Assessing cognition in people with severe mental disorders in low- and middle-income countries: a systematic review of assessment measures

Background

Cognitive difficulties are common in people with severe mental disorders (SMDs) and various measures of cognition are of proven validity. However, there is a lack of systematic evidence regarding the psychometric properties of these measures in low- and middle-income countries (LMICs).

Objective

To systematically review the psychometric properties of cognitive measures validated in people with SMDs in LMICs.

Methods

We conducted a systematic review of the literature by searching from four electronic databases. Two authors independently screened studies for their eligibility. Measurement properties of measures in all included studies were extracted. All eligible measures were assessed against criteria set for clinical and research recommendations. Results are summarized narratively and measures were grouped by measurement type and population.

Results

We identified 23 unique measures from 28 studies. None of these was from low-income settings. Seventeen of the measures were performance-based. The majority (n = 16/23) of the measures were validated in people with schizophrenia. The most commonly reported measurement properties were: known group, convergent, and divergent validity (n = 25/28). For most psychometric property, studies of methodological qualities were found to be doubtful. Among measures evaluated in people with schizophrenia, Brief Assessment of Cognition in Schizophrenia, Cognitive Assessment Interview, MATRICS Consensus Cognitive Battery, and CogState Schizophrenia Battery were with the highest scores for clinical and research recommendation.

Conclusions

Studies included in our review provide only limited quality evidence and future studies should consider adapting and validating measures using stronger designs and methods. Nonetheless, validated assessments of cognition could help in the management and allocating therapy in people with SMDs in LMICs.

     

Cognitive performance in a South African cohort of people with HIV and comorbid major depressive disorder

Journal of NeuroVirology - Cognitive performance in people with HIV (PWH) may be affected by brain injury attributable to the infection itself, by other medical and psychiatric comorbidities...     

Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

Purpose: Fractures of the humeral shaft are common and account for 3%e5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors. Methods: The study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures. Results: Of 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p=0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p=0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p=0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months. Conclusion: Contrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.     

The zinc finger protein ZPR1 is a potential modifier of spinal muscular atrophy

Spinal muscular atrophy (SMA) is caused by mutation of the Survival Motor Neurons 1 (SMN1) gene and is characterized by degeneration of spinal motor neurons. The severity of SMA is primarily influenced by the copy number of the SMN2 gene. Additional modifier genes that lie outside the SMA locus exist and one gene that could modify SMA is the Zinc Finger Protein (ZPR1) gene. To test the significance of ZPR1 downregulation in SMA, we examined the effect of reduced ZPR1 expression in mice with mild and severe SMA. We report that the reduced ZPR1 expression causes increase in the loss of motor neurons, hypermyelination in phrenic nerves, increase in respiratory distress and disease severity and reduces the lifespan of SMA mice. The deficiency of SMN-containing sub-nuclear bodies correlates with the severity of SMA. ZPR1 is required for the accumulation of SMN in sub-nuclear bodies. Further, we report that ZPR1 overexpression increases levels of SMN and promotes accumulation of SMN in sub-nuclear bodies in SMA patient fibroblasts. ZPR1 stimulates neurite growth and rescues axonal growth defects in SMN-deficient spinal cord neurons from SMA mice. These data suggest that the severity of disease correlates negatively with ZPR1 levels and ZPR1 may be a protective modifier of SMA.     

Efficacy of abdominal computed tomography in evaluation of possible abdominal abscess

A retrospective analysis was made of all abdominal computed tomography scans performed because of clinical suspicion of an abscess at our institution over a 12-month period. Of 130 patients examined, 45 patients had had abdominal surgery within the previous 2-week period. Of these patients, 14 were found to have abscesses on computed tomography, with three known false-negative studies. An additional nine patients had sterile postoperative collections. Nine patients had had an abdominal abscess previously diagnosed, and five of these had a residual abscess. A total of seven abscesses were found by computed tomography in 76 patients who had had no surgery in the previous 2 weeks, with one known false-negative study. High-risk categories of nonoperative patients were identified. Only one positive study occurred in a patient without a high clinical index of suspicion for an intraabdominal abscess, although a total of 50 patients fell into this low-risk, nonoperative category. The cost-effectiveness of computed tomography studies in such low-risk patients is questioned.     

Patent umbilical vein. Diagnosis by technetium-99m tagged red blood cell scintigraphy

Abdominal scanning with Tc-99m labeled red blood cells serendipitously demonstrated collateral flow in a patent umbilical vein in a patient with unsuspected advanced cirrhotic liver disease and portal hypertension. Knowledge of this was crucial in planning the optimal surgical approach in this patient, referred for resection of a bladder carcinoma. Furthermore, the nuclide study was helpful in clarifying several questions posed by a prior abdominal pelvic CT scan.     

Variation in the thickness of the diaphragmatic crura with respiration

Misinterpretation of the diaphragmatic crura on axial computed tomography images is a recognized pitfall in diagnosis. The right diaphragmatic crus is generally longer and thicker than the left. The authors observed a case in which the left crus was thicker than the right, causing diagnostic difficulty. Obtaining scans at full expiration and full inspiration clarified the situation. Confirmation of respiratory variation in crural thickness was obtained in ten patients. The crura increased in thickness on inspiration, compared with the size on expiration.     

Tryptophan degradation is associated with risk-taking propensity in methamphetamine users with treated HIV infection

Journal of NeuroVirology - Few studies have examined neuroimmune pathways that could contribute to impulsivity in people living with HIV who use substances. Eighty-four methamphetamine-using,...