: Frontal CBF did not increase in postmenopausal women with moderate/severe symptoms of depression during the WCST activation task, and reduced frontal CBF was related to the impairment of cognitive function. The combination of the functional activation test and SPECT imaging powerfully revealed this functional disease, which remains undetectable using more common baseline measurements.     

Latent structure of the Wisconsin Card Sorting Test in a clinical sample.

The aims of this study were to: (a) examine the consistency of the published Wisconsin Card Sorting Test (WCST) factor structures; (b) determine the factor structure of the WCST in a large, heterogeneous sample; and (c) compare the WCST factor analytically with other neuropsychological procedures. Two WCST factors (concept formation/perseveration and Failure-to-Maintain-Set [FMS]) were consistently reported in the literature. Our analysis of data from 473 clinical cases replicated the two factors previously reported and revealed a third on which nonperseverative errors (NPE) was the sole salient variable. This pattern was maintained in three of four diagnostically distinct subgroups. These factors are potentially clinically meaningful, with each seeming to reflect one of three qualitatively different performance styles. In the construct validation factor analysis, WCST scores loaded independently of other neuropsychological variables, indicating that the WCST contributes uniquely to neuropsychological evaluation. Nevertheless, despite the rational interpretation of the factors, the cognitive processes underlying WCST performance remain poorly understood. Future directions for the application of these factor analytic findings are discussed.     

抑郁症患者认知功能与脑源性神经营养因子相关性研究

目的探讨抑郁症患者认知功能及血清脑源性神经营养因子BDNF及其与抑郁严重程度的关系,为防治疾病提供重要依据。方法采用酶联免疫吸附法、汉密尔顿抑郁量表(HAMD)和威斯康星卡片分类(WCST)测验分别测定40例抑郁症患者的血清BDNF水平、抑郁严重程度及认知功能,并与49名正常对照组进行对比分析。结果研究组治疗前总应答数、非持续性错误数均明显增加,正确应答数明显减少,血清BDNF水平明显降低,与对照组比较有显著性差异(P<0.01)。研究组治疗8周末总应答数、持续性错误数、非持续性错误数减少,完成分类数和正确应答数增加,血清BDNF水平明显升高,HAMD总分明显降低,与治疗前比较有显著差异(P<0.05或P<0.01)。治疗前,患者组WCST非持续性错误与血清BDNF水平呈负相关(r=-0.34,P<0.05),血清BDNF水平与HAMD总分无相关(r=-0.10,P>0.05)。治疗后,WCST上述5个指标与血清BDNF水平及HAMD总分均无相关(P>0.05)。结论抑郁症患者存在认知功能受损及血清BDNF水平的下降,抗抑郁治疗可改善认知功能,并显著提高血清BDNF水平。     

Behavioural and neuropsychological correlates of frontal lobe features in dementia

BACKGROUND: In order to characterize frontal lobe features and their behavioural and cognitive correlates across diagnostic categories, we performed a cross-sectional analysis of behavioural and neuropsychological data from a large, prospective Belgian study on behavioural and psychological signs and symptoms of dementia (BPSD). METHOD: Patients with probable Alzheimer's disease (AD) (n=170), frontotemporal dementia (FTD) (n=28), mixed dementia (MXD) (n=29) and dementia with Lewy bodies (DLB) (n=21) were included and underwent neuropsychological and behavioural assessment by means of a battery of tests and scales. Frontal lobe symptoms were quantified by means of the Middelheim Frontality Score (MFS). RESULTS: In AD (and to a lesser extent in MXD), MFS total scores were negatively correlated with scores on MMSE (Spearman: r=-0.36, p<0.001) and a Verbal Fluency Task (r=-0.38, p<0.001) and were associated with increased severity and frequency of psychosis (r=0.24, p<0.01), activity disturbances (r=0.44, p<0.001) and aggressiveness (r=0.43, p<0.001). In DLB, MFS total scores were negatively correlated with MMSE scores (r=-0.50, p=0.020). No associations were found in FTD patients. CONCLUSIONS: A cross-sectional analysis of frontal lobe features, behavioural characteristics and neuropsychological data demonstrated that, in AD (and to a lesser extent in MXD) patients, frontal lobe symptoms were associated with more pronounced cognitive deficits (of frontal origin), with increased severity and frequency of agitated and aggressive behaviour, and with increased severity of psychosis and depressive symptoms. Given the small sample sizes of the DLB and FTD patient groups, negative findings in these patient groups should be interpreted cautiously.     

Antidepressant response and well-being in pre-, peri- and postmenopausal women with major depressive disorder treated with fluoxetine

BACKGROUND: We assessed the impact of menopausal status on treatment response and well-being in a cohort of outpatient women with major depressive disorder (DSM-III-R criteria), who received treatment with fluoxetine (20 mg/day for 8 weeks). METHODS: Menopausal status was defined based on age, presence of menstrual irregularity or amenorrhea and vasomotor symptoms. Remission and response of depression were defined as a 17-item Hamilton Depression Rating Scale (HAM-D-17) score or=50%, respectively. Well-being was assessed by self-rating with the Symptom Questionnaire. Remitters were followed up for 28 additional weeks. RESULTS: No differences in rates of response and remission as well as in levels of well-being were observed among pre- (n = 121), peri- (n = 28) and postmenopausal (n = 35) women at the endpoint of the acute phase, even after adjustment for baseline depression severity. Residual symptoms, however, were significantly more common in postmenopausal women, except for the continuation phase endpoint. Differences in residual symptoms during the acute phase subsided after adjustment for baseline depression severity. CONCLUSIONS: Overall, menopausal status did not significantly affect the response to fluoxetine treatment and the degree of posttreatment well-being among major depressive disorder patients.     

Executive dysfunction and memory in older patients with major and minor depression.

Executive function, known to be impaired during late-life depression, is dependent on frontostriatal pathways. Memory is also frequently observed to be impaired among late-life depressed patients, so we assessed the possibility that executive function mediates the learning and recall deficit as a "downstream" effect of the frontostriatal compromise in executive function. A cross-sectional sample of minor and major depressed patients (N = 95) and nondepressed volunteers (N = 71), screened for other Axis I disorders, dementia, medical comorbidity and severity of depression, completed a neuropsychological battery that included the California Verbal Learning Test (CVLT) and other tests selected for convergent and divergent validity testing. Depressed patients differed from controls on learning the word list and on related and unrelated executive tasks. Executive function was a mediator for depressed patients verbal learning scores (z = -2.67, p = .01). A nonverbal executive score also mediated verbal learning (z = -2.18, p = .03) indicating convergent validity of executive dysfunction during verbal learning exercises. In conclusion, the verbal memory deficits typically attributed to late-life depression may result from impaired executive functioning during the learning phase of the recall task.     

Brain injury in battered women

The goals of the present study were to examine (a) whether battered women in a sample of both shelter and nonshelter women are sustaining brain injuries from their partners and (b) if so, whether such brain injuries are associated with partner abuse severity, cognitive functioning, or psychopathology. Ninety-nine battered women were assessed using neuropsychological, psychopathology, and abuse history measures. Almost three quarters of the sample sustained at least 1 partner-related brain injury and half sustained multiple partner-related brain injuries. Further, in a subset of women (n = 57), brain injury severity was negatively associated with measures of memory, learning, and cognitive flexibility and was positively associated with partner abuse severity, general distress, anhedonic depression, worry, anxious arousal, and posttraumatic stress disorder symptomatology.     

首发与复发性抑郁症患者执行功能的比较

目的比较首发与复发性抑郁症患者的认知执行功能。方法对43例首发抑郁症患者以及48例复发抑郁症患者,采用17项汉密尔顿抑郁量表测定抑郁严重程度,采用威斯康星卡片分类测验测定执行功能,并进行治疗前后的执行功能比较。结果治疗前首发组与复发组各项执行功能指标均较对照组差（P〈0.05）;分类数首发组高于复发组（P〈0.05）。治疗后首发组除分类数外,其它指标均与对照组有统计学差异（P〈0.05）;复发组各项指标仍较对照组为差（P〈0.05）;首发组与复发组治疗后比较,各项指标首发组均优于复发组（P〈0.05）;治疗后,无论是首发组还是复发组,其HAMD17评分及执行功能的各项指标均有显著性改善（P〈0.05）。结论首发与复发性抑郁症患者均存在执行功能的损害;复发性抑郁症患者的执行功能损害更为严重。药物治疗后,首发、复发性抑郁症患者执行功能均有一定程度的恢复。     

Executive dysfunction and memory in older patients with major and minor depression.

Executive function, known to be impaired during late-life depression, is dependent on frontostriatal pathways. Memory is also frequently observed to be impaired among late-life depressed patients, so we assessed the possibility that executive function mediates the learning and recall deficit as a "downstream" effect of the frontostriatal compromise in executive function. A cross-sectional sample of minor and major depressed patients (N=95) and nondepressed volunteers (N=71), screened for other Axis I disorders, dementia, medical comorbidity, and severity of depression, completed a neuropsychological battery that included the California Verbal Learning Test and other tests selected for convergent and divergent validity testing. Depressed patients differed from controls on learning the word list and on verbal and nonverbal executive tasks. Executive function was a mediator for depressed patients verbal learning scores (z=-2.67, p=.01). A nonverbal executive score also mediated verbal learning (z=-2.18, p=.03) indicating convergent validity of executive dysfunction during verbal learning exercises. In conclusion, the verbal memory deficits typically attributed to late-life depression may result from impaired executive functioning during the learning phase of the recall task.     

奎的平和氯丙嗪对精神分裂症认知功能影响的双盲对照研究

目的 :探讨奎的平和氯丙嗪对精神分裂症患者认知功能的影响。方法 :40例精神分裂症患者随机均分为奎的平组和氯丙嗪组 ,在治疗前、治疗后 4、 6周作知识、算术、数字符号、数字广度 (顺、逆 )、木块拼图、瞬时逻辑记忆、视觉再生即刻和延迟、STROOPC测验、词汇流畅、TOH总分 ,计划时间、延迟逻辑记忆、WCST等神经心理测验 ,整个研究过程采用双盲双模拟法。为观察学习效应 ,12例健康者在相同间隔时间作神经心理测验。所得数据用SPSS10 0进行统计分析。结果 :治疗后 ,奎的平组大部分患者神经心理测验成绩提高而氯丙嗪组的测验结果变化不大 ,尤其在注意、执行功能方面。奎的平对精神分裂症患者认知功能的改善作用优于氯丙嗪 (P <0 0 5 )。结论 :奎的平对精神分裂症患者的注意和执行功能有改善作用而氯丙嗪不明显。     

抑郁症共病2型糖尿病患者的认知功能及神经内分泌指标

目的:探讨共病糖尿病后抑郁症的认知功能特点及其与神经内分泌的相关性。方法:按照目的抽样的方法,选取符合中国精神障碍分类方案与诊断标准第3版诊断标准的门诊和住院抑郁症患者84例,其中合并2型糖尿病的患者为共病组(n=42);未合并糖尿病的患者为非共病组(n=42)。对两组进行汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、伦敦塔、言语流畅性、言语记忆、Stroop、连线测验、威斯康星卡片(WCST)测查,并测定血浆皮质醇(COR)与促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、游离甲状腺素(F4)、游离三碘甲状腺原氨酸(F3)浓度。共病组28例和非共病组25例完成认知功能和血浆测查。结果:共病组HAMD总分和躯体化障碍、认知障碍因子分高于非共病组(均P0.05),ACTH和COR的水平高于非共病组(均P0.05),两组TSH、F4、F3差异无统计学意义。共病组的WCST的完成第一分类所需的应答数、错误应答数、持续应答数、持续性错误数和非持续性错误数均高于非共病组(均P0.05);共病组的伦敦塔因子分评分和认知功能的语言记忆评分方面的评分低于非共病组(P0.05);而WCST完成分类数和连线测验、言语流畅性和Stroop等得分差异无统计学意义(P0.05)。共病组TOL与HAMD得分之间呈负相关(r=-0.53,P0.01);COR水平同WCST持续性错误得分呈正相关(r=0.38,P0.05),与RVR和Stroop得分呈负相关(r=-0.56,-0.55;均P0.01);ACTH水平同WCST持续性错误呈正相关(r=0.528,P0.01),与HVLT-R和Stroop得分呈负相关(r=-0.64,-0.60;均P0.01)。非共病组认知功能和HAMD评分、HAMA评分以及神经内分泌指标之间无统计学相关。结论:共病糖尿病后抑郁程度加重,认知功能受损严重,主要表现在执行功能、注意力和语言记忆方面,可能与皮质醇和促肾上腺皮质激素升高有关。     

Executive dysfunction in medicated, remitted state of major depression

BACKGROUND: Past neuropsychological studies on depression have documented executive dysfunction and it has been reported that some dysfunction persists even after depressive symptoms disappear. Studies have shown a correlation between cerebrovascular lesions and executive dysfunction in depression among the elderly. The aim of the present study was to focus on executive functions in remitted major depressive disorder (MDD) patients, and to investigate whether remitted young and elderly patients show different patterns of executive dysfunction, and to ascertain the relationships with vascular lesions. METHODS: Subjects were 79 inpatients with MDD and 85 healthy controls. Each subject received Wisconsin Card Sorting Test (WCST), Stroop test, and Verbal Fluency Test (VFT) in a remitted state. Both the MDD and control groups were divided into young and elderly groups, and the performances between 4 groups were compared. RESULTS: For Stroop test, the scores of the MDD group were significantly lower than controls. In addition, as for VFT, the scores for the elderly MDD group were significantly lower than the other groups. Multiple regression analysis showed that VFT scores were affected by the presence of vascular lesions. CONCLUSIONS: The results of the present study demonstrated that executive dysfunction remained even in a remitted state in MDD patients, but the patterns of impairment were different between young and elderly patients. The results also suggested that vascular lesions affect executive dysfunction, particularly in elderly depressive patients.     

Use of Wisconsin Card Sorting Test short forms with school-age children.

Short forms of the Wisconsin Card Sorting Test (WCST) have been developed and studied in adult populations, however studies addressing their use in children are lacking. This study compared the full WCST to two short forms in a sample of 174 school-age children who were referred for neuropsychological evaluation. Multiple regression was used to predict standard scores (SSs) on the full WCST. Percent scores were obtained, and normative data from the WCST manual was then used to obtain SSs. We found that scores from the short forms were significantly correlated with corresponding scores on the full WCST, however a high proportion of children obtained short form SSs, which differed significantly from the SSs obtained on the full WCST. It is recommended that clinicians use the full WCST with children, unless at least four categories are reached in the first deck.     

Depression and self-reported physical health in patients with coronary disease: mediating and moderating factors

OBJECTIVES: The purpose of this study was to define how the relation between depression and self-reported physical health in patients with coronary disease is modified by other patient-centered factors. METHODS: We conducted a prospective cohort study of 111 patients (members of a health maintenance organization) with angiographically documented coronary disease, examining factors (physical symptoms, psychological states and traits, and spousal support) modifying the relation between depression and patient-reported physical health 5 years later using multiple hierarchical regression models. RESULTS: Five regression models (all including demographic and disease severity covariates) were constructed to predict physical health from depression only (R2 = 0.22); depression plus angina and fatigue (R2 = 0.53); depression plus positive affect and novelty seeking and their interaction (R2 = 0.48); depression plus spousal support (R2 = 0.27); and depression, angina, fatigue, positive affect, and novelty seeking (overall model) (R2 = 0.65). Depression remained significant in each model, but the proportion of variance it predicted was diminished in the presence of the other variables (bivariate r = 0.39, partial r = 0.37-0.13). CONCLUSIONS: The effect of depression on self-reported physical health is significantly mediated by physical symptoms (angina and fatigue), personality states and traits (positive affect and novelty seeking), and spousal support. Positive affect and novelty seeking had more marked effects on physical health in the presence of more depression. Thus, a broad range of factors beyond the severity of coronary disease itself affect the perceived physical health of patients with coronary heart disease.     

焦虑、抑郁与女性压力性尿失禁的相关性

目的 研究焦虑、抑郁状态对女性压力性尿失禁（SUI）严重程度的影响及其相关性。方法 选择2012年1月~2018年6月于我院妇科、泌尿外科就诊的具有完整临床资料的106例女性SUI患者,根据SUI严重程度分为轻度（41例）、中度（36例）和重度组（29例）,采用综合性医院焦虑抑郁量表（HADS）对患者焦虑、抑郁状态进行评估,比较三组焦虑、抑郁状态及其与SUI严重程度的相关性。结果 轻、中、重度组SUI焦虑（HADS≥8分）的患病率分别为7.32%、36.11%和68.97%,抑郁（HADS≥8）的患病率分别为9.76%、38.89%和72.41%,中、重度组比轻度组焦虑、抑郁的患病率增加（P＜0.05）。焦虑、抑郁状态与SUI的严重程度呈正相关（r=0.271和0.293,P＜0.05）。结论 焦虑、抑郁状态对女性压力性尿失禁的严重程度有明显影响,其可能通过共同的生物学通路影响女性压力性尿失禁的发病过程。