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Cognitive Assessment (cognitive + assessment)
Selected AbstractsCognitive Assessment for Clinicians.EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2009Second Edition No abstract is available for this article. [source] Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive AssessmentGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2010Yoshinori Fujiwara Aim: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects. Methods: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. Results: The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test,retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P < 0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS-R (r = 0.79, P < 0.001) and CDR (r = ,0.79, P < 0.001) scores. The areas under receiver,operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90,1.00) and 0.99 (95% CI = 0.00,1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75,0.95) and 0.97 (95% CI = 0.00,1.00), and 0.86 (95% CI = 0.76,0.95) and 0.97 (95% CI = 0.00,1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI. Conclusion: The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community. Geriatr Gerontol Int 2010; 10: 225,232. [source] The Brief Kingston Standardized Cognitive Assessment,RevisedINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2005Robert W. Hopkins Abstract Objectives The Kingston Standardized Cognitive Assessment,Revised (KSCA-R) was designed to be a cognitive screening tool available to health professionals who were not trained in specialized cognitive assessment techniques. It was introduced to bridge the gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. We now present the Brief Kingston Standardized Cognitive Assessment,Revised (BriefKSCA-R). Methods Groups of Alzheimer's disease patients, patients suffering from other dementias, and a group of normal community dwelling elderly were assessed using the BriefKSCA-R. Results This shortened version of the full Kingston Standardized Cognitive Assessment,Revised can be given in half the time while retaining most of the full KSCA-R's effectiveness. Conclusions Suitable for a quick screening, or follow-up of patients already more fully assessed. Copyright © 2005 John Wiley & Sons, Ltd. [source] Cognitive impairment in Parkinson's disease: Tools for diagnosis and assessment,,MOVEMENT DISORDERS, Issue 8 2009Jaime Kulisevsky MD Abstract Cognitive impairment (CI) and dementia are frequent and debilitating features associated with Parkinson's disease (PD). Formal neuropsychological examination is required to ascertain the degree and pattern of CI over the course of the disease. The use of different tools may explain heterogeneous data obtained from studies to date. Normative data for extensively used scales [Mattis Dementia Rating Scale (MDRS), Mini-Mental State Examination (MMSE)] is incomplete in PD populations. According to sample characteristics, statistical analyses, and methodological quality, 33 studies using scales not specific to PD (MDRS, MMSE, Cambridge Cognitive Assessment, FAB) or PD-specific scales (Mini-Mental Parkinson, Scales for Outcomes of Parkinson's disease,Cognition, Parkinson's Disease,Cognitive Rating Scale, and Parkinson Neuropsychometric Dementia Assessment) were eligible for the critical analysis of their appropriateness to assess cognition in PD. Of the four scales specifically designed for PD, the SCOPA-COG and the PD-CRS have undergone extensive and rigorous validation processes. While the SCOPA-COG mainly assesses "frontal-subcortical" cognitive defects, the PD-CRS also assesses "instrumental-cortical" functions, allowing better characterization of the different patterns of CI that may be present in PD from the earliest stages. The MMP and PANDA scales were designed as brief screening tests for CI and have not yet been subjected to extensive clinimetric evaluations. Further research on PD-specific tools seems mandatory to help establish accurate cut-off scores for the diagnosis of mild PDD, detect cognitive profiles more prone to the future development of dementia, and allow comparisons between different descriptive or interventional studies. © 2009 Movement Disorder Society [source] Perceptual, motor and cognitive performance components of Bedouin children in IsraelOCCUPATIONAL THERAPY INTERNATIONAL, Issue 4 2000Shula Parush PhD Abstract The purpose of this study was to evaluate the perceptual, motor and cognitive performance abilities of Bedouin children as compared with mainstream Israeli children of the same age. The study population comprised two age groups (6,8 year olds and 10,12 year olds) living in two different types of settlements (rural and town). Participants included 20 children in each group. The Test of Visual-Perceptual Skills (TVPS), the Developmental Test of Visual-Motor Integration (VMI), selected subtests from the Bruininks-Oseretsky Test of Motor Proficiency and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were used. Older participants in all three groups performed better than the younger subjects. There were no significant differences between the two Bedouin groups in either age category. The mainstream Israeli subjects scored significantly higher than the two Bedouin groups on most variables tested. The lack of differences between the two Bedouin groups may indicate that the transition from nomadic communities to urban communities is mainly external and has not caused a significant change in perception, perceptual-motor and cognitive performance abilities. The results of this study may be used as a base for developing preventive intervention programmes to meet the specific needs of Bedouin children. A limitation of this study was the classification of the Bedouin population according to their dwelling place and not according to their sociodemographic background, such as parents' economic status, parents' education and so on. Recommendations for future research include expanding the number of participants, including children from additional rural schools of various distant tribes and incorporating more detailed cognitive assessments. Copyright © 2000 Whurr Publishers Ltd. [source] Parkinsonism and dystonia caused by the illicit use of ephedrone,A longitudinal study,MOVEMENT DISORDERS, Issue 15 2008Marianna Selikhova MD Abstract A neurological syndrome characterized by levodopa unresponsive bradykinesia, retropulsion with falls backwards, dysarthria, gait disturbance, dystonia, and emotional lability was identified in 13 male opiate addicts following the prolonged intravenous use of ephedrone (methcathinone), a central nervous stimulant prepared from pseudoephedrine, potassium permanganate, and vinegar. The natural history, response to treatment, and clinical features has been studied, and MR and dopamine transporter SPECT brain imaging were carried out. Pubic hair was sampled for manganese. The clinical and radiological picture closely resembled previous reports of chronic manganese poisoning and increased mean manganese level in pubic hair observed for at least 1 year after cessation of ephedrone. Odor identification was intact. Cognitive assessment showed a mild executive dysfunction and a mild depression. DaTSCANs were all normal. The neurological syndrome bears some similarities to PSP but differs from Parkinson's disease. Delayed neurological progression despite discontinuation of ephedrone occurred in one-third of cases. Ephedrone poisoning should be considered as a possible cause of secondary Parkinsonism in young adults, particularly from Eastern Europe. © 2008 Movement Disorder Society [source] School psychologists' perceptions regarding the practice of identifying reading disabilities: Cognitive assessment and response to intervention considerations,PSYCHOLOGY IN THE SCHOOLS, Issue 3 2010Greg R. Machek This study surveyed a national sample of school psychologists with respect to the identification of reading disabilities (RD). It covers school psychologists' opinions regarding perceived benefits of the use of cognitive assessment in RD identification, both within and outside of an IQ,achievement discrepancy model. The survey also solicited opinions about the nature of RD, particularly conceptions of general slow learners (and readers) versus those evidencing a discrepancy. Results related to school psychologists' concerns about job security, should IQ testing be reduced, are presented. Furthermore, the perceived benefits of a Response to Intervention (RTI) model, how school psychologists see themselves contributing to an RTI effort, as well as possible hurdles to RTI implementation are covered. Measurement of these perceptions may be beneficial in informing current and future service delivery models for RD identification as well as possible training needs of currently practicing school psychologists. Finally, the current work represents an effort to measure assessment acceptability for RD identification techniques. © 2010 Wiley Periodicals, Inc. [source] General measures of cognition for the preschool childDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 3 2005Elizabeth O. LichtenbergerArticle first published online: 13 SEP 200 Abstract Preschool-age children who are experiencing delays in physical, cognitive, communication, social, emotional, or adaptive development are often referred for a comprehensive assessment to make diagnostic determinations and to help develop appropriate interventions. Typically cognitive assessment has a key role in a comprehensive evaluation of a young child. In this article, five individually administered tests of cognitive ability, normed for the preschool-age child, are reviewed. These specific tests include the Bayley Scales of Infant Development, 2nd edition, the Kaufman Assessment Battery for Children, 2nd edition, the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, the Stanford-Binet Intelligence Scale, 5th edition, and the Differential Abilities Scales. The following is provided for these cognitive instruments: a description of the test procedures, information on scoring systems, highlights of the technical qualities, and a summary of the general meaning of test results. The article concludes with strengths and limitations of the instruments. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:197,208. [source] Critical evaluation of cognitive dysfunctions as endophenotypes of schizophreniaACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2004S. Kéri Objective:, Cognitive dysfunctions are potential endophenotypes of schizophrenia. The aim of this study was to investigate whether recent evidence indeed suggests that cognitive dysfunctions are potent indicators of specific genetic traits that represent susceptibility for schizophrenia. Method:, Studies including large, well-defined samples and controlled cognitive assessment have been reviewed. Results:, Evidence suggests that schizophrenia patients and their unaffected biological relatives are impaired in several cognitive domains, including working memory, executive functions, sustained attention, verbal episodic memory, processing of visual and auditory stimuli, and smooth pursuit eye movements. However, these impairments are present only in a limited proportion of subjects, showing low specificity and sensitivity and high variability. Linkage with specific genes is weak. Conclusion:, Although some results are promising, at present cognitive dysfunctions cannot be considered as highly sensitive and specific endophenotypes of schizophrenia. [source] Cognitive functioning in substance abuse and dependence: a population-based study of young adultsADDICTION, Issue 9 2009Antti Latvala ABSTRACT Aims To investigate whether substance use disorders (SUDs) are associated with verbal intellectual ability, psychomotor processing speed, verbal and visual working memory, executive function and verbal learning in young adults, and to study the associations of SUD characteristics with cognitive performance. Participants A population-based sample (n = 466) of young Finnish adults aged 21,35 years. Measurements Diagnostic assessment was based on all available information from a structured psychiatric interview (SCID-I) and in- and out-patient medical records. Established neuropsychological tests were used in the cognitive assessment. Confounding factors included in the analyses were comorbid psychiatric disorders and risk factors for SUDs, representing behavioural and affective factors, parental factors, early initiation of substance use and education-related factors. Findings Adjusted for age and gender, life-time DSM-IV SUD was associated with poorer verbal intellectual ability, as measured with the Wechsler Adult Intelligence Scale,Revised (WAIS-R) vocabulary subtest, and slower psychomotor processing, as measured with the WAIS-R digit symbol subtest. Poorer verbal intellectual ability was accounted for by parental and own low basic education, whereas the association with slower psychomotor processing remained after adjustment for SUD risk factors. Poorer verbal intellectual ability was related to substance abuse rather than dependence. Other SUD characteristics were not associated with cognition. Conclusions Poorer verbal intellectual ability and less efficient psychomotor processing are associated with life-time alcohol and other substance use disorders in young adulthood. Poorer verbal intellectual ability seems to be related to parental and own low basic education, whereas slower psychomotor processing is associated with SUD independently of risk factors. [source] Selective non-response to clinical assessment in the longitudinal study of aging: implications for estimating population levels of cognitive function and dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2002Kaarin J. Anstey Abstract Objective To identify the cognitive outcome of interviewed participants who did not progress to partake in clinical assessments in a longitudinal aging study. Design A retrospective study was conducted on participants who were interviewed but who did not complete the clinical assessment (including an extended cognitive assessment) at either Wave 1 or both Wave 1 and Wave 3 of the Australian Longitudinal Study of Ageing. A total of 1947 participants aged 70 and older commenced the study, 246 participants without clinical data at either or both Waves 1 and 3 were identified for the sub-sample followed-up retrospectively. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was administered to informants and medical records were reviewed. Results Participants who did not complete the clinical assessment at Wave 3 reported poorer health and had poorer cognitive function at Wave 1 independent of age and gender. Rates of possible dementia or cognitive decline were higher in the group who did not undertake the clinical assessment compared with both those who did the clinical assessment and with population data. Conclusion Selective non-response to clinical assessment in a longitudinal aging study is associated with higher risk of cognitive decline and probable dementia. Longitudinal aging studies may underestimate rates of dementia and population levels of cognitive decline. Copyright © 2002 John Wiley & Sons, Ltd. [source] Simplifying Detection of Cognitive Impairment: Comparison of the Mini-Cog and Mini-Mental State Examination in a Multiethnic SampleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Soo Borson MD Objectives: To compare detection of cognitive impairment using the Mini-Cog and Mini-Mental State Examination (MMSE) and to identify sociodemographic variables that influence detection in an ethnoculturally diverse sample. Design: Cross-sectional. Setting: A registry of the University of Washington Alzheimer's Disease Research Center Satellite. Participants: A heterogeneous community sample (n=371) of predominantly ethnic minority elderly assessed using a standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). Measurements: Demographic data, a standardized research protocol for cognitive assessment and dementia diagnosis, MMSE, and Mini-Cog. Results: Both screens effectively detected cognitive impairment, the Mini-Cog slightly better than the MMSE (P<.01). Overall accuracy of classification was 83% for the Mini-Cog and 81% for the MMSE. The Mini-Cog was superior in recognizing patients with Alzheimer-type dementias (P=.05). Low education negatively affected detection using the MMSE (P<.001), whereas education did not affect the Mini-Cog, and low literacy minimally affected it. Conclusion: The Mini-Cog detects clinically significant cognitive impairment as well as or better than the MMSE in multiethnic elderly individuals, is easier to administer to non-English speakers, and is less biased by low education and literacy. [source] A Chart-Based Method for Identification of Delirium: Validation Compared with Interviewer Ratings Using the Confusion Assessment MethodJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Sharon K. Inouye MD Objectives: To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM). Design: Prospective validation study. Setting: Teaching hospital. Participants: Nine hundred nineteen older hospitalized patients. Measurements: A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined. Results: Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present. Conclusion: A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes. [source] School psychologists' perceptions regarding the practice of identifying reading disabilities: Cognitive assessment and response to intervention considerations,PSYCHOLOGY IN THE SCHOOLS, Issue 3 2010Greg R. Machek This study surveyed a national sample of school psychologists with respect to the identification of reading disabilities (RD). It covers school psychologists' opinions regarding perceived benefits of the use of cognitive assessment in RD identification, both within and outside of an IQ,achievement discrepancy model. The survey also solicited opinions about the nature of RD, particularly conceptions of general slow learners (and readers) versus those evidencing a discrepancy. Results related to school psychologists' concerns about job security, should IQ testing be reduced, are presented. Furthermore, the perceived benefits of a Response to Intervention (RTI) model, how school psychologists see themselves contributing to an RTI effort, as well as possible hurdles to RTI implementation are covered. Measurement of these perceptions may be beneficial in informing current and future service delivery models for RD identification as well as possible training needs of currently practicing school psychologists. Finally, the current work represents an effort to measure assessment acceptability for RD identification techniques. © 2010 Wiley Periodicals, Inc. [source] Cognitive hypothesis testing and response to intervention for children with reading problemsPSYCHOLOGY IN THE SCHOOLS, Issue 8 2006Catherine A. Fiorello Response to intervention (RTI) must be combined with comprehensive cognitive assessment to identify children with learning disabilities. This article presents the Cognitive Hypothesis Testing (CHT) model for integrating RTI and comprehensive evaluation practices in the identification of children with reading disabilities. The CHT model utilizes a scientific method approach for interpreting cognitive and neuropsychological processes together with evaluation of ecological and treatment validity data to develop targeted interventions for students who do not respond to standard academic interventions. A case study highlights how CHT practices can lead to effective interventions for a child who did not respond to a phonologically based reading intervention. In addition, discriminant analyses of 128 children with reading disabilities revealed the presence of Global, Phonemic, Fluency-Comprehension, and Orthographic subtypes. Results suggest subtypes show disparate cognitive profiles that differentially impact their reading achievement, supporting our contention that individual assessment of cognitive processing strengths and weaknesses is not only necessary for identifying children with reading disabilities but also can lead to individualized interventions designed to meet their unique learning needs. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 835,853, 2006. [source] Telomere length predicts poststroke mortality, dementia, and cognitive declineANNALS OF NEUROLOGY, Issue 2 2006Carmen Martin-Ruiz PhD Objective Long-term cognitive development is variable among stroke survivors, with a high proportion developing dementia. Early identification of those at risk is highly desirable to target interventions for secondary prevention. Telomere length in peripheral blood mononuclear cells was tested as prognostic risk marker. Methods A cohort of 195 nondemented stroke survivors was followed prospectively from 3 months after stroke for 2 years for cognitive assessment and diagnosis of dementia and for 5 years for survival. Telomere lengths in peripheral blood mononuclear cells were measured at 3 months after stroke by in-gel hybridization. Hazard ratios for survival in relation to telomere length and odds ratios for dementia were estimated using multivariate techniques, and changes in Mini-Mental State Examination scores between baseline and 2 years were related to telomere length using multivariate linear regression. Results Longer telomeres at baseline were associated with reduced risk for death (hazard ratio for linear trend per 1,000bp = 0.52; 95% confidence interval, 0.28,0.98; p = 0.04, adjusted for age) and dementia (odds ratio for linear trend per 1,000bp = 0.19; 95% confidence interval, 0.07,0.54; p = 0.002) and less reduction in Mini-Mental State Examination score (p = 0.04, adjusted for baseline score). Interpretation Telomere length is a prognostic marker for poststroke cognitive decline, dementia, and death. Ann Neurol 2006 [source] Quality Indicators for Geriatric Emergency CareACADEMIC EMERGENCY MEDICINE, Issue 5 2009Kevin M. Terrell DO Abstract Objectives:, Emergency departments (EDs), similar to other health care environments, are concerned with improving the quality of patient care. Older patients comprise a large, growing, and particularly vulnerable subset of ED users. The project objective was to develop ED-specific quality indicators for older patients to help practitioners identify quality gaps and focus quality improvement efforts. Methods:, The Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, including members representing the American College of Emergency Physicians (ACEP), selected three conditions where there are quality gaps in the care of older patients: cognitive assessment, pain management, and transitional care in both directions between nursing homes and EDs. For each condition, a content expert created potential quality indicators based on a systematic review of the literature, supplemented with expert opinion when necessary. The original candidate quality indicators were modified in response to evaluation by four groups: the Task Force, the SAEM Geriatric Interest Group, and audiences at the 2007 SAEM Annual Meeting and the 2008 American Geriatrics Society Annual Meeting. Results:, The authors offer 6 quality indicators for cognitive assessment, 6 for pain management, and 11 for transitions between nursing homes and EDs. Conclusions:, These quality indicators will help researchers and clinicians target quality improvement efforts. The next steps will be to test the feasibility of capturing the quality indicators in existing medical records and to measure the extent to which each quality indicator is successfully met in current emergency practice. [source] Driving and dementia: a prospective audit of clients referred to an aged care assessment teamAUSTRALASIAN JOURNAL ON AGEING, Issue 4 2003Robert Bunt Objective: Many people with dementia or cognitive Impairment continue to drive. Given Australia's ageing population, this raises safety concerns for the driver in the community. This paper presents data collected by the NS W Central Coast Aged Care Assessment Team (ACAT), outlining the extent of the problem on the Central Coast and offers some suggestions about dealing with this issue. Method: A prospective audit of clients referred to Central Coast ACAT over a seven month period. Data describing the clients' cognitive state and also their driving habits were collected during routine ACAT assessments. Results: 1203 people were referred to ACAT during the study period. 100 (8%) of these were driving and 34% of those driving had some form of cognitive impairment. In some cases the impairment was quite severe. Most of these drivers were male. In a majority of the cases, concerns were expressed by someone familiar with the person, regarding their capacity to drive safely. Conclusion: The results support findings from other studies, which suggest there is a small but significant number of elderly people with cognitive impairment who are still driving. We propose that a safety first policy should be adopted and where there is doubt about the persons ability to drive safely, an Occupationul Therapy driving test in conjunction with a detailed cognitive assessment needs to be performed. [source] Comprehensive cognitive neurological assessment in strokeACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009M. Hoffmann Background,,, Cognitive syndromes (CS) after stroke may be important to measure and monitor for management and emerging therapies. Aim,,, To incorporate known behavioral neurological and neuropsychiatric syndromes into a bedside cognitive assessment in patients with stroke. Methods,,, A validated cognitive examination (comprehensive cognitive neurological test in stroke, Coconuts) was administered during the first month of stroke presentation and analyzed according to five large-scale networks for cognition and correlated with neuropsychological tests. Validity testing of the test was performed for overall sensitivity, specificity, positive predictive value and negative predictive value to stroke in comparison with MRI diagnosis of stroke as well as discriminant validity, construct validity and inter-rater reliability. Results,,, Overall the sensitivity of the Coconuts scale was 91% and specificity 35%, PPV 88% and NPV 41% vs stroke lesions using MRI. Cognitive syndrome frequencies: frontal network syndrome frequency was 908/1796 (51%), left hemisphere network syndrome frequency was 646/1796 (36%), right hemisphere network included 275/1796 (15.3%), occipitotemporal network for complex visual processing 107/1796 (6%), the hippocampal limbic network for amnesias and emotional disorders 397/1796 (22%) and miscellaneous network syndromes 481/1796 (27%). Conclusion,,, The Coconuts is a valid and practical test of a comprehensive array of known behavioral neurological and neuropsychiatric syndromes in patients with stroke. [source] The influence of cognitive impairment on health-related quality of life in neurological diseaseACTA NEUROPSYCHIATRICA, Issue 1 2010Alex J. Mitchell Mitchell AJ, Kemp S, Benito-León J, Reuber M. The influence of cognitive impairment on health-related quality of life in neurological disease. Background: Cognitive impairment is the most consistent neurological complication of acquired and degenerative brain disorders. Historically, most focus was on dementia but now has been broadened to include the important construct of mild cognitive impairment. Methods: Systematic search and review of articles linked quality of life (QoL) and cognitive complications of neurological disorders. We excluded QoL in dementia. Results: Our search identified 249 publications. Most research examined patients with brain tumours, stroke, epilepsy, head injury, Huntington's disease, motor neuron disease, multiple sclerosis and Parkinson's disease. Results suggested that the majority of patients with epilepsy, motor neuron disease, multiple sclerosis, Parkinson's disease, stroke and head injury have subtle cognitive deficits early in their disease course. These cognitive complaints are often overlooked by clinicians. In many cases, the cognitive impairment is progressive but it can also be relapsing-remitting and in some cases reversible. Despite the importance of severe cognitive impairment in the form of dementia, there is now increasing recognition of a broad spectrum of impairment, including those with subclinical or mild cognitive impairment. Even mild cognitive difficulties can have functional and psychiatric consequences,especially when they are persistent and untreated. Specific cognitive deficits such an inattention, dysexecutive function and processing speed may affect a number of quality of life (QoL) domains. For example, cognitive impairment influences return to work, interpersonal relationships and leisure activities. In addition, fear of future cognitive decline may also impact upon QoL. Conclusions: We recommend further development of simple tools to screen for cognitive impairments in each neurological condition. We also recommend that a thorough cognitive assessment should be a part of routine clinical practice in those caring for individuals with neurological disorders. [source] Stability of cognitive impairment in chronic schizophrenia over brief and intermediate re-test intervalsHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2009Robert H. Pietrzak Abstract Objective This study examined between- and within-subject stability of cognitive performance in individuals with chronic schizophrenia. Methods Thirty individuals with schizophrenia and 20 healthy controls matched by age, sex, education, and estimated IQ underwent repeated cognitive assessments at baseline and 30 days using computerized tests of psychomotor function, visual attention/information processing, non-verbal learning, and executive function. Results Compared to healthy controls, individuals with schizophrenia scored lower on all cognitive measures and demonstrated greater variability in cognitive performance. Within-subject variability in cognitive performance in both the schizophrenia and healthy control groups remained stable at brief (i.e., hours) and intermediate (i.e., one month) assessments. Conclusions These results demonstrate the stability of between- and within-subject variability in cognitive performance in schizophrenia, and suggest that variability in cognitive performance may reflect an inherent characteristic of the disorder, rather than differences in test,retest reliability/error of cognitive measures. Copyright © 2008 John Wiley & Sons, Ltd. [source] Nocturnal sleep duration and cognitive impairment in a population-based study of older adultsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2010Adrian Loerbroks Abstract Objective We aimed to investigate the association between nocturnal sleep duration, changes in nocturnal sleep duration and cognitive impairment in older adults. Methods 4010 participants of a population-based cohort study provided information on nocturnal sleep duration at baseline (1991,1995) and at follow-up (2002/2003). 792 follow-up participants aged 70+ by 2006 participated in telephone-based cognitive assessments. Several cognitive tests were used including the telephone interview for cognitive status (TICS). Cognitive impairment was defined as <31 points on the TICS (13.0%) and as below this percentile on the other tests. Based on individual tests, a verbal memory score and a total score were constructed. Multivariable prevalence ratios (PRs) of cognitive impairment and 95% confidence intervals (95%CIs) were computed using Poisson regression. Analyses were restricted to those free of depression in 2002/2003 (n,=,695). Results Sleeping ,6 or 8,h per night (versus 7,h) were unrelated to cognitive impairment. Sleeping ,9,h was positively, although imprecisely, associated with impairment of verbal memory (PR,=,1.7, 95%CI,=,1.0, 3.0), and less pronounced with the other cognitive measures. An increase in sleep duration from 7,8,h in 1992,1995 to ,9,h 8.5 years later (versus sleeping 7,8,h at both time points) was associated with an increased prevalence of cognitive impairment according to the TICS (PR,=,2.1, 95%,=,1.0, 4.5) and the verbal memory score (PR,=,2.0, 95%CI,=,1.0, 3.8). Conclusions Increases in sleep duration are associated with cognitive impairment. A biological explanation for this association is currently lacking. Increases in sleep duration could be a marker of cognitive deficits. Copyright © 2009 John Wiley & Sons, Ltd. [source] Brain Microstructure Is Related to Math Ability in Children With Fetal Alcohol Spectrum DisorderALCOHOLISM, Issue 2 2010Catherine Lebel Background:, Children with fetal alcohol spectrum disorder (FASD) often demonstrate a variety of cognitive deficits, but mathematical ability seems to be particularly affected by prenatal alcohol exposure. Parietal brain regions have been implicated in both functional and structural studies of mathematical ability in healthy individuals, but little is known about the brain structure underlying mathematical deficits in children with FASD. The goal of this study was to use diffusion tensor imaging (DTI) to investigate the relationship between mathematical skill and brain white matter structure in children with FASD. Methods:, Twenty-one children aged 5 to 13 years diagnosed with FASD underwent DTI on a 1.5-T MRI scanner and cognitive assessments including the Woodcock-Johnson Quantitative Concepts test. Voxel-based analysis was conducted by normalizing subject images to a template and correlating fractional anisotropy (FA) values across the brain white matter with age-standardized math scores. Results:, Voxel-based analysis revealed 4 clusters with significant correlations between FA and math scores: 2 positively-correlated clusters in the left parietal region, 1 positively-correlated cluster in the left cerebellum, and 1 negatively-correlated cluster in the bilateral brainstem. Diffusion tractography identified the specific white matter tracts passing through these clusters, namely the left superior longitudinal fasciculus, left corticospinal tract and body of the corpus callosum, middle cerebellar peduncle, and bilateral projection fibers including the anterior and posterior limbs of the internal capsule. Conclusions:, These results identify 4 key regions related to mathematical ability and provide a link between brain microstructure and cognitive skills in children with FASD. Given previous findings in typically developing children and those with other abnormal conditions, our results highlight the consistent importance of the left parietal area for mathematical tasks across various populations, and also demonstrate other regions that may be specific to mathematical processing in children with FASD. [source] Perceptual, motor and cognitive performance components of Bedouin children in IsraelOCCUPATIONAL THERAPY INTERNATIONAL, Issue 4 2000Shula Parush PhD Abstract The purpose of this study was to evaluate the perceptual, motor and cognitive performance abilities of Bedouin children as compared with mainstream Israeli children of the same age. The study population comprised two age groups (6,8 year olds and 10,12 year olds) living in two different types of settlements (rural and town). Participants included 20 children in each group. The Test of Visual-Perceptual Skills (TVPS), the Developmental Test of Visual-Motor Integration (VMI), selected subtests from the Bruininks-Oseretsky Test of Motor Proficiency and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were used. Older participants in all three groups performed better than the younger subjects. There were no significant differences between the two Bedouin groups in either age category. The mainstream Israeli subjects scored significantly higher than the two Bedouin groups on most variables tested. The lack of differences between the two Bedouin groups may indicate that the transition from nomadic communities to urban communities is mainly external and has not caused a significant change in perception, perceptual-motor and cognitive performance abilities. The results of this study may be used as a base for developing preventive intervention programmes to meet the specific needs of Bedouin children. A limitation of this study was the classification of the Bedouin population according to their dwelling place and not according to their sociodemographic background, such as parents' economic status, parents' education and so on. Recommendations for future research include expanding the number of participants, including children from additional rural schools of various distant tribes and incorporating more detailed cognitive assessments. Copyright © 2000 Whurr Publishers Ltd. [source] Growth and developmental outcomes of three high-risk infant rhesus macaques (Macaca mulatta)AMERICAN JOURNAL OF PRIMATOLOGY, Issue 5 2007Amanda M. Dettmer Abstract Infants classified as "high risk" are born with a greater chance of developing medical complications at birth, and may have cognitive and other developmental complications later in life. Very few reports exist regarding the survival and outcome of such infants in primate colonies. Here we present early growth and developmental data on three high-risk infant rhesus macaques (one female and two males) that were born either with intrauterine growth restriction (IUGR; born below the 1st birth weight percentile for gestational age) or extremely prematurely (at gestational days 128 and 140; mean full-term gestation=164 days). We compared the outcome of these infants with that of healthy controls born at term and found no gross developmental delays in these infants with respect to growth, neonatal reflex and motor skill development, early cognitive development, or social behavior. Neurological and cognitive assessments were compared in terms of both postnatal and gestational age. The survival of these infants was dependent on a 24-hr staffed nursery and a fluid protocol that catered to each high-risk infant's individual needs. When such measures are implemented, infants such as these have a good chance of survival and can serve as excellent models for high-risk human babies and their subsequent development. Am. J. Primatol. 69:503,518, 2007. © 2007 Wiley-Liss, Inc. [source] Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosusARTHRITIS & RHEUMATISM, Issue 10 2002G. P. Th. Objective To investigate the relationship between quantitative estimates of global brain damage based on magnetization transfer imaging (MTI) and cerebral functioning, as measured by neurologic, psychiatric, and cognitive assessments, as well as disease duration in patients with a history of neuropsychiatric systemic lupus erythematosus (NPSLE). Methods In a clinically heterogeneous group of 24 female patients (age range 19,65 years, mean age 35 years) with a history of NPSLE, the correlation values of several volumetric MTI measures and an estimate of cerebral atrophy, neurologic functioning (Kurtzke's Expanded Disability Status Scale [EDSS]), psychiatric functioning (the Hospital Anxiety and Depression Scale [HADS]), and cognitive functioning (cognitive impairment score [CIS] derived from the revised Wechsler Adult Intelligence Scale), as well as several measures of disease duration were assessed using Pearson's correlation coefficient. Results Quantitative volumetric estimates of global brain damage based on MTI and a measure of global brain atrophy correlated significantly with the EDSS, HADS, and CIS scores. No significant correlation was found between the quantitative estimates of global brain damage and the measures of disease duration. Conclusion The results of this study demonstrate that volumetric MTI parameters and cerebral atrophy reflect functionally relevant brain damage in patients with NPSLE. Furthermore, the absence of a linear relationship between disease duration and results of volumetric MTI measures and atrophy suggests a complicated pattern of accumulating brain damage in patients with NPSLE. [source] Reporting outcomes in clinical trials for bipolar disorder: a commentary and suggestions for changeBIPOLAR DISORDERS, Issue 5 2008Anabel Martinez-Arán Objective:, Newer outcome measures and statistical reporting that better translate efficacy data to evidence-based psychiatric care are needed when evaluating clinical trials for bipolar disorder. Using efficacy studies as illustrations, the authors review and recommend changes in the reporting of traditional clinical outcomes both in the acute and maintenance phases of bipolar disorder. Methods:, Definitions of response, remission, relapse, recovery, and recurrence are reviewed and recommendations for change are made. These suggestions include reporting the numbers needed to treat or harm (NNT or NNH), and a ratio of the two, likelihood of help or harm (LHH), as an important element of the effect size (ES). Moreover, models of prediction that conduct sensitivity or specificity analyses and utilize decision trees to help predict positive and negative outcomes of interest (for instance, excessive weight gain, or time to remission) using positive or negative predictive values (PPV or NPV) are reviewed for potential value to clinicians. Finally, functional and cognitive assessments are recommended for maintenance studies of bipolar disorder. Results:, The examples provided in this manuscript underscore that reporting the NNT or NNH, or alternative effect sizes, or using PPV or NPV may be of particular value to clinicians. Such reports are likely to help translate efficacy-driven clinical data to information that will more readily guide clinicians on the benefits and risks of specific interventions in bipolar disorder. Conclusions:, The authors opine that reporting these newer outcomes, such as NNT or NNH, area under the receiver operating curve (AUC), or PPV or NPV will help translate the results of clinical trials into a language that is more readily understood by clinicians. Moreover, assessing and evaluating functional and cognitive outcomes will not only inform clinicians about potential differences among therapeutic options, but likely will make it easier to communicate such differences to persons with bipolar illness or to their families. Finally, we hope such scientific and research efforts will translate to optimism for recovery-based outcomes in persons with bipolar disorder. [source] | ||||||||||||||||||||||||||||