Sex steroids to maintain cognitive function in women after the menopause: A meta-analyses of treatment trials

It is still debated whether estrogen treatment after the menopause could result in improved cognitive function in women. This debate is based on many animal and cell culture data showing that estrogens can positively affect the aging brain. Observational data also show a halved risk of dementia in women who took estrogens around the age of menopause. However, large treatment trials have shown negative effects of long-term treatment with estrogens in older women. The present meta-analyses included 36 randomised treatment trials and tested various hypotheses which have been developed to attempt to explain discrepant data. Results indicated that, contrary to expectations, age of women and duration of time elapsed when treatment was initiated since menopause (‘window of opportunity’ hypothesis) did not significantly affect treatment outcome, nor did it matter whether women were symptomatic or not. It was not clear whether bilateral oophorectomy affected the outcome, as this effect was based on only a few studies from the same group and some observational studies show negative effects on cognition in surgical menopausal women treated with hormones for more than 10 years. Duration of treatment overall significantly affected outcome. More negative effects were seen in longer studies, where positive effects were mainly seen in short term studies (<4 months). Treatment with combined estrogens and progestagens also negatively affected the outcome. Whether women with symptoms should be treated for a couple of months or using other (intermittent) modes of treatment and whether this could have long-term positive consequences remains to be investigated.     

利培酮联合氢溴酸加兰他敏对精神分裂症患者认知功能的影响

目的 探讨利培酮联合氢溴酸加兰他敏对精神分裂症认知功能的影响.方法 将60例精神分裂症患者随机分为两组,每组30例,两组均口服利培酮治疗,研究组联合氢溴酸加兰他敏治疗,对照组联合安慰剂治疗,观察12周.于治疗前及治疗第6周、12周末采用阳性与阴性症状量表评定临床疗效,采用威斯康星卡片分类测验、沟槽钉板测验、连线测验A、韦氏智力量表中的数字符号、数字广度测验、韦氏记忆量表中的视觉再生测验评定两组患者的认知功能,采用副反应量表评定不良反应.结果 治疗后两组阳性与阴性症状量表评分均较治疗前显著下降(P＜0.01),同期两组间比较差异均无显著性(P＞0.05).治疗12周末两组威斯康星卡片分类测验完成分类数和持续错误数、连线测验A、数字符号、数字广度、视觉再生测验和沟槽钉板测验均较治疗前明显改善(P＜0.05或0.01);研究组数字广度和视觉再生测验变化值显著高于对照组(P＜0.05或0.01).两组不良反应均轻微,研究组不良反应发生率为63.3%,对照组为53.3%,两组差异无显著性(χ2=0.48,P＞0.05).结论利培酮联合氢溴酸加兰他敏治疗能更好地改善精神分裂症的记忆功能.     

艾司西酞普兰与氟西汀治疗精神分裂症后抑郁对照研究

目的 探讨艾司西酞普兰与氟西汀治疗精神分裂症后抑郁的疗效和安全性以及对认知功能的影响.方法 将60例精神分裂症后抑郁患者随机分为两组,每组30例,在维持原用抗精神病药物治疗的基础上,研究组晨口服艾司西酞普兰治疗,对照组晨口服氟西汀治疗,观察8周.于治疗前及治疗1周、2周、4周、6周、8周末采用汉密顿抑郁量表评定抑郁症状...     

抑郁症患者认知功能障碍的研究

目的：探讨抑郁症患者认知功能障碍的特点。方法：使用威斯康星卡片分类测验（WCST）、汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）对110例符合中国精神障碍分类与诊断标准第3版抑郁发作诊断标准的抑郁症患者于治疗前及治疗第6周末进行评定，以114名正常人作对照。结果：抑郁症患者WCST的总错误数、持续错误数和随机错误数同正常人相比差异均有显著性（P〈0．01）；WCST的正确数和分类教与HAMD 总分呈负相关（P〈0．05）；对患者治疗前后比较发现，WCST随病情的好转均有不同程度的改善。结论：抑郁症患者存在认知功能障碍．其认知功能障碍与病情的严重程度有关。存在着特质性和状态性。[著者文摘]     

Cortical thickness is linked to executive functioning in adulthood and aging

Executive functions that are dependent upon the frontal-parietal network decline considerably during the course of normal aging. To delineate neuroanatomical correlates of age-related executive impairment, we investigated the relation between cortical thickness and executive functioning in 73 younger (20-32 years) and 56 older (60-71 years) healthy adults. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). Cortical thickness was measured at each location of the cortical mantle using surface-based segmentation procedures on high-resolution T1-weighted magnetic resonance images. For regions involved in WCST performance, such as the lateral prefrontal and parietal cortices, we found that thicker cortex was related to higher accuracy. Follow-up ROI-based analyses revealed that these associations were stronger in older than in younger adults. Moreover, among older adults, high and low performers differed in cortical thickness within regions generally linked to WCST performance. Our results indicate that the structural cortical correlates of executive functioning largely overlap with previously identified functional patterns. We conclude that structural preservation of relevant brain regions is associated with higher levels of executive performance in old age, and underscore the need to consider the heterogeneity of brain aging in relation to cognitive functioning.     

A proton magnetic resonance spectroscopy study in schizoaffective disorder: Comparison of bipolar disorder and schziophrenia

The aim of this study was to compare schizoaffective disorder, bipolar disorder and schizophrenia based on (1)H-MRS metabolite values in dorsolateral prefrontal cortex and executive functions. The subjects comprised 15 patients with bipolar disorder type I (BD), 15 with schizophrenia (SCH), 15 with schizoaffective disorder (SAD) and 15 healthy controls. We performed proton magnetic resonance spectroscopy ((1)H-MRS) of the dorsolateral prefrontal cortex (DLPFC) bilaterally. Levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho) and creatine-containing compounds (Cr) were measured in the DLPFC using (1)H-MRS. We administered the Wisconsin Card Sorting Test (WCST) and the Stroop Test (ST) to evaluate executive functions. The SAD, BD and SCH patients had lower levels of NAA than the control group. The SAD and BD patients had low levels of Cho compared to the control group. The left DLPFC Cr levels in all of the patient groups and the right DLPFC Cr levels in the BD and SAD groups were lower than in the control group. The levels of NAA Cho and Cr were not related to executive functions and attention performance. Cr level were related to attention processes, only in SCH. Our results indicate that NAA levels are reduced in schizoaffective disorder, bipolar disorder and schizophrenia, but the reduction in the levels of NAA is not a distinctive feature among these three illnesses. Schizoaffective and bipolar disorders have similar features related to the levels of compounds containing Cho and Cr. This similarity may be related to these illnesses both having an affective basis.     

Cognition and communication dysfunctions in early-onset schizophrenia: Effect of risperidone

Background

Cognitive impairment and formal thought disorder, also referred to as communication disturbances, are considered the core symptoms of schizophrenia, strongly affecting social functioning and long-term outcome. Several studies in adult patients suggest improvement of both functions after the treatment with atypical antipsychotic drugs. Such medications are also used as first line treatment in early-onset schizophrenia, however their efficacy in cognitive and communication domains in this population have not been systematically assessed.

Aim of the study

Evaluation of risperidone efficacy at psychopathological symptoms, cognitive impairment and formal thought disorder in adolescents with schizophrenia spectrum diagnosis.

Material and method

Psychopathological symptoms, cognitive functioning and formal thought disorder were evaluated in 32 hospitalized adolescent patients with schizophrenia spectrum diagnosis at the beginning of risperidone treatment and after clinical improvement and compared to the results of matched healthy control group.

Results

Risperidone treatment was associated with reduction of symptom severity and moderate improvement of formal thought disorder and some aspects of executive functions. Working memory and verbal fluency were not improved. There were few correlations between psychopathological symptoms and results of cognitive tests, mainly between negative symptoms and executive functions.

Discussion

In early-onset schizophrenia spectrum disorders atypical antipsychotic treatment is associated with alleviation of symptoms and only selective and moderate cognitive and communication improvement.     

Neuropsychological performance in OCD: a study in medication-naïve patients

Background

Obsessive-compulsive disorder (OCD) is associated with impairments in multiple neuropsychological domains but the findings are rather inconsistent across studies. One potential reason for poor replication is the confounding influence of medications. There is limited research on neuropsychological performance in medication-naïve, never treated OCD patients.

Methods

In this study, we assessed 31 medication-naïve, never-treated, DSM-IV OCD patients free of comorbid major depression and 31 healthy controls individually matched for age, gender and years of education, with tests of attention, executive function, memory reasoning and visuo-spatial function.

Results

Medication-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Patients performed somewhat poorly only on the highest goal hierarchy of the Tower of London (TOL) test (p = 0.001, effect size = 0.68).

Conclusions

It is intriguing to find that symptomatic, drug-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Our finding of medium effect size on TOL highest goal hierarchy test suggests that brain regions outside the affective orbitofrontal loop may also be perhaps involved in OCD. This finding however needs replication because of modest effect size. Future studies should focus on studying medication-naïve, co-morbidity-free patients and relatives using symptom dimensions for consistent and robust findings.     

Factors affecting the short‐term prognosis of alcohol dependent patients undergoing inpatient detoxification

Stable measures of psychological functioning require a considerable period of abstinence. However, the duration of inpatient detoxification programs has decreased dramatically in most health care systems, posing a novel challenge for clinical evaluation of patients. The present study was carried out to examine whether factors predicting short‐term prognosis can be identified in alcohol dependent subjects during early stages of inpatient detoxification. Self‐reports of mood states were obtained, and executive cognitive functioning was examined. Outcome was studied at 2–3 months. No correlation was found between self‐reported symptoms of depression, hopelessness, and anxiety, and percentage of nondrinking days. A significant positive correlation was found between Wisconsin Card Sorting Test (WCST) performance and short‐term prognosis measured by this parameter. Thus, in addition to transient withdrawal‐related effects, impairments of WCST performance in early stages of alcohol detoxification may reflect more long standing deficits in problem‐solving strategies, of possible relevance for matching patients to treatment services.     

Leukemia inhibitory factor gene is associated with schizophrenia and working memory function

Leukemia inhibitory factor (LIF), a member of the interleukin-6 cytokine family, regulates the neuronal phenotype and coordinates astrocyte, oligodendrocyte, microglia, and inflammatory cell responses. The LIF gene is located on 22q12.1–q12.2, a hot spot for schizophrenia. Three polymorphisms of the LIF gene (rs929271, rs737812, and rs929273) were examined in a case–control association study of 390 patients with schizophrenia and 410 age- and sex-matched controls. Effects of a risk genotype of LIF on cognitive domains were evaluated by the Wechsler Adult Intelligence Scale—Revised, Wechsler Memory Scale—Revised, and Wisconsin Card Sorting Test (WCST) in 355 healthy volunteers. The LIF gene showed significant associations with schizophrenia at rs929271 and a haplotype consisting of rs929271–rs737812. After stratification by subtype of schizophrenia, the hebephrenic, but not paranoid, type was associated with the LIF gene at rs929271 (allele, P = 0.014) and the haplotype (permutation P = 0.013). Having the T-allele and T-carrier genotypes (TT and TG) of rs929271 were risks for hebephrenic schizophrenia, and the odds ratios were 1.38 (95% CI: 1.21–1.56) and 1.54 (95%CI: 1.19–1.98), respectively. Subjects with T-carrier genotypes made significantly more errors on the WCST compared with those without (P = 0.04). The present study indicated that the LIF gene variant may produce susceptibility to hebephrenic schizophrenia and deterioration of working memory function.