Article

Subjective Perception of Cognition is Related to Mood and Not Performance

February 2009
Epilepsy & Behavior 14(3):459-64

February 2009
14(3):459-64

DOI:10.1016/j.yebeh.2008.12.007

Source
PubMed

Authors:

Susan E Marino

University of Minnesota Twin Cities

Kimford Meador

Stanford University

Michael S Okun

University of Florida

Show all 13 authorsHide

Clinicians monitor cognitive effects of drugs primarily by asking patients to describe their side effects. We examined the relationship of subjective perception of cognition to mood and objective cognitive performance in healthy volunteers and neurological patients. Three separate experiments used healthy adults treated with lamotrigine (LTG) and topiramate (TPM), adults with epilepsy on LTG or TPM, and patients with idiopathic Parkinson's disease. Correlations were calculated for change scores on and off drugs in the first two experiments and for the single assessment in Experiment 3. Across all three experiments, significant correlations were more frequent (chi(2)=259, P < or = 0.000) for mood versus subjective cognitive perception (59%) compared with subjective versus objective cognition (2%) and mood versus objective cognitive performance (2%). Subjective perception of cognitive effects is related more to mood than objective performance. Clinicians should be aware of this relationship when assessing patients' cognitive complaints.

Subjective Cognitive Complaints in Parkinson's Disease: A Systematic Review and Meta-Analysis

Article

Full-text available

Jan 2024
MOVEMENT DISORD

Background Subjective cognitive complaints (SCCs) in Parkinson's disease (PD) are reported frequently, but their prevalence and association with changes on objective testing are not fully known. Objective We aimed to determine the prevalence, clinical correlates, and predictive value of SCCs in PD. Methods We conducted a systematic review and meta‐analysis. From 204 abstracts, we selected 31 studies (n = 3441 patients), and from these, identified the prevalence, clinical features, associations with neuropsychiatric symptoms, and predictive values of SCCs in PD. Results The meta‐analysis showed an SCC prevalence of 36%. This prevalence, however, was significantly moderated by study heterogeneity regarding female sex, disease severity, levodopa equivalent daily dosage, exclusion from the overall sample of patients with objective cognitive impairment, and measurement instrument. SCC prevalence did not differ between de novo and treated PD patients. SCCs were weakly and negligibly associated with cognitive changes on objective testing in cross‐sectional studies. However, in cognitively healthy patients, SCCs had a risk ratio of 2.71 for later cognitive decline over a mean follow‐up of 3.16 years. Moreover, SCCs were moderately related to co‐occurring symptoms of depression, anxiety, or apathy and were more strongly related to these neuropsychiatric symptoms than objective cognitive functioning. Conclusion Our analyses suggest that SCCs in patients with and without objective cognitive impairment are frequent, occurring in more than one third of PD patients. Establishing uniform measurement instruments for identifying PD‐related SCCs is critical to understand their implications. Even in cases lacking evidence of objective cognitive impairment and where SCCs might reflect underlying neuropsychiatric symptoms, the possibility of later cognitive deterioration should not be excluded. Therefore, SCCs in PD patients warrant close monitoring for opportunities for targeted and effective interventions. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Recall and Self-Relevance of Emotional Words Predict Subjective Self-Evaluation of Cognition in Patients with MTLE with or without Depressive Symptoms

Article

Full-text available

Oct 2021
BSRCCS

We examined whether word processing is associated with subjective self-evaluation of cognition in patients with mesial temporal lobe epilepsy (MTLE) as a function of their depressive symptoms. MTLE patients with (MTLE +d, N = 28) or without (MTLE -d, N = 11) depression were compared to pair-matched healthy control participants on free recall and self-relevance ratings of emotionally valenced words. Correlation and hierarchical analyses were conducted to investigate whether the subjective self-evaluation of cognition in MTLE patients is predicted by the negative emotional bias reflected in task performance. MTLE +d patients endorsed as self-relevant fewer positive words and more negative words than the MTLE -d patients and healthy participants. They also self-evaluated their cognition poorer than the MTLE -d patients. Analyses indicated that recall and self-endorsement of emotional words predicted both self-evaluation of cognition as well as epilepsy duration. Our findings indicate that negative self-relevance emotional bias is observed in MTLE patients and is predictive of subjective self-evaluation of cognition. Application of brief behavioral tasks probing emotional functions could be valuable for clinical research and practice in the patients with MTLE.

The Current Landscape of Internet Gaming Disorder: Literature Review of Definition, Determinants, Interventions and Policies in Internet Gaming Disorder

Article

Jan 2021

Genevieve Yong

As online gaming increases in popularity globally, a proportion of gamers face challenges in regulating their gaming behaviors, leading to the presentation of addiction-like symptoms (Wei et al., 2017), which are associated with negative health outcomes (Lam, 2014), di culty in sustaining attention (Bailey et al., 2010), worsened academic performance (Wright, 2011, Brunborg et al., 2014, Ferguson et al., 2011) and decreased social skills (Zamani et al., 2010). To categorise and consolidate the phenomenon of problematic gaming behaviour, Internet Gaming Disorder (IGD) was introduced into the field of clinical study. This paper aims to provide a systematic review of the symptoms of IGD, controversies surrounding empirical research of IGD symptoms, as well as assessment tools and prevalence rates. Determinants of IGD behaviour are also presented, which aid in understanding the multitude of risk factors that interplay to produce these behaviours. In view of this, this paper examines several previously studied intervention methods of IGD to compare the advantages and disadvantages of different intervention methods, thus providing a more holistic view of their effectiveness and limitations. Through the analysis of both international and Singaporean policy strategies, the merits of using a combination of interventions and policies are also elucidated.

Older adults with epilepsy: memory complaints and objective neuropsychological performance

Article

Full-text available

Feb 2021

Introduction: People with epilepsy frequently complain of poor memory. Objective: To assess the occurrence of memory complaints in older adults with epilepsy (OAE) and whether it is associated with clinical variables, objective cognitive performance, and quality of life (QoL). Methods: The Memory Complaint Questionnaire (MAC-Q) was related to objective cognitive performance, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Quality of Life in Epilepsy Inventory (QOLIE-31), and the clinical characteristics of 83 OAE. Results: OAE showed worse cognitive performance and higher MAC-Q scores when compared to a similar control group (n=40). Impairment in multiple cognitive domains occurred in 34 (41%) OAE and was associated with older age and lower educational level. Memory complaints (MAC-Q≥25) were reported by 45 (54.2%) OAE and associated with older age, lower educational level, onset at ≥60 years, higher NDDI-E scores, lower QOLIE-31 scores, and impairment in multiple cognitive domains. Conclusions: OAE presented worse cognitive performance and greater memory complaints. Episode onset at ≥60 years of age was associated with complaints, but not with objective cognitive deficit. We found an association between subjective and objective cognitive performance, with aspects of epilepsy and worse QoL scores.

Disentangling the Role of Working Memory in Parkinson’s Disease

Article

Full-text available

Sep 2020

Working memory (WM) represents a core cognitive function with a major striatal contribution, and thus WM deficits, commonly observed in Parkinson's disease (PD), could also relate to many other problems in PD patients. Our online study aimed to determine the subdomains of WM that are particularly affected in PD and to clarify the links between WM and everyday cognitive deficits, other executive functions, psychiatric and PD symptoms, as well as early cognitive impairment. Fifty-two mild-to-moderate PD patients and 54 healthy controls performed seven WM tasks tapping selective updating, continuous monitoring, or maintenance of currently active information. Self-ratings of everyday cognition, depression, and apathy symptoms, as well as screenings of global cognitive impairment, were also collected. The data were analyzed using structural equation modeling. Of the three WM domains, only selective updating was directly predictive of PD group membership. More widespread WM deficits were observed only in relation to global cognitive impairment in PD patients. Self-rated everyday cognition or psychiatric symptoms were not linked to WM performance but correlated with each other. Our findings suggest that WM has a rather limited role in the clinical manifestation of PD. Nevertheless, due to its elementary link to striatal function, the updating component of WM could be a candidate for a cognitive marker of PD also in patients who are otherwise cognitively well-preserved.

Altered awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review

Article

Full-text available

Sep 2020

Objectives Altered awareness of cognitive and neuropsychiatric symptoms is a common feature of neurodegeneration, which can significantly impact on quality of life, medication concordance and personal safety. Elucidating how awareness is affected by common alpha‐synucleinopathies therefore has significant clinical relevance. We performed a systematic review of the literature on awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies. Methods Searches of PubMed and Web of Science were carried out, using keywords and MeSH subheadings, limited to papers in English dealing with humans. The terms “Parkinson's” or “Lewy body” were used to denote the disease of interest, combined with either “agnosia”, “anosognosia”, “insight”, “metacognition”, or “neuropsychology” to denote the neuropsychological area of interest. Results 21 publications investigating awareness of cognitive symptoms, and 18 publications on awareness of neuropsychiatric symptoms were identified. The large majority focused on Parkinson's disease rather than Dementia with Lewy Bodies. Cognitively intact people with Parkinson's disease may over‐report cognitive symptoms, whilst those with cognitive impairment under‐report symptoms. Awareness of neuropsychiatric symptoms is likely to decline over time, particularly in those with progressive cognitive impairment. Conclusions Altered awareness of cognitive and neuropsychiatric symptoms is common in Parkinson's disease. Symptom awareness varies significantly between individuals, and appears to be influenced by mood and global cognitive functioning, with executive functioning specifically implicated. There are gaps in our understanding of how dopaminergic medications influence symptom awareness, and a need for longitudinal studies of how awareness changes over time in Parkinson's disease and Dementia with Lewy Bodies. This article is protected by copyright. All rights reserved.

Presence or absence of cognitive complaints in Parkinson’s disease: Mood disorder or anosognosia?

Article

Full-text available

Jun 2016
ARQ NEURO-PSIQUIAT

We intended to evaluate whether non-demented Parkinsons's disease (PD) patients, with or without subjective cognitive complaint, demonstrate differences between them and in comparison to controls concerning cognitive performance and mood. We evaluated 77 subjects between 30 and 70 years, divided as follows: PD without cognitive complaints (n = 31), PD with cognitive complaints (n = 21) and controls (n = 25). We applied the following tests: SCOPA-Cog, Trail Making Test-B, Phonemic Fluency, Clock Drawing Test, Boston Naming Test, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory. PD without complaints presented lower total score on Scales for outcome of Parkinson's disease-cognition as compared to controls (p = 0.048). PD with complaints group showed higher scores on HADS (p = 0.011). PD without complaints group showed poorer cognitive performance compared to controls, but was similar to the PD with complaints group. Moreover, this group was different from the PD without complaints and control groups concerning mood.

Novelty preference assessed by eye tracking: A sensitive measure of impaired recognition memory in epilepsy

Article

Apr 2024
EPILEPSY BEHAV

Long COVID neuropsychological follow-up: Is cognitive rehabilitation relevant?

Article

Full-text available

Dec 2023
NEUROREHABILITATION

Background: Duration of neuropsychological disorders caused by long COVID, and the variables that impact outcomes, are still largely unknown. Objective: To describe the cognitive profile of patients with long COVID post-participation in a neuropsychological rehabilitation program and subsequent reassessment and identify the factors that influence recovery. Methods: 208 patients (mean age of 48.8 y.o.), mostly female, were reevaluated 25 months after their first COVID infection and 17 months after their initial evaluation. Patients underwent subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing Tests (NEUPSILIN) for executive functions, Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref. Results: We noted a discrete improvement of neuropsychological symptoms 25 months after the acute stage of COVID-19; nonetheless, performance was not within the normative parameters of standardized neuropsychological testing. These results negatively impact QoL and corroborate patients' subjective assessments of cognitive issues experienced in daily life. Improvement was seen in those who participated in psychoeducational neuropsychological rehabilitation, had higher levels of education, and lower depression scores on the HADS. Conclusion: Our data reveal the persistence of long-term cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological rehabilitation is shown to be important, whether in-person or online.

Aerobic physical exercise versus dual-task cognitive walking in cognitive rehabilitation of people with stroke: a randomized clinical trial

Article

Full-text available

Oct 2023

Introduction Stroke is a neurological deficit caused by an acute focal injury to the central nervous system due to vascular injury that can result in loss of neurological function, lasting brain damage, long-term disability and, in some cases, death. The literature reports that aerobic physical exercise, as well as dual-task cognitive walking, are used for the cognitive recovery of people with stroke. We aimed to assess whether aerobic physical exercise influences post-stroke cognitive recovery, namely performance on selective and sustained attention. We tested the hypothesis that post-stroke aerobic physical exercise leads to more significant gains than post-stroke dual-task cognitive walking. Methods We used a Randomized Clinical Trial, single-blind, parallel group, to verify the existence of differences between two groups. A total of 34 patients with subacute to chronic stroke were divided into two groups to train three times a week for 12 weeks: the aerobic physical exercise (PE) group engaged in 20 min on a treadmill, 20 min on a stationary bicycle and 5 min on a desk bike pedal exerciser per session; the dual-task (DT) gait exercise group walked for 45 min while simultaneously performing cognitive tasks per session. All participants were assessed on cognitive functioning with the Mini-Mental State Examination (MMSE) and d2 Test of Attention before acute interventions and post interventions. We have also applied a Visual Analog Scale to monitor the participants’ perceived difficulty, pre-, post-acute, and post-chronic interventions. Participants also responded to a Borg Scale of perceived exertion following the acute and the final session of chronic training. Results A mixed model ANOVA revealed a significant interaction effect with a large effect size for most of the cognitive variables under study. The variables associated with the d2 Test of Attention showed significant differences between the groups, mainly from T0 to T2. Also for MMSE, an ANOVA revealed a significant interaction effect with significant improvements from T0 to T2. Our results strongly suggest that aerobic physical exercise is more beneficial than dual-task cognitive-gait exercise since in the PE group, cognitive attention scores increase, and cognitive impairment and perception of exertion decrease, compared to the DT group. Conclusion These findings support that PE provides more significant benefits for patients post-stroke when compared to DT.

The Fading Affect Bias is Disrupted by False Memories in Two Diary Studies of Social Media Events

Article

Full-text available

Jan 2022

Unpleasant affect fades faster than pleasant affect, and this phenomenon is referred to as the Fading Affect Bias (FAB). The FAB is moderated and mediated by many variables, including rehearsal and memory specificity, and researchers have emphasized the importance of memory for the FAB, but research has not evaluated the link of the FAB to objective memory measures. Using diary methodology across the span of 1 week, the current study examined the relation of event memory to the FAB for 1) social media events in Experiment 1 (n = 30) and 2) social media and non‐social media events with longer titles in Experiment 2 (n = 63) than in Experiment 1. The FAB was negatively predicted by false memories for 1) social media events in Experiment 1 and 2) both social media and non‐social media events in Experiment 2. These relations were mediated by rehearsals in both experiments. Implications are discussed. This article is protected by copyright. All rights reserved.

A pilot study assessing the brain gauge as an indicator of cognitive recovery in alcohol dependence

Article

Full-text available

Mar 2021

Alcohol dependence (AD) is associated with multiple cognitive deficits, which can affect treatment outcomes. Current measures of tracking brain recovery (e.g., functional magnetic resonance imaging) can be less accessible for practitioners. This study pilots a novel device (the brain gauge; BG) to assess its utility, and track recovery of cognitive function in residential alcohol treatment. Methods: A repeated measures design assessed changes in cognitive function during detoxification. Twenty-one participants with AD (16 Male; Mean age 43.85 ± 6.21) completed a battery of alcohol and memory questionnaires and BG tasks at two time-points (∼days 4 and 10) during a single managed detoxification episode. Results: Repeated measures ANCOVA revealed that some BG metrics significantly improved, with medium to large effect sizes - processing speed, focus, temporal order judgement and overall cortical metric. However, differences in subjective cognitive function were non-significant after controlling for depression and anxiety change scores. Anxiety change emerged as a significant factor in subjective cognitive function. Conclusions: We conclude it is possible that the prefrontal cortex (PFC) recovers more slowly compared to other brain areas, and there are compounding effects of improvements in anxiety and depression, and metacognitive deficits on subjective EF assessments. Future research should seek to validate the clinical utility of the BG by comparing against established neuroimaging methods.

Individual cognitive changes in subjective cognitive decline, mild cognitive impairment and Alzheimer’s disease using the reliable change index methodology

Article

Full-text available

Oct 2020

Objective The development of Alzheimer’s disease (AD) can be assessed using the neuropsychological test battery Vienna (NTBV). The objective of this study was to investigate whether the NTBV test scores of a diagnostic group have changed significantly over time and whether this change is due to disease progression. Methods In this study 358 patients referred to a memory outpatient clinic because of cognitive deterioration were analyzed. The same patients were surveyed in a follow-up assessment after a mean interval of 25.96 months to examine cognitive performance and disease progression. Patients were divided into the subgroups healthy controls (HC), subjective cognitive decline (SCD), mild cognitive impairment (MCI) and AD on the basis of the test results. Reliable change index methodology was used to assess improvement or deterioration in test scores in diagnostic groups compared to HC. Results Deterioration in the SCD group ranged from 0% to 18.8%. The MCI group showed declines between 1.6% and 29.1%. Patients who developed AD deteriorated between 0% and 54.2%. Improvements ranged from 0% to 73.4% in the SCD group and from 0% to 25.1% for the MCI group. The improvement in the AD group ranged between 0% and 44.0%. Conclusion The results reflect the cognitive deterioration of patients during the disease progression. Nevertheless, improvements in diagnostic groups could be detected. The significantly positive changes might be due to practice effects, also a lack of motivation or attention in the first test could have yielded “improvement” in the retest.

Personality determinants of subjective executive function in older adults

Article

Sep 2019

Objectives: Problems in subjective executive function, the perceived cognitive control of mental processes for goal-directed behavior, may indicate cognitive impairment in older adulthood. Although, previous studies highlight the importance of personality on objective cognitive performance, no studies clarify their role with subjective executive function. To inform methods of early identification of cognitive impairment, this study explored how temperament and personality traits account for problems in subjective executive function. Method: The current project examined the associations between temperament and personality on subjective executive function across two samples of community-dwelling older adults (65+ years, n1 = 25, n2 = 50). Both studies measured subjective executive function (Behavioral Rating Inventory of Executive Function-Adult) and separately administered scales on temperament (Adult Temperament Questionnaire) and personality (Big Five Inventory). Results: Concerning temperament, older adults higher in negative affect endorsed greater difficulty in subjective executive function. Regarding personality traits, older adults with higher neuroticism and lower conscientiousness reported higher difficulty in subjective executive function. Conclusion: Findings enhance our understanding of subtle cognitive changes and may aid in early detection. In particular, distressful inclinations were associated with more reported problems in executive function whereas problem-solving tendencies were inversely related. Future work should examine if enhanced negativity coupled with analytical disengagement predicts problems in subjective executive function over time.

Subjective cognitive complaints in patients with Parkinson's disease

Article

Aug 2019
ACTA NEUROL SCAND

Mild cognitive impairment (MCI) is common in Parkinson's disease (PD), affecting almost all PD patients at some time. It has been shown that PD patients, who express subjective cognitive complaints are at a higher risk of eventually developing PD-MCI. This is corroborated by the Move-ment Disorders Society's (MDS) diagnostic criteria from 2012 for PD-MCI, from which it follows that a subjective cognitive complaint must be present in addition to objective cognitive impairment for a PD patient to receive a diagnosis of PD-MCI. Nevertheless, there is currently no standardised measurement available for assessing subjective cognitive complaints. Therefore, this review aims to generate an overview of how subjective cognitive complaints are commonly operationalised in the empirical literature as well as whether they are found to be associated with the level of cognitive impairment. The findings revealed that a broad range of measures has been used to obtain subjective cognitive complaints and that there is little consistency between different studies with regards to how they have obtained these complaints, from whom they had obtained them, how many they have obtained, which types of complaints they have obtained, and whether they were associated with cognitive impairment. Given the fact that the presence of subjective cognitive complaints is a requirement for setting a diagnosis, there is a need for more methodological consensus with regards to the measurement hereof. This article is protected by copyright. All rights reserved.

Cognitive symptoms in major depressive disorder: Associations with clinical and functional outcomes in a 6-month, non-interventional, prospective study in China

Article

Full-text available

Jul 2019

Objective: Cognitive symptoms in major depressive disorder (MDD) are common and may negatively impact clinical and functional outcomes. The Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study aimed to assess the prevalence and course of cognitive symptoms, and their associations with clinical and functional outcomes during 6 months of antidepressant treatment, in a real-world setting among Chinese patients with MDD. Patients and methods: Outpatients (n=598) aged 18–65 years with MDD and a total score ≥17 on the Hamilton Depression Rating Scale – 17 Items (HAM-D17) were observed over 6 months after initiating new antidepressant monotherapy, with follow-up visits at months 1, 2, and 6. Cognitive symptoms were assessed using the Perceived Deficits Questionnaire – Depression (PDQ-D) and cognitive performance using the Digit Symbol Substitution Test (DSST). Results: At baseline, 76.9% of patients had indications of cognitive symptoms (PDQ-D total score ≥21); at month 6, this was reduced, but still present in 32.4%. Across the 6-month study period, patients improved across cognitive, clinical and functional assessments. High levels of cognitive symptoms (PDQ-D) consistently predicted worse clinical outcomes, ie, lower odds for remission and increased odds for relapse, as well as worse patient-reported functional outcomes and lower quality of life. In contrast, cognitive performance (DSST) predicted performance-based functioning but only a few patient-reported functional outcomes (absenteeism and quality of life), and no clinical outcomes. PDQ-D and DSST scores were uncorrelated at baseline. Conclusion: The study highlights the importance of assessing and targeting cognitive symptoms for increasing patients’ chances of recovery and restoring functioning in the treatment of MDD. The results further highlight the relevance of complementary assessment methods to fully capture aspects of cognitive symptoms in patients with depression.

Neurocognitive and psychosocial late effects of cranial radiotherapy in adult survivors of childhood and adolescent cancers

Conference Paper

Sep 2018

Lara Payne

Overview This thesis examines the late effects of cranial radiotherapy in adult survivors of childhood cancers. Part 1 is a systematic literature review which aims to extend previous research by summarising the neurocognitive outcomes associated with the specific effects of cranial radiotherapy up to 34 years after completing treatment. Results indicated that cranial radiotherapy has greater effects on memory, processing speed, and attention than intelligence and general executive functions. Younger age at diagnosis and higher radiotherapy dosage were also associated with increased risk of adverse neurocognitive outcomes in adulthood. Part 2 is an empirical paper which evaluates neurocognitive and psychosocial late effects of cranial radiotherapy within a specific subgroup of survivors of adolescent cancers. Adult survivors reported generally positive social adjustment, and IQ scores and levels of depression and anxiety were comparable to the normal population. Total radiotherapy dosage and receiving additional chemotherapy significantly predicted IQ. However, findings must be interpreted with caution, and the need for larger longitudinal studies with sufficient statistical power to fully characterise enduring deficits and determine factors that place survivors at greatest risk is discussed. Part 3 is a critical appraisal of the research process which discusses issues of project development and the theoretical and methodological limitations inherent in studying the specific effects of cranial radiotherapy. The concept of post-traumatic growth and its applications to the current findings are also considered.

A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

Article

Apr 2019

Background People with traumatic brain injuries (TBIs) commonly report memory impairments. These are persistent, debilitating and reduce quality of life, but patients do not routinely receive memory rehabilitation after discharge from hospital. Objective To assess the clinical effectiveness and cost-effectiveness of a group memory rehabilitation programme for people with TBI. Design Multicentre, pragmatic, cluster randomised controlled trial. Qualitative and health economic evaluations were also undertaken. Setting Community settings in nine sites in England. Participants Participants were aged 18–69 years, had undergone a TBI > 3 months prior to recruitment, reported memory problems, were able to travel to a site to attend group sessions, could communicate in English and gave informed consent. Randomisation and blinding Clusters of four to six participants were randomised to the memory rehabilitation arm or the usual-care arm on a 1 : 1 ratio. Randomisation was based on a computer-generated pseudo-random code using random permuted blocks of randomly varying size, stratified by study site. Participants and therapists were aware of the treatment allocation whereas outcome assessors were blinded. Interventions In the memory rehabilitation arm 10 weekly sessions of a manualised memory rehabilitation programme were provided in addition to usual care. Participants were taught restitution strategies to retrain impaired memory functions and compensation strategies to enable them to cope with memory problems. The usual-care arm received usual care only. Main outcome measures Outcomes were assessed at 6 and 12 months after randomisation. Primary outcome: patient-completed Everyday Memory Questionnaire – patient version (EMQ-p) at 6 months’ follow-up. Secondary outcomes: Rivermead Behavioural Memory Test – third edition (RBMT-3), General Health Questionnaire 30-item version, European Brain Injury Questionnaire, Everyday Memory Questionnaire – relative version and individual goal attainment. Costs (based on a UK NHS and Personal Social Services perspective) were collected using a service use questionnaire, with the EuroQol-5 Dimensions, five-level version, used to derive quality-adjusted life-years (QALYs). A Markov model was developed to explore cost-effectiveness at 5 and 10 years, with a 3.5% discount applied. Results We randomised 328 participants (memory rehabilitation, n = 171; usual care, n = 157), with 129 in the memory rehabilitation arm and 122 in the usual-care arm included in the primary analysis. We found no clinically important difference on the EMQ-p between the two arms at 6 months’ follow-up (adjusted difference in mean scores –2.1, 95% confidence interval –6.7 to 2.5; p = 0.37). For secondary outcomes, differences favouring the memory rehabilitation arm were observed at 6 months’ follow-up for the RBMT-3 and goal attainment, but remained only for goal attainment at 12 months’ follow-up. There were no differences between arms in mood or quality of life. The qualitative results suggested positive experiences of participating in the trial and of attending the groups. Participants reported that memory rehabilitation was not routinely accessible in usual care. The primary health economics outcome at 12 months found memory rehabilitation to be £26.89 cheaper than usual care but less effective, with an incremental QALY loss of 0.007. Differences in costs and effects were not statistically significant and non-parametric bootstrapping demonstrated considerable uncertainty in these findings. No safety concerns were raised and no deaths were reported. Limitations As a pragmatic trial, we had broad inclusion criteria and, therefore, there was considerable heterogeneity within the sample. The study was not powered to perform further subgroup analyses. Participants and therapists could not be blinded to treatment allocation. Conclusions The group memory rehabilitation delivered in this trial is very unlikely to lead to clinical benefits or to be a cost-effective treatment for people with TBI in the community. Future studies should examine the selection of participants who may benefit most from memory rehabilitation. Trial registration Current Controlled Trials ISRCTN65792154. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 23, No. 16. See the NIHR Journals Library website for further project information.

Divergence of subjective and performance-based cognitive gains following cognitive training in schizophrenia

Article

Full-text available

Aug 2019
SCHIZOPHR RES

Background: Cognitive training is effective for improving cognitive performance among people with schizophrenia. An individual's perception of their own cognition is dissociable from performance on objective cognitive tests. Since subjective cognitive benefit may impact engagement, motivation, and satisfaction with time-intensive cognitive interventions, this study aimed to determine whether subjective cognitive difficulties improve in conjunction with cognitive gains following 30 h of cognitive training. Methods: Patients with schizophrenia or schizoaffective disorder (N = 46) were randomized to treatment as usual (TAU) or TAU augmented with auditory-targeted cognitive training (TCT). All participants completed assessment batteries at baseline and follow-up. As previously reported, the TCT group showed significant improvements in verbal learning and memory and reductions in auditory hallucinations relative to the TAU group. Results: Subjective cognitive difficulties did not significantly improve following TCT, even among TCT participants who showed improvements in cognitive performance (all ps > 0.05). Subjective cognitive difficulties were significantly associated with severity of depressive symptoms and hallucinations (r = 0.48 and r = 0.28, p < 0.001), but not global or specific domains of cognition (all rs < 0.1) at baseline. There were no significant relationships between change in subjective cognitive difficulties and change in cognitive or clinical variables (all ps > 0.05). Discussion: Patients with schizophrenia do not detect change in their cognition following cognitive training, even among those who showed robust gains in cognitive performance. Failure to detect improvement may undermine treatment engagement, motivation, and satisfaction. Translating score improvements on the cognitive exercises into tangible metrics, and providing ongoing, clinician-delivered feedback on performance may facilitate patient ability to detect improvements and improve motivation to engage with cognitive training interventions.

Opioid modulation of cognitive impairment in depression

Chapter

Jan 2018
Progr Brain Res

The failure of traditional antidepressant medications to adequately target cognitive impairment is associated with poor treatment response, increased risk of relapse, and greater lifetime disability. Opioid receptor antagonists are currently under development as novel therapeutics for major depressive disorder (MDD) and other stress-related illnesses. Although it is known that dysregulation of the endogenous opioid system is observed in patients diagnosed with MDD, the impact of opioidergic neurotransmission on cognitive impairment has not been systematically evaluated. Here we review the literature indicating that opioid manipulations can alter cognitive functions in humans. Furthermore, we detail the preclinical studies that demonstrate the ability of mu-opioid receptor and kappa-opioid receptor ligands to modulate several cognitive processes. Specifically, this review focuses on domains within higher order cognitive processing, including attention and executive functioning, which can differentiate cognitive processes influenced by motivational state.

Neurocognitive effects of methylphenidate in adults with attention-deficit/hyperactivity disorder: A meta-analysis

Article

May 2018
NEUROSCI BIOBEHAV R

PIEVSKY, M. A., and R. E. McGrath. Neurocognitive effects of methylphenidate in adults with attention-deficit/hyperactivity disorder: A meta-analysis…NEUROSCI BIOBEHAV REV 81(1) XXX-XXX, 2017.- This meta-analysis summarized 21 double-blind randomized controlled trials with a mean study duration of 18 days comparing the neurocognitive functioning of adults with attention-deficit/hyperactivity disorder (ADHD) on methylphenidate vs placebo. Effect sizes were weighted using a random-effects model. Scores on neurocognitive measures and tests of driving ability were on average higher on methylphenidate than on placebo, g = .17, p < .01, 95% CI = [.05, .28], with little heterogeneity, Q(20) = 15.05, p = .77, I2 = 0. Performance on methylphenidate was significantly better than on placebo for the following domains: working memory (mean g = .13, 95% CI = [.00, .26]), reaction time variability (.16, [.03, .28]), vigilance (.22, [.11, .33]), driving (.22, [.10, .34]), and response inhibition (.23, [.10, .36]). Quantitative and qualitative assessment revealed evidence of publication bias. Summarizing across studies, methylphenidate improved the performance of adults with ADHD on neurocognitive measures and tests of driving, suggesting that methylphenidate is an effective treatment for adults with ADHD and can improve processes related to attention and concentration.

Antiepileptic drug treatment of generalized tonic-clonic seizures: An evaluation of regulatory data and five criteria for drug selection

Article

Mar 2018
EPILEPSY BEHAV

Background: A generalized tonic-clonic seizure (GTCS) is the most severe form of common epileptic seizure and carries the greatest risk of harm. The aim of this review is to provide an evidence-based guide for the selection of antiepileptic drugs (AEDs) for patients with GTCSs. Eight AEDs are approved in Europe and the USA for the treatment of both primarily GTCSs (PGTCSs) and secondarily GTCSs (SGTCSs) and are considered in this paper. Methods: Each AED is evaluated using five criteria: (1) efficacy, by seizure type (a: PGTCSs and b: SGTCSs); (2) adverse effects; (3) interactions; (4) adherence and dosing; and (5) mechanism of action (MOA). To ensure the inclusions of robust data, only efficacy data accepted by regulatory authorities were considered, and data related to adverse effects, interactions, adherence, and MOA were all extracted from UK Summaries of Product Characteristics (SPCs). Results: (1a) There is class 1 evidence of the efficacy of only four AEDs in controlling PGTCSs (lamotrigine, levetiracetam, perampanel, and topiramate). (1b) There is no class 1 evidence of the efficacy of any AED in SGTCSs although some evidence from pooled/subgroup analyses or meta-analyses supports the use of the four AEDs (levetiracetam, perampanel, topiramate, and with less robust data for lamotrigine). (2) AEDs are associated with different, but to some extent overlapping, common adverse effect profiles but have differing idiosyncratic adverse effects. (3) Pharmacokinetic interactions are seen with most, but not all, AEDs and are most common with carbamazepine and phenytoin. (4) Good adherence is important for seizure control and is influenced by frequency of dosing, among other factors. (5) Mechanism of action is also a consideration in rationalising AED selection when switching or combining AEDs. Conclusion: Ultimately, the choice of AED depends on all these factors but particularly on efficacy and adverse effects. Different patients will weigh the various factors differently, and the role of the treating physician is to provide accurate information to allow patients to make informed choices.

The effects of vortioxetine on cognitive performance in working patients with major depressive disorder: A short-term, randomized, double-blind, exploratory study

Article

Full-text available

Dec 2017
J AFFECT DISORDERS

Background: Major Depressive Disorder (MDD) is a complex disease characterized by emotional, physical and cognitive symptoms. We explored the efficacy of vortioxetine versus placebo on outcomes of cognition, functioning and mood symptoms in working patients with depression, using paroxetine as an active reference. Methods: Gainfully employed patients (18-65 years, N = 152) with MDD were randomized 1:1:1 to 8 weeks' double-blind, parallel treatment either with vortioxetine (10mg/day) or paroxetine (20mg/day), or with placebo. The primary efficacy measure was the Digit Symbol Substitution Test (DSST), analyzed using a mixed model for repeated measurements, and the key secondary efficacy measure was the University of San Diego Performance-based Skills Assessment - Brief (UPSA-B), analyzed using analysis of covariance (last observation carried forward). Results: At week 8, DSST and UPSA-B performance had improved relative to baseline in all treatment groups, with no statistically significant differences between treatment groups. While improvements in mood were comparable for vortioxetine and paroxetine, numerical improvements in cognitive performance (DSST) were larger with vortioxetine. Vortioxetine significantly improved overall cognitive performance and clinician-rated functioning relative to placebo. The majority of adverse events were mild or moderate, with nausea being the most common adverse event for vortioxetine. Limitations: Small sample sizes implied limited statistical power. Conclusion: This explorative study showed no significant differences versus placebo in DSST or UPSA-B performance at week 8. However, secondary results support vortioxetine as an effective and well-tolerated antidepressant, supporting an added benefit for cognition and functioning, which could have particular therapeutic relevance for the working patient population.

Subjective complaints after acquired brain injury: Presentation of the Brain Injury Complaint Questionnaire (BICoQ)

Article

Oct 2017

The objective of the present study was to present a new complaint questionnaire designed to assess a wide range of difficulties commonly reported by patients with acquired brain injury. Patients (n = 619) had been referred to a community re-entry service at a chronic stage after brain injury, mainly traumatic brain injury (TBI). The Brain Injury Complaint Questionnaire (BICoQ) includes 25 questions in the following domains: cognition, behavior, fatigue and sleep, mood, and somatic problems. A self and a proxy questionnaire were given. An additional question was given to the relative, about the patient's awareness of his difficulties. The questionnaires had a good internal coherence, as measured with Cronbach's alpha. The most frequent complaints were, in decreasing order, mental slowness, memory troubles, fatigue, concentration difficulties, anxiety, and dual tasking problems. Principal component analysis with varimax rotation yielded six underlying factors explaining 50.5% of total variance: somatic concerns, cognition, and lack of drive, lack of control, psycholinguistic disorders, mood, and mental fatigue/slowness. About 52% of patients reported fewer complaints than their proxy, suggesting lack of awareness. The total complaint scores were not significantly correlated with any injury severity measure, but were significantly correlated with disability and poorer quality of life (Note: only factor 2 [cognition/lack of drive] was significantly related to disability.) The BICoQ is a simple scale that can be used in addition to traditional clinical and cognitive assessment measures, and to assess awareness of everyday life problems.

Impact of depression and anxiety on perception of drug-related adverse events and quality of life in patients with epilepsy

Article

Jan 2017

Depression and anxiety affect the perception of adverse effects of antiepileptic drugs and the quality of life among patients with epilepsy. There are no available studies in Bulgarian on investigating the interrelations between these clinical parameters. The aim of the present study was to assess the influence of depression and anxiety on perception of drug-related adverse effects and the quality of life in Bulgarian patients with epilepsy, comparing the impact of some clinical and sociodemographic characteristics. The study group consisted of 131 consecutive patients with epilepsy (57 male and 74 female, average age 40.13 ± 13.37 years). The methods used were documentary analysis, an interview on clinical factors, questionnaires (Liverpool Adverse Events Profile, Hospital Anxiety and Depression Scale and Quality of Life in Epilepsy Inventory – 89), and statistical methods. Depression was observed in 32 (24%) of the studied participants and anxiety symptoms – in 44 (34%). We found significant positive correlations between depression and anxiety and the total LAEP score, as well as the presence of neurological and psychiatric AEs and a mild correlation between depression and anxiety and the presence of non-neurological AEs. The statistical analysis revealed that the subscales of QOLIE-89 were negatively correlated to higher scores of the HADS subscales for depression and anxiety, the presence of neurological and psychiatric AEs, higher number of prescribed drugs, older age, seizure frequency, and symptomatic type of epilepsy. Depression and anxiety in patients with epilepsy are closely connected to perception for frequenter and severer drug-related AEs and worse quality of life. The results will be useful in the assessment of adverse effects of antiepileptic drugs, and those in adjusting the antiepileptic therapy.

Do complaints of everyday cognitive failures in high schizotypy relate to emotional working memory deficits in the lab?

Article

Jul 2017

Background: Individuals high on schizotypy complain of increased cognitive failures in everyday life. However, the neuropsychological performance of this group does not consistently indicate underlying ability deficits. It is possible that current neuropsychological tests lack ecological validity. Given the increased affective reactivity of high schizotypes, they may be more sensitive to emotional content interfering with cognitive ability. This study sought to explore whether an affective n-back working memory task would elicit impaired performance in schizotypy, echoing complaints concerning real world cognition. Methods: 127 healthy participants completed self-report measures of schizotypy and cognitive failures and an affective n-back working memory task. This task was varied across three levels of load (1- to 3-back) and four types of stimulus emotion (neutral, fearful, happy, sad). Differences between high (n=39) and low (n=48) schizotypy groups on performance outcomes of hits and false alarms were examined, with emotion and load as within-groups variables. Results: As expected, high schizotypes reported heightened vulnerability to cognitive failures. They also demonstrated a relative working memory impairment for emotional versus neutral stimuli, whereas low schizotypes did not. High schizotypes performed most poorly in response to fearful stimuli. For false alarms, there was an interaction between schizotypy, load, and emotion, such that high schizotypy was associated with deficits in response to fearful stimuli only at higher levels of task difficulty. Inclusion of self-reported cognitive failures did not account for this. Conclusion: These findings suggest that the "gap" between subjective and objective cognition in schizotypy may reflect the heightened emotional demands associated with cognitive functioning in the real world, although other factors also seem to play a role. There is a need to improve the ecological validity of objective assessments, whilst also recognizing that self-reported cognitive failures tap into a range of factors difficult to assess in the lab, including emotion. Cognitive interventions for at-risk individuals will likely be more beneficial if they address emotional processing alongside other aspects of cognition.

Fatigue during treatment with antiepileptic drugs: A levetiracetam-specific adverse event?

Article

Jul 2017
EPILEPSY BEHAV

Purpose To examine the prevalence and clinical correlates of fatigue as an adverse event (AE) of antiepileptic drug (AED) treatment in patients with epilepsy. Methods Data from 443 adult outpatients with epilepsy assessed with the Adverse Event Profile (AEP) and the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) were analysed. Results Fatigue is reported by 36.6% of patients as always a problem during AED treatment. Fatigue is more likely to be reported by females (64.8% vs. 35.2%; Chi-Square = 16.762; df = 3; p = 0.001) and during treatment with levetiracetam (42.3% vs. 33.2%; Chi-Square = 11.462; df = 3; p = 0.009). The associations with the female gender and levetiracetam treatment were not mediated by depression, as identified with the NDDIE, and could not be simply explained by the large number of subjects on levetiracetam treatment, as analogous figures resulted from the analysis of a monotherapy subsample (41.7% vs. 30.3%; Chi-Square = 11.547; df = 3; p = 0.009). Conclusions One third of patients with epilepsy reports fatigue as a significant problem during AED treatment. Fatigue is more likely to be reported by females and seems to be specifically associated with LEV treatment. However, fatigue is not mediated by a negative effect of LEV on mood.

Everyday memory impairment in patients with temporal lobe epilepsy caused by hippocampal sclerosis

Article

Apr 2017
EPILEPSY BEHAV

Objective: Patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) have episodic memory impairment. Memory has rarely been evaluated using an ecologic measure, even though performance on these tests is more related to patients' memory complaints. We aimed to measure everyday memory of patients with TLE-HS to age- and gender-matched controls. Methods: We evaluated 31 patients with TLE-HS and 34 healthy controls, without epilepsy and psychiatric disorders, using the Rivermead Behavioral Memory Test (RBMT), Visual Reproduction (WMS-III) and Logical Memory (WMS-III). We evaluated the impact of clinical variables such as the age of onset, epilepsy duration, AED use, history of status epilepticus, and seizure frequency on everyday memory. Statistical analyses were performed using MANCOVA with years of education as a confounding factor. Results: Patients showed worse performance than controls on traditional memory tests and in the overall score of RBMT. Patients had more difficulties to recall names, a hidden belonging, to deliver a message, object recognition, to remember a story full of details, a previously presented short route, and in time and space orientation. Clinical epilepsy variables were not associated with RBMT performance. Memory span and working memory were correlated with worse performance on RBMT. Significance: Patients with TLE-HS demonstrated deficits in everyday memory functions. A standard neuropsychological battery, designed to assess episodic memory, would not evaluate these impairments. Impairment in recalling names, routes, stories, messages, and space/time disorientation can adversely impact social adaptation, and we must consider these ecologic measures with greater attention in the neuropsychological evaluation of patients with memory complaints.

Memory and mood outcomes after anterior thalamic stimulation for refractory partial epilepsy

Article

Dec 2016

Purpose: Bilateral deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) reduces seizures and is relatively safe but may be accompanied by complaints of memory problems and depression. This study examined incidence of memory and depression adverse events (AE) in the SANTE study blinded phase and their relationship to objective neurobehavioral measures, baseline characteristics, quality of life and long-term neurobehavioral outcome. Method: The neurobehavioral AE and neuropsychological data from a previously reported prospective randomized trial (SANTE) were analyzed. Reliable change indices (RCI) were calculated for memory and mood measures. Analyses examined relationships among AEs, RCIs, demographic and seizure variables, and long-term neurobehavioral outcome. Results: No significant cognitive declines or worsening of depression scores were observed through the blinded phase or in open-label at 7-years. Higher scores were observed at 7 years on measures of executive functions and attention. Depression and memory-related AEs were not associated with reliable change on objective measures or 7-year neurobehavioral outcome. The AEs were without significant impact on life quality. Memory and depression AEs were not related to demographic or seizure characteristics, change in seizure frequency, frequency of AE or depression report. Conclusion: Bilateral ANT DBS was associated with subjective depression and memory AEs during the blinded phase in a minority of patients that were not accompanied by objective, long-term neurobehavioral worsening. Monitoring and neuropsychological assessment of depression and memory are recommended from a theoretical standpoint and because more memory and depression AEs occurred in the active stimulation than control group.

Subjective memory complaints in patients with epilepsy: The role of depression, psychological distress, and attentional functions

Article

Aug 2016

While objective memory dysfunctions have been thoroughly investigated in patients with epilepsy, assessment of subjective memory complaints (SMC) remains challenging. Former studies have demonstrated an impact of patients' depressive mood on SMC. However, the impact of more general psychological distress and cognitive functioning in non-memory domains on SMC has only received little attention so far. We therefore sought to determine the factors which may particularly predict SMC in a sample of patients with focal epilepsy (n=99) who accomplished (1) a comprehensive neuropsychological assessment, (2) a subjective memory questionnaire, and (3) scales of self-rated depressive mood and psychological distress. General psychological distress (as measured by the Symptom Checklist- 90-Revised) accounted for a high proportion of SMC and, critically, explained more variance than depressive mood as a single factor (as measured by the Beck Depression Inventory II). Furthermore, SMC were predicted by recall measures of a verbal serial learning task, but also by measures of attention, importantly. Hence, our data firstly indicate that beyond the impact of depressive mood, SMC may be more accurately explained by psychological distress in a more general sense. Secondly, our study provides evidence that patients' estimation of subjective memory is not solely based on functioning in memory domains. Attentional resources may also be critical for patients' perception of everyday memory functioning.

Subjective Memory Complaints and Conversion to Dementia in Patients with Subjective Cognitive Decline and Patients with Mild Cognitive Impairment

Article

Full-text available

Apr 2016

Background: Subjective cognitive complaints and their clinical significance are discussed controversially. Objectives: To determine the clinical validity of subjective cognitive complaints among subjects with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Design: Longitudinal study with one follow up examination at a University based out-patient memory clinic. Participants: A clinical sample of patietns with SCD and MCI (n = 141), aged 50 and older, who came to the memory outpatient clinic. Results: No significant differences between converters and non converters regarding subjective cognitive complaints were detected. MCI patients had a higher risk than the patients with SCD developing AD (OR = 7.3 [CI 0.9 to 61.2]. Verbal memory testing using the Verbal Selektive Reminding Test (VSRT) showed better diagnostic validity than subjective cognitive complaints using the Forgetfulness Assessment Inventory (FAI) in predicting conversion to dementia. Conclusion: Verbal memory testing was superior in predicting conversion to dementia compared to subjective cognitive complaints.

Examining the Association between Patient-Reported Symptoms of Attention and Memory Dysfunction with Objective Cognitive Performance: A Latent Regression Rasch Model Approach

Article

Apr 2016

Objective. Patient-reported cognition generally exhibits poor concordance with objectively assessed cognitive performance. In this article, we introduce latent regression Rasch modeling and provide a step-by-step tutorial for applying Rasch methods as an alternative to traditional correlation to better clarify the relationship of self-report and objective cognitive performance. An example analysis using these methods is also included. Method. Introduction to latent regression Rasch modeling is provided together with a tutorial on implementing it using the JAGS programming language for the Bayesian posterior parameter estimates. In an example analysis, data from a longitudinal neurocognitive outcomes study of 132 breast cancer patients and 45 non-cancer matched controls that included self-report and objective performance measures pre- and post-treatment were analyzed using both conventional and latent regression Rasch model approaches. Results. Consistent with previous research, conventional analysis and correlations between neurocognitive decline and self-reported problems were generally near zero. In contrast, application of latent regression Rasch modeling found statistically reliable associations between objective attention and processing speed measures with self-reported Attention and Memory scores. Conclusions. Latent regression Rasch modeling, together with correlation of specific self-reported cognitive domains with neurocognitive measures, helps to clarify the relationship of self-report with objective performance. While the majority of patients attribute their cognitive difficulties to memory decline, the Rash modeling suggests the importance of processing speed and initial learning. To encourage the use of this method, a step-by-step guide and programming language for implementation is provided. Implications of this method in cognitive outcomes research are discussed.

Validation of the Cognitive Assessment Instrument for Obsessions and Compulsions (CAIOC-13) in an Indian Sample

Article

May 2024

Background Brief self-report measures of cognition are advantageous for flagging significant cognitive dysfunction without extensive neuropsychological assessments. The Cognitive Assessment Instrument for Obsessions and Compulsions (CAIOC-13) is a recently developed self-report that assesses everyday cognitive dysfunction in obsessive-compulsive disorder (OCD), for example, difficulties with reading, slowness, and decision-making. This study was undertaken to validate the CAIOC-13 in an Indian sample of OCD. Material and Methods 75 subjects with OCD and 81 non-clinical controls completed CAIOC-13, Perceived Deficits Questionnaire (PDQ), and Dysfunctional Attitude Scale-Short Form (DAS-SF1). Convergent and divergent validity with PDQ and DAS-SF1 were established with Pearson’s correlation; the Receiver Operating Characteristic (ROC) curve was used to analyze discriminant validity; and factorial structure was evaluated using the principal component analysis (PCA). Results CAIOC-13 scores showed a strong significant correlation ( r = 0.56; p < .001) with PDQ and a moderate correlation with DAS-SF1 scores ( r = 0.33; p = .003). CAIOC-13 could accurately discriminate between OCD and controls (area under curve = 0.92). PCA revealed strong loading on a single component. Conclusion CAIOC-13 is a valid tool for briefly assessing OCD-related cognitive dysfunction in Indian samples. Future studies may examine the correlation of CAIOC-13 with standardized neuropsychological assessments.

Depression in Epilepsy

Chapter

Apr 2024

Oh-Young Kwon

Depression is prevalent in people living with epilepsy (PLWE) due to a reciprocal relationship between both conditions. Various depressive disorders can occur in PLWE, often linked to hyperactivity of the hypothalamic-pituitary-adrenal axis, neuroinflammation, and serotonin transmission disruptions, among other factors. Antiseizure medications with adverse psychotropic effects can also cause or exacerbate depression. Depressive symptoms in PLWE are classified into interictal and peri-ictal types. The peri-ictal classes are further subdivided into preictal, ictal, and postictal categories. The dysphoric mood is the most common preictal symptom. Ictal symptoms are usually short-lived, and postictal symptoms may not occur immediately. Depression profoundly impacts PLWE, increasing suicidality, stigma, pharmacoresistance to antiseizure medications, and unfavorable epilepsy surgery outcomes. It notably deteriorates their quality of life even more than the level of seizure control. Therefore, early depression detection is crucial, though the hectic epilepsy clinical environments pose challenges. Efficient use of brief time-taking screening tools can help overcome busy clinical environments. Treatment primarily involves antidepressants, especially selective serotonin reuptake inhibitors, due to their lower seizure risk and favorable side effects. Cognitive-behavioral therapy alongside antidepressants can also be beneficial. When choosing antiseizure medications for PLWE who have depression or are prone to depression, those with positive psychotropic effects should be considered primarily.

The impact of musical reward responses on cognitive function in older adults with type 2 diabetes

Article

Jan 2024

Narrative Review of Topiramate: Clinical Uses and Pharmacological Considerations

Article

Jun 2023
ADV THER

Due to the diverse mechanisms of action of antiseizure drugs, there has been a rise in prescriptions of these drugs for non-epileptic pathologies. One drug that is now being used for a variety of conditions is topiramate. This is a narrative review that used PubMed, Google Scholar, MEDLINE, and ScienceDirect to review literature on the clinical and pharmacologic properties of topiramate. Topiramate is a commonly prescribed second-generation antiseizure drug. The drug works through multiple pathways to prevent seizures. In this regard, topiramate blocks sodium and calcium voltage-gated channels, inhibits glutamate receptors, enhances gamma-aminobutyric acid (GABA) receptors, and inhibits carbonic anhydrase. Topiramate is approved by the Food and Drug Administration (FDA) for epilepsy treatment and migraine prophylaxis. Topiramate in combination with phentermine is also FDA-approved for weight loss in patients with a body mass index (BMI) > 30. The current target dosing for topiramate monotherapy is 400 mg/day and 100 mg/day to treat epilepsy and migraines, respectively. Commonly reported side effects include paresthesia, confusion, fatigue, dizziness, and change in taste. More uncommon and serious adverse effects can include acute glaucoma, metabolic acidosis, nephrolithiasis, hepatotoxicity, and teratogenicity. Related to a broad side effect profile, physicians prescribing this drug should routinely monitor for side effects and/or toxicity. The present investigation reviews various anti-seizure medications before summarizing indications of topiramate, off-label uses, pharmacodynamics, pharmacokinetics, adverse effects, and drug-drug interactions.

Domain-specific relationships of subjective and objective cognition in epilepsy

Article

Apr 2023

Objective: Many people with epilepsy report subjective cognitive impairment (SCI), i.e., problems with memory, attention or executive functions, reducing quality of life. Nevertheless, overlap with objective cognitive impairment (OCI) is often weak. One reason may be a domain-specific mismatch between subjective reports and objective tests. We aimed to evaluate relations between SCI and OCI of corresponding domains and to assess whether these differ between persons that over- or underestimate their performance. Methods: In this prospective, cross-sectional sample of 104 adult in-patients with epilepsy, we performed multiple regression analyses predicting SCI in the domains attention, memory and executive functions. We tested relationships with measures of psychomotor speed, short-term memory, verbal learning, verbal delayed recall, and word fluency while controlling for age, sex, seizure frequency, structural lesions, mono- vs. polytherapy and adverse events of antiseizure medication (ASM), depressive and anxiety symptoms, level of education, and employment status. Furthermore, we tested whether these relationships differed between realistic raters and over- and underestimators. Results: We found domain-specific relations for attention and executive functions for the full sample, explaining a small proportion of variance of SCI (General dominance index [GDI] 0.03 and 0.004), whereas ASM adverse events and psychological variables were more important predictors. When dividing the sample according to the concordance of SCI and OCI, we found high frequencies of both over- (23-46%) and underestimation (31-35%) depending on the domain. The explanatory power of OCI for SCI was stronger within the subgroups compared to the full sample, suggesting non-linear relationships and different underlying mechanisms for realistic raters, underestimators and overestimators. Significance: Domain-specific SCI and OCI are related, and both should be assessed with standardized instruments. These relationships differ between over- and underestimators as well as realistic raters. Based on the concordance of self-ratings and objective measures, tailored counseling and treatment should be offered.

The Relationship Between Multimorbidity and Types of Chronic Diseases and Self-Rated Memory

Article

Apr 2022
RES AGING

This study explores the impact of multimorbidity and types of chronic diseases on self-rated memory in older adults in the United States. Data were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS, N = 6,481). Logistic regressions were used to examine the associations between ㅠ multimorbidity and types of chronic diseases and fair/poor self-rated memory. Compared to respondents with no or one chronic disease, respondents with multimorbidity showed 35% higher odds of reporting fair/poor self-rated memory. Also, stroke, osteoporosis, and arthritis were identified as increasing the odds of reporting fair/poor self-rated memory by 41%, 20%, and 30%, respectively. Demonstrating the importance of both multimorbidity and types of chronic diseases in self-reporting of memory, our findings suggest the need to educate older adults with multimorbidity and certain types of diseases regarding negative self-rated memory and its consequences.

Hazardous employment of invalid measures for cognitive outcome assessment: You only see what your test can show you

Article

Mar 2021
EPILEPSY BEHAV

Effects of ketogenic diet on cognitive function in pentylenetetrazol-kindled rats

Article

Dec 2020
EPILEPSY RES

Although the ketogenic diet (KD) is known to control seizures and improve cognition function in patients with drug-refractory epilepsy, the underlying mechanism remains unknown. In the present study, using pentylenetetrazol (PTZ)-induced and kindled rats, we found that KD significantly improved the impaired spatial reference memory of PTZ-kindled rats in the Morris water maze. To explore the mechanism underlying the action of KD in PTZ-kindled rats, quantitative real-time PCR (qRT-PCR) and immunohistochemical analysis were used to detect the expression of GluR1 and NR2B. The results showed that both the mRNA and protein expression of GluR1 and NR2B were significantly downregulated in the hippocampus of PTZ-kindled rats, while KD could observably improve both the mRNA and protein expression of GluR1 and NR2B in the hippocampus of PTZ-kindled rats. Additionally, KD improved the over-activated MAPK in PTZ-kindled rats, but not CAMKII, as detected by enzyme-linked immuno sorbent assay (ELISA), suggesting that the MAPK signaling pathway might be involved in the memory improvement of KD in PTZ-kindled rats. In conclusion, these results demonstrate that KD can indeed improve impaired spatial reference memory in PTZ-kindled rats, and KD can improve the expression of NR2B and GluR1.

Self-awareness and underestimation of cognitive abilities in patients with adult temporal lobe epilepsy after surgical treatment

Article

Full-text available

Nov 2020

Introduction Self-awareness of cognitive, emotional, functional, and social performance is critical for compliance with treatment. However, few studies have investigated self-awareness and the associated effects on other cognitive variables in patients with temporal lobe epilepsy (TLE) after surgical treatment. Aim This study was designed to investigate the prevalence of impaired self-awareness (ISA) in patients with TLE who have undergone surgical treatment. Associated correlations with clinical variables (frequency of seizures before surgery, time elapsed since the epilepsy diagnosis, depression, and anxiety) and verbal and visual episodic memory function and differences between patients with right and left TLE were also investigated. Method Twenty-three adults with TLE after surgical treatment were assessed with the Patient Competency Rating Scale (PCRS-R-BR), the Rey Auditory Verbal Learning Task (RAVLT), and the Modified Ruche Visuospatial Learning Test (RUCHE-M). Patients were considered to have memory dysfunction if delayed recall as assessed with the RUCHE-M or RAVLT was at or below the 25th percentile. Patients were considered to have ISA if PCRS-R-BR discrepancy scores were at or above the 75th percentile. Underestimated cognitive ability (UCA) was defined as a PCRS-R-BR discrepancy percentile score ≤ 25. Results were analyzed using frequency, Spearman correlation, regression analyses, and the Mann–Whitney test. Results Frequency analysis of the total sample indicated ISA in 39.13% of patients (n = 9), UCA in 39.13% of patients (n = 9), and impaired verbal and/or visual memory performance in 69.56% of patients (n = 16). Moderate positive correlations were found between the frequency of seizures before surgical treatment and relatives' reports, as well as between the duration of time that had elapsed since the epilepsy diagnosis and patient reports. Negative and moderate correlations were found between the frequency of seizures and the discrepancy score, as well as between depression and patient reports. No differences in PCRS-R-BR were found between patients with right vs. left TLE. No clinical variables significantly predicted self-report or self-awareness. Conclusion Patients with TLE exhibit various patterns of ISA and negative effects on cognitive function after surgical treatment. Emotional factors and relatives' reports must be considered when assessing these patients.

Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors: Description and understanding

Article

May 2020

Objectives The frequency of cognitive difficulties in childhood cancer survivors varies according to the measurement strategy. The goal of this research is to (1) describe agreements and differences between measures of working memory and attention (2) identify contributors of these differences, such as emotional distress, affects, and fatigue. Methods We used data available for 138 adults successfully treated for childhood acute lymphoblastic leukemia (ALL) (PETALE cohort). Working memory and attention were assessed using subtests from the WAIS‐IV and self‐reported questionnaires (BRIEF‐SR and CAARS‐S:L). Potential contributors included emotional distress, anxiety, depression (BSI‐18), affects (PANAS), and fatigue (PedsQL‐MFS). We explored measurement agreements and differences using diagnostic indices and multivariate regression models. Results The frequencies of working memory and attention deficits were higher when using cognitive tests (15‐21%) than with self‐reports (10‐11%). Self‐reported questionnaires showed high specificity (median 0.87) and low sensitivity (median 0.10) suggesting they did not reliably identify positive cases on cognitive tests. We identified negative affectivity as a possible contributor to inconsistencies between self‐report and test results. Conclusions When measuring working memory and attention in childhood ALL survivors, cognitive test results and self‐reports should not be considered equivalent. At best, self‐report may be used for screening (high specificity), but not to assess prevalence in large samples. Self‐reported difficulties are also probably influenced by negative mood in this population. This article is protected by copyright. All rights reserved.

Factors associated with subjective cognitive function in epilepsy and psychogenic non-epileptic seizures

Article

Apr 2020
EPILEPSY RES

Objective To identify factors associated with subjective cognitive complaints in people with presumed seizure disorders referred for video electroencephalogram monitoring (VEM). Methods Adult patients admitted for inpatient VEM were recruited. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Screening Tool, subjective cognitive function with the Quality of Life in Epilepsy Inventory-89 subscales, and anxiety and depressive symptoms with the Hospital Anxiety and Depression Scale. Multivariate Bayesian general linear models were used to identify predictors of subjective cognitive function. Results 331 patients met inclusion criteria. Mean age was 39.3 years and 61.9% patients were female. Diagnoses included epilepsy, psychogenic non-epileptic seizures (PNES) or both conditions. Depression, anxiety and objective cognitive function were predictors of subjective cognitive function across all domains. Depression was the strongest predictor of subjective memory and attention, whilst objective cognition was the strongest predictor of subjective language function. Mood also mediated the relationship between objective function and subjective function across all domains to varying extents; depression exerted the strongest effect of 22% for the memory domain; conversely, language domain was least influenced by mood, with depression mediating 11% and anxiety mediating only 9% of the subjective-objective relationship. Significance Mood and objective cognitive function are both important contributors to subjective cognitive function for patients undergoing VEM. Clinicians should consider referring patients with cognitive complaints for both neurocognitive workup and neuropsychiatric evaluation. Future work may examine the effects of treating concomitant mood disorders on subjective cognitive function.

Antiepileptic drugs are not independently associated with cognitive dysfunction

Article

Feb 2020

Objective: To test the hypothesis that individual antiepileptic drugs (AEDs) are not associated with cognitive impairment beyond other clinically relevant factors, we performed a cross-sectional study of patients admitted to an inpatient video-EEG monitoring unit. Methods: We prospectively enrolled patients admitted to an inpatient specialist epilepsy program between 2009 and 2016. Assessments included objective cognitive function, quality of life subscales for subjective cognitive function, and questionnaires for anxiety and depressive symptoms. Bayesian model averaging identified predictors of cognitive function. Bayesian model selection approach investigated effect of individual AEDs on cognition. Conventional frequentist analyses were also performed. Results: A total of 331 patients met inclusion criteria. Mean age was 39.3 years and 61.9% of patients were women. A total of 45.0% of patients were prescribed AED polypharmacy, 25.1% AED monotherapy, and 29.9% no AED. Age, seizure frequency, and a diagnosis of concomitant epilepsy and psychogenic nonepileptic seizure were predictors of objective cognitive function. Depression, anxiety, and seizure frequency were predictors of subjective cognitive function. Individual AEDs were not independently associated with impaired cognitive function beyond other clinically relevant variables. Conclusions: This study found that no AED was independently associated with cognitive dysfunction. Significant determinants of objective and subjective cognitive dysfunction included seizure frequency and depression, respectively. These findings suggest that optimizing therapy to prevent seizures is not likely to occur at the expense of cognitive function.

Antiepileptic drug effects on subjective and objective cognition

Article

Jan 2020
EPILEPSY BEHAV

Rationale: Cognitive impairment is one of the most common complaints for persons with epilepsy (PWE). These impairments are not only associated with seizures, but are also regularly reported as adverse effects of antiepileptic drugs (AEDs). Previous studies have examined cognitive effects of both AED monotherapy and polytherapy, yet there is limited research on these differences with respect to both subjective and objective cognition. The current study uses data from previous research conducted by the Centers for Disease Control and Prevention (CDC)-sponsored Managing Epilepsy Well (MEW) Network collaborative. We used three distinct archival datasets from the following: (1) the HOBSCOTCH efficacy trial at Dartmouth-Hitchcock Medical Center (HOB-1), (2) the multisite replication trial (HOB-2), and (3) epilepsy self-management research conducted at the NYU School of Medicine. Methods: This retrospective analysis combined baseline data from three datasets to determine how the number of AEDs and the type of AEDs were associated with subjective (patient-reported) and objective (examiner-assessed) cognition. Subjective cognition was captured using the cognitive subscale of the Quality of Life in Epilepsy Inventory (QOLIE-31) in all three datasets (n = 224), while objective cognition was measured using the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) in the HOB-1 dataset (n = 65) and the Brief Test of Adult Cognition by Telephone (BTACT) in the HOB-2 dataset (n = 91). Multivariable linear regression was utilized for our initial assessments, followed by propensity score matching to provide stronger control of covariates. Matching was based on significantly different covariates, such as education, depression, and history of prior epilepsy surgery. Nonparametric statistical tests were utilized to compare these matched subjects. Results: Subjective cognitive impairment was significantly worse among individuals on monotherapy (1 AED) compared with those on polytherapy (2+ AEDs) (adjusted p = 0.041). These findings were consistent with our propensity score matched comparison of monotherapy and polytherapy, which indicated that polytherapy was associated with worse overall subjective cognition (adjusted p = 0.01), in addition to impairments on the RBANS (Total score p = 0.05) and specific subdomains of the BTACT (Episodic Verbal Memory p < 0.01, Working Memory p < 0.01, Processing Speed p < 0.01). Interestingly, older generation AEDs were associated with better language performance than newer generation and combined generation AED therapy (RBANS Language p = 0.03). These language-specific findings remained significant after controlling for the effects of topiramate and zonisamide (p = 0.04). Conclusions: A greater number of AEDs is significantly and negatively associated with subjective and objective cognition in PWE, and is in line with previous research. Antiepileptic drug type did not, in itself, appear to be associated with subjective cognition. Our findings suggest that ineffective AEDs should be replaced, rather than introducing additional AEDs to a treatment regimen. Further, while subjective and objective cognition assessments were both sensitive at detecting differences based on AED status, the neuropsychological objective subdomains offer additional and specific insights into how cognition is impaired with AEDs.

Naming decline after epilepsy surgery is associated with subjective language complaints

Article

Aug 2019

Objective: This retrospective, observational study investigated the relationship between objective naming decline and patient report of subjective decline in language functioning following epilepsy surgery. The role of depression in this relationship was also examined. Methods: A total of 429 adults with pharmacoresistant epilepsy completed the Boston Naming Test (BNT) and Memory Assessment Clinics Self-Rating Scale (MAC-S) before and after resective surgery. Multiple regression analyses were used to examine the relationship between objective naming decline and subjective language functioning, while controlling for the confounding effect of depression. Results: Individuals who experienced moderate to severe naming decline (≥11 raw points on BNT) following surgery reported a decline in subjective language functioning (p < .001) and endorsed problems with word-retrieval as well as more general semantic abilities. Those who experienced mild naming decline (5-10 raw points) also reported an increase in subjective language problems (p = .006). Complaints in this group were less severe than in those with more marked naming declines and were primarily related to word-retrieval. Both of these relationships remained significant after controlling for the confounding effect of depression (p < .005-.014). Conclusions: Individuals with epilepsy who experience naming decline following surgery perceive these declines in their daily life, regardless of whether or not they are depressed. Findings support the utilization of risk models to predict naming outcome and the importance of counseling patients regarding the risk for naming decline following surgery.

Eveningness is associated with greater subjective cognitive impairment in individuals with self-reported symptoms of unipolar depression

Article

May 2019
J AFFECT DISORDERS

Background: Eveningness is associated with depression diagnosis and increased depressive symptom severity. Time-of-day preference has been linked with differences in cognitive function in the general population, with cognitive difficulties being a major factor in psychosocial impairment in depression. We therefore investigated the impact of time-of-day preference and self-reported depressed state on subjective cognitive function. Methods: Participants over the age of 18 with a self-reported history of depression completed an online questionnaire. They provided demographic and mental health information, and completed self-report scales assessing depression symptoms, time-of-day preference, and cognition. Participants were classified as "currently" or "previously depressed" based on self-reported symptoms, and as having a morning, neither, or evening time-of-day preference. Results: A total of 804 participants reporting a history of unipolar depression were included. Currently-depressed participants reported more cognitive difficulties in all areas measured. Evening types reported more complex attentional and retrospective memory difficulties than neither types, and reported more executive and prospective memory difficulties than both neither and morning types. There was an additive effect of mood state and time-of-day preference, with self-reported depressed evening types reporting the most cognitive problems. Limitations: Depression history, time-of-day preference, and cognitive function were assessed using unsupervised self-report measures. Time-of-day preference does not necessarily reflect the physiological circadian system. Conclusions: Both depressed state and evening preference were individually associated with subjective cognitive complaints in people with a self-reported history of unipolar depression. The additive effect of poor mood and eveningness is important given the high prevalence of eveningness in depression. Assessment of time-of-day preference could help to identify those susceptible to cognitive symptoms, and inform treatment.

Common psychiatric comorbidities in epilepsy: How big of a problem is it?

Article

Aug 2018

Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. Theories of comorbidity are complex, but recurring associations between the conditions suggest overlap that is more than simple co-occurrence. Common underlying pathophysiology may imply that epilepsy itself may constituently include psychiatric symptoms. Conditions such as depression or cognitive difficulties commonly occur and in some cases, are considered to be associated with specific epilepsy characteristics such as localization or seizure type. Regardless of etiologic attributions to psychiatric comorbidity, it is clear today that treatment for epilepsy needs to target psychiatric illness. In many cases, quality-of-life improvements depend more upon addressing psychiatric symptoms than seizures themselves.

Evaluating subjective cognitive impairment in the adult epilepsy clinic: Effects of depression, number of antiepileptic medications, and seizure frequency

Article

Feb 2018
EPILEPSY BEHAV

Objective: Subjective cognitive complaints are a frequent concern of patients with epilepsy. The Aldenkamp-Baker Neuropsychological Assessment Schedule (ABNAS) is a patient-reported scale validated to measure adverse cognitive effects of antiepileptic drugs (AEDs). The goals of this study were to identify predictors of patient-reported cognitive dysfunction and to assess the relationship between subjective and objective cognitive impairment. Methods: The Cleveland Clinic Knowledge Program Data Registry was used to identify adult patients seen in outpatient epilepsy clinic from January to May 2015 and who completed the following scales: ABNAS for subjective cognitive impairment, Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder 7-item (GAD-7) scale, Quality of Life in Epilepsy (QOLIE-10), and EuroQOL five dimensions questionnaire (EQ-5D) for health-related quality of life. Topiramate (TPM) was considered a high-risk medication for cognitive impairment. Patients were categorized into groups based on total ABNAS score: subjective cognitive impairment (ABNAS>15; N=270) and no subjective cognitive impairment (ABNAS≤15; N=400). Multivariable logistic regression models were constructed to identify independent predictors of subjective cognitive impairment. In a subset of patients who had neuropsychological testing within 6months of completing the ABNAS (N=60), Pearson correlations and multivariable logistic regression models, controlling for number of AEDs, depression, and anxiety, assessed the relationship between subjective cognitive impairment and objective cognitive performance on measures of intelligence, attention/working memory, verbal fluency, naming, processing speed, manual dexterity, visuomotor processing, and verbal memory. Results: Forty percent of patients in the overall sample (N=270/670) reported cognitive impairment. The variables most strongly associated with subjective cognitive impairment were PHQ-9 score, number of AEDs, and seizure frequency. In the subset of patients with neuropsychological testing, ABNAS score was correlated with anxiety (r=0.44), depression (r=0.38), and attention/working memory (r=-0.31). After adjusting for depression and anxiety, patients who endorsed subjective cognitive impairment scored significantly lower on measures of nonverbal intelligence and attention/working memory, but not on other cognitive measures. Conclusions: Subjective cognitive impairment as reported on the ABNAS is most strongly associated with depressive symptomatology, number of AEDs, and seizure frequency, but not with most objective cognitive measures. Identifying these three predictors provides a clear framework to understand and address subjective cognitive complaints in adult patients with epilepsy.

Mood State, Anxiety, and Psychosis in Epilepsy

Chapter

Jul 2015

Michael Salzberg

The psychiatric comorbidities of epilepsy are common and distressing, add to disability and impaired quality of life (QOL), and contribute to an elevated suicide rate. This chapter reviews recent developments concerning mood and anxiety disorders and the psychoses. It focuses on key publications in the last 5 years concerning epilepsy in adult populations (for childhood epilepsy. The chapter concerns about suicidality triggered by antiepileptic drugs (AEDs). It also focuses on depression (for bipolar disorder in epilepsy). Human studies of depression in epilepsy tend to be psychosocial or neurobiological in nature, with few spanning both domains. Recent advances concerning psychoses of epilepsy (POE) involve pathogenesis and the interrelationships of subtypes, with few developments regarding clinical practice, as highlighted by a Cochrane review showing a near absence of randomized controlled treatment trials.

Perception of Cognitive Function in Older Adults Following Coronary Artery Bypass Surgery

Article

Full-text available

May 1999

This study examined the effects of coronary artery bypass grafting (CABG) on objective and subjective measures of neurocognitive functioning. Participants were 170 older patients (127 men and 43 women; mean age = 61 years) undergoing CABG. Measures of neurocognitive function, depression, anxiety, and perceived cognitive abilities were administered immediately prior to and 6 weeks following surgery. Although objective measures of impaired cognitive performance following CABG were not related to perceived cognitive difficulties, the presence of anxiety and depression was related to the perception of cognitive functioning. Patients who reported high levels of anxiety and depression 6 weeks after surgery perceived themselves as having poorer cognitive function. Interventions designed to reduce emotional distress could improve patient's perceived cognitive abilities following CABG.

Perception of cognitive function in older adults following coronary artery bypass surgery

Article

Full-text available

Jun 1999

Depression, APOE genotype and subjective memory impairment: A cross-sectional study in an African-Caribbean population

Article

Full-text available

Apr 2001

Subjective memory impairment (SMI) is common in older populations but its aetiology and clinical significance is uncertain. Depression has been reported to be strongly associated with SMI. Associations with objective cognitive impairment are less clear cut. Other factors suggested to be associated with SMI include poor physical health and the apolipoprotein E (APOE) epsilon4 allele. Studies of SMI have been predominantly confined to white Caucasian populations. A community study was carried out in a UK African-Caribbean population aged 55-75, sampled from primary care lists. Twenty-three per cent were classified with SMI. Depression was defined using the 10-item Geriatric Depression Scale. Other aetiological factors investigated were education, objective cognitive function, APOE genotype, disablement and vascular disease/risk. The principal analysis was restricted to 243 participants scoring > 20 on the Mini-Mental State Examination (85%). A second analysis included all 290 participants. Depression, self-reported physical impairment and APOE epsilon4 were associated with SMI. The association between SMI and physical impairment was not explained by depression, vascular disease/risk, or disability/handicap. The association between epsilon4 and SMI increased as MMSE scores decreased and was particularly strong in those with depression. The epsilon4 allele was present in 69% (95% CI 41-89%) of those with depression and SMI compared with 28% (20-36%) of those with neither. Depression may not be a sufficient explanation for subjective memory complaints. Memory complaints in the presence of depression are associated with high prevalence of epsilon4 and therefore, presumably, a raised risk of subsequent dementia.

Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers

Article

Full-text available

Jul 2005
NEUROLOGY

The relative cognitive and behavioral effects of lamotrigine (LTG) and topiramate (TPM) are unclear. The authors directly compared the cognitive and behavioral effects of LTG and TPM in 47 healthy adults using a double-blind, randomized crossover design with two 12-week treatment periods. During each treatment condition, subjects were titrated to receive either LTG or TPM at a target dose of 300 mg/day for each. Neuropsychological evaluation included 17 measures yielding 41 variables of cognitive function and subjective behavioral effects. Subjects were tested at the end of each antiepileptic drug (AED) treatment period and during two drug-free conditions (pretreatment baseline and 1 month following final AED withdrawal). Direct comparison of the two AEDs revealed significantly better performance on 33 (80%) variables for LTG, but none for TPM. Even after adjustment for blood levels, performance was better on 19 (46%) variables for LTG, but none for TPM. Differences spanned both objective cognitive and subjective behavioral measures. Comparison of TPM to the non-drug average revealed significantly better performance for non-drug average on 36 (88%) variables, but none for TPM. Comparison of LTG to non-drug average revealed better performance on 7 (17%) variables for non-drug average and 4 (10%) variables for LTG. Lamotrigine produces significantly fewer untoward cognitive and behavioral effects compared to topiramate (TPM) at the dosages, titrations, and timeframes employed in this study. The dosages employed may not have been equivalent in efficacy. Future studies are needed to delineate the cognitive and behavioral effects of TPM at lower dosages.

Subjective Perception of Cognitive Deficit in Psychotic Patients

Article

Full-text available

Feb 2006

The objective of this study is to evaluate the subjective perception of cognitive deficit and how it relates to the perception of patients' relatives. Differences between the subjective perception of cognitive deficits in 107 DSM-IV-diagnosed psychotic patients and that of their relatives or caregivers were evaluated using the GEOPTE Scale. Fair agreement was observed between patient and family perception of cognitive functions, although there were important differences on those items that correspond to social functioning. A high degree of correlation was detected between the scores on this scale and clinical global impression scores, as well as the physicians' global impression of cognitive impairment. Psychotic patients maintain insight as to their cognitive deficits, but they fail to conserve an awareness of their perception of social functioning.

AOne-Year Open-Label Trial of Risperidone Augmentation in Lithium Nonresponder Youth with Preschool-Onset Bipolar Disorder

Article

Full-text available

Jun 2006

The aim of this study was to assess the safety and efficacy of risperidone augmentation of lithium in preschool-onset bipolar disorder (BD) among youth who insufficiently respond to lithium monotherapy. Thirty-eight subjects between the ages of 4 and 17 years (mean age = 11.37 +/- 3.8 years) with onset of BD in preschool years (manic or mixed episode) entered this 12-month trial. All subjects received lithium monotherapy. Patients who failed to adequately respond to lithium monotherapy after 8 weeks and those who relapsed after an initial response were given risperidone augmentation for up to 11 months. The Young Mania Rating Scale (YMRS) was the primary outcome measure. Response was defined as a > or =50% decrease from baseline. Additional data were collected on diagnostic comorbidity, family history, number of hospitalizations, perinatal risk factors, history of physical or sexual abuse, Child Depression Rating Scale-Revised (CDRS-R), Clinical Global Impression (CGI) scale for BD (CGI-BP), Children's Global Assessment Scale (C-GAS), and adverse medication effects. Of the 38 subjects treated with lithium monotherapy, 17 responded, whereas 21 required augmentation with risperidone. Response rate in the youths treated with lithium + risperidone was 85.7% (n = 18/21). Significant predictors of inadequate response to lithium monotherapy requiring augmentation were: (1) attention-deficit/hyperactivity disorder (ADHD), (2) severity at baseline, (3) history of sexual or physical abuse, and (4) preschool age. Combination treatment of lithium and risperidone was found to be safe and well tolerated. A substantial proportion of youth with a history of preschool-onset BD treated with lithium were either nonresponders or partial responders. Subsequent augmentation of lithium with risperidone in these cases was well tolerated and efficacious. Potential predictors of lithium nonresponse identified in this study may guide the choice of medications earlier in the treatment process.

“Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician

Book

Dec 1975
J PSYCHIATR RES

The Mattis Dementia Rating Scale: Normative data from 1,001 healthy volunteers

Article

May 1994

We administered the Mattis Dementia Rating Scale (MDRS) to 1,001 healthy volunteers, aged 50 to 80 years, randomly selected from our community. Multivariate regression analysis revealed educational level (p = 0.000004) and age (p = 0.00001), but no other sociodemographic or risk factors for stroke, to be significantly associated with the MDRS score. The age- and education-specific lowest quintile cutoff scores ranged from 140 in subjects aged 50 to 59 years with at least college experience to 130 in subjects aged 70 to 80 years with only 4 to 9 years of schooling. These percentile distributions obtained for decades of age and different levels of education should be useful reference values for clinicians and investigators when applying the MDRS to assess cognitive functioning.

Memory Complaints in Older Adults

Article

Jan 1991
ARCH NEUROL-CHICAGO

Karen Bolla

• Complaints of poor memory by patients may be an early symptom of a pathologic process like Alzheimer's disease. It is therefore important to determine if patients' complaints of memory impairments are an accurate reflection of real memory disturbance. The relationship between memory complaints (metamemory) and objective memory performance, mood, age, verbal intelligence, and sex was examined in a group of 199 healthy, community dwelling adults (39 to 89 years old). Memory complaints demonstrated a stronger association with depressed mood than with performance on memory tests. Increasing reports of depressive symptoms were associated with more overall memory complaints. Verbal intelligence, age, and sex also contributed to memory complaints. Patients with higher verbal intelligence reported fewer complaints and placed less emphasis on forgetting. Older individuals reported greater frequency of forgetting and greater frequency of using memory techniques. Specific types of memory complaints, seriousness of forgetting, and types of memory aids employed are also described. These results showed that self-rating of memory disturbance by older adults may be related more to depressed mood than to poor performance on memory tests.

Memory complaint in attenders at a self-referral memory clinic: The role of cognitive factors, affective symptoms and personality

Article

Sep 1995
INT J GERIATR PSYCH

Memory complaint has been shown to be poorly correlated with objective memory performance in non-demented elderly people. A previous study indicated the possible importance of depression and personality in the presentation of memory complaint in people with mild memory impairment. The present study overcomes some previous methodological limitations and describes memory complaint, cognitive, affective and personality variables in subjects with mild cognitive impairment self-referring to a memory clinic, with non-presenting age- and sex-matched community controls. Self-referrers had a higher original IQ, but no evidence of greater decline in memory despite having more memory complaint. Personality factors were demonstrated to be important alongside affective symptoms in the presentation of memory complaint in these subjects.

Memory complaints in young and elderly subjects

Article

Apr 1999
INT J GERIATR PSYCH

Objective To compare the quantitative and qualitative aspects of memory complaints in cognitively normal subjects aged under and above 50 years.SettingA memory clinic located in a general hospital in a suburb of Paris offering direct access to subjects.DesignRetrospective review of the files of consecutive patients who attended the clinic during one year.ParticipantsSubjects were included if (a) they presented with memory complaints, (b) they had normal general cognitive functioning according to age and educational level, (c) they were devoid of present or past history of neurologic or psychiatric disorders.Methods Subjects rated the severity of memory complaints as major or minor and filled in a 8-item questionnaire assessing various memory difficulties in everyday life. Relationship between severity of memory complaints and demographic data, memory performance and affective status was compared in 183 non-depressed, non-cognitively impaired healthy adults aged 50 years and over, and in 77 younger adults.ResultsSemiologic aspects and correlates of memory complaints were similar in younger and older adults. No close relationship was found between severity of memory complaints and memory performance. In both age groups, memory complaints were strongly related to affective status, mainly to the severity of anxious symptomatology. Memory complaints were related to gender in younger subjects, and to subjective assessment of well-being in older.Conclusion Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age. Copyright © 1999 John Wiley & Sons, Ltd.

Everyday memory failures in people with epilepsy

Article

Feb 1992
EPILEPSIA

In a series of studies, we have explored the nature of memory problems experienced by people with epilepsy. By means of a questionnaire, the first study surveyed everyday memory failures experienced by 742 people with epilepsy. Findings revealed a high level of failures that were associated with later age of onset of seizures and raised levels of anxiety and depression. A second smaller prospective study confirmed these findings and suggested that patients with epilepsy had underestimated the frequency of memory complaints when assessed retrospectively. The third study investigated the relationship between self-reported memory failures and neuropsychological test performance. A measure of verbal recall was the best predictor of reported memory failures. Again, older age of onset and mood were found to be pertinent variables in relation to memory complaints.

The Short Form of the Geriatric Depression Scale: A Comparison With the 30-Item Form

Article

Jul 1991

The Geriatric Depression Scale (GDS) exists in both short and long forms. The original 30-item form of the GDS has been shown to be an effective screening test for depression in a variety of settings. However, its utility in patients with demen tia of the Alzheimer type (DAT) is questionable. The short, 15-item version of the GDS was developed primarily for brev ity and, in particular, for use in populations such as the medically ill or those with dementia, where the longer form might be burdensome. How well this short form works in these populations, however, is largely undetermined. In this paper, the sensitivity and specificity of the 15- and 30-item GDS are compared in a group of patients who were either cognitively intact or had mild DAT. The findings suggest that the short version of the GDS, like its longer prede cessor, is an effective screening tool in the cognitively intact. However, in a population of subjects with mild DAT, it does not appear to retain its validity. (J Geriatr Psychiatry Neurol 1991;4:173-178).

Memory complaints in older adults: Fact or fiction?

Article

Feb 1991
ARCH NEUROL-CHICAGO

Complaints of poor memory by patients may be an early symptom of a pathologic process like Alzheimer's disease. It is therefore important to determine if patients' complaints of memory impairments are an accurate reflection of real memory disturbance. The relationship between memory complaints (metamemory) and objective memory performance, mood, age, verbal intelligence, and sex was examined in a group of 199 healthy, community dwelling adults (39 to 89 years old). Memory complaints demonstrated a stronger association with depressed mood than with performance on memory tests. Increasing reports of depressive symptoms were associated with more overall memory complaints. Verbal intelligence, age, and sex also contributed to memory complaints. Patients with higher verbal intelligence reported fewer complaints and placed less emphasis on forgetting. Older individuals reported greater frequency of forgetting and greater frequency of using memory techniques. Specific types of memory complaints, seriousness of forgetting, and types of memory aids employed are also described. These results showed that self-rating of memory disturbance by older adults may be related more to depressed mood than to poor performance on memory tests.

Memory self-rating and objective test performance in a normal elderly sample

Article

Jul 1986

Self-rated decline in memory relative to estimated abilities at age 60 was investigated in a group of 88 normal elderly subjects age 60 to 90. Self-ratings of storage, retrieval, attention/concentration, remote memory, and depression formed a factor which was orthogonal to objective measures of memory function. Self-rated remote memory was also associated with objective measures of recent/remote memory, and self-rated depression was additionally related to objective measures of attention/concentration.

The Relationship of Neuropsychological Functioning to Quality of Life in Epilepsy

Article

Oct 1995
ARCH NEUROL-CHICAGO

To examine the relationship of objectively assessed cognitive functioning to self-reported quality of life. Correlational, multiple regression, and factor analytic comparisons of a new self-report quality of life inventory with neuropsychological tests of cognition and mood. Two hundred fifty-seven patients with epilepsy. Twenty-five epilepsy centers and neurology clinics across the United States. A recently developed self-report (ie, Quality of Life in Epilepsy-89 inventory) and objective tests of memory, verbal abilities, spatial functions, psychomotor and cognitive processing speed, cognitive flexibility, and mood. Factors that assessed mood, psychomotor speed, verbal memory, and language correlated significantly with selected scales of the Quality of Life in Epilepsy-89 inventory (P < .0001) and were predictive of overall quality of life (P < .002 to P < .0001). The mood factor showed the highest correlations (r = -.20 to r = -.73) and was the strongest predictor of quality of life in regression analyses (46.7% explained variance, P < .0001). Mood may be adversely affected by diminished quality of life, or perceived quality of life may be affected by mood disturbance. Quantitative quality of life assessments can be used in conjunction with formal neuropsychological testing of mood and cognition when evaluating patients with epilepsy.

Epilepsy and poor memory: Who complains and what do they mean?

Article

Jun 1993

The aim of this study was to increase the understanding of the major causes of memory complaints made by people with epilepsy. Neuropsychological test performance, patients' self-reports of memory failures and the use of memory support strategies were compared in two groups of 30 patients with epilepsy differing in level of memory complaints. Those reporting significant memory difficulties performed more poorly on two of the six measures of memory administered. Age of onset of seizures was significantly later in the 'complaining' group but none of the other treatment and epilepsy variables considered differentiated the groups. Patients who complained of memory problems, however, were significantly more depressed and anxious than non-complainers. These findings may have implications for memory rehabilitation interventions in the population.

Memory complaints in epilepsy: Correlations with cognitive performance and neuroticism

Article

Jul 1993
EPILEPSY RES

Subjective memory functioning was assessed by a questionnaire in 102 patients with epilepsy. Factor analysis of their responses yielded five factors: (1) Absentmindedness, (2) Retrieval, (3) Memory for Semantic Structures, (4) Childhood Memories and (5) Rote Memory. Scales representing the factors were constructed. On all scales, patients (n = 71) who had been specifically referred for an evaluation of subjective memory problems showed moderate to large differences from normal Controls (n = 111) in complaint scores, indicating adequate sensitivity of the scales to clinically significant complaint levels. By contrast, candidates for epilepsy surgery (n = 31) resembled the Controls in their perceived memory status, showing a moderately elevated complaint level on only one of the factor based scales. Relationships of subjective memory difficulties to performance on objective tests of memory and other relevant cognitive functions as well as neuroticism were examined. The two epilepsy groups were fairly similar in their test performance, but differed markedly in their subjective memory problems. Also, correlational analysis revealed only a single weak correlation between cognitive tests and subjective memory ratings. The present findings indicate that there is no simple relationship between subjective evaluations of memory and test performance. Patients' memory complaints do not accurately predict disturbances that can be measured on standard neuropsychological tests. Such complaints may be related more to neuroticism. Also, psychosocial difficulties which may accompany chronic disorders in general may have to be invoked to account for memory complaints in people with epilepsy. The epilepsy itself does not appear to be a critical factor in producing memory complaints.

Memory and epilepsy: current perspectives

Article

Jan 1997

Self-reporting of everyday memory in patients with epilepsy: Relation to neuropsychological, clinical, pathological and treatment factors

Article

Oct 1997
EPILEPSY RES

Patients with epilepsy frequently complain of memory problems, but neuropsychological tests sometimes fail to detect consistent deficits; this may be because laboratory tests are poor indicators of everyday memory problems, or because subjective memory difficulties may be provoked by a variety of factors. To address these issues, we compared 100 patients with epilepsy and 57 healthy controls by means of our Questionnaire of Memory Efficiency, the State-Trait Anxiety Inventory, the Self-Rating Depression Scale and a battery of tests. The Chronbach test showed the Questionnaire of Memory Efficiency to be satisfactorily reliable. Patients reported significantly greater memory difficulties and higher levels of anxiety and depression than controls. Questionnaire of Memory Efficiency scores correlated with anxiety and depression levels, as well as with memory and learning test scores and regression analysis showed that anxiety, depression and visual learning had the most consistent explanatory power. No correlation was found with clinical variables or the presence of detectable brain lesion. Patients undergoing polytherapy or treatment for long periods reported the greatest memory difficulties. These findings suggest that subjective perception of memory failure reflects objective memory impairment. However, emotional factors and low self-esteem may bloat the reporting of everyday memory difficulties. The Questionnaire of Memory Efficiency seems able to provide information about everyday memory problems in patients with epilepsy that may be useful for planning neuropsychological counselling or rehabilitation.

Quality of Life Perception in Patients With Intractable Epilepsy or Pseudoseizures

Article

Jun 1998
ARCH NEUROL-CHICAGO

To contrast and compare self-reported quality of life in patients with intractable epilepsy and pseudoseizures and to examine the relationship between self-reports and objective measures of cognitive functioning in both of these groups. Case series using profile analysis and analysis of covariance. University epilepsy surgery program. Forty-three patients with intractable complex partial seizures of unilateral temporal lobe origin and 25 patients with pseudoseizures. Quality of Life in Epilepsy Inventory-89; neuropsychological tests assessing verbal memory, nonverbal memory, naming, and attention; and the Depression Scale (2) of the MMPI-2 (Minnesota Multiphasic Personality Inventory). Patients with pseudoseizures described themselves as more limited in the physical health domain than patients with complex partial seizures. Self-perceptions of cognitive functioning were similar between groups, despite the superior performance of patients with pseudoseizures on objective measures. Self-perception of cognitive dysfunction was related to mood disorder in the pseudoseizure group only, and there were no relationships between subjective and objective measurements of cognitive status within this group independent of mood disorder. For the complex partial seizures group, relationships between subjective and objective measures of cognitive function were dependent on the side of seizure onset. Results are consistent with hypotheses that suggest that patients with pseudoseizures focus on physical rather than psychological explanations for stress, and that this focus is related, at least in a subgroup of patients, to mood disorder. Results also provide support for the validity of the Quality of Life in Epilepsy Inventory-89 in populations with intractable seizure disorder, although there is evidence for a possible floor effect on some of the subscales.

Memory complaints in young and elderly subjects

Article

May 1999

To compare the quantitative and qualitative aspects of memory complaints in cognitively normal subjects aged under and above 50 years. A memory clinic located in a general hospital in a suburb of Paris offering direct access to subjects. Retrospective review of the files of consecutive patients who attended the clinic during one year. Subjects were included if (a) they presented with memory complaints, (b) they had normal general cognitive functioning according to age and educational level, (c) they were devoid of present or past history of neurologic or psychiatric disorders. Subjects rated the severity of memory complaints as major or minor and filled in a 8-item questionnaire assessing various memory difficulties in everyday life. Relationship between severity of memory complaints and demographic data, memory performance and affective status was compared in 183 non-depressed, non-cognitively impaired healthy adults aged 50 years and over, and in 77 younger adults. Semiologic aspects and correlates of memory complaints were similar in younger and older adults. No close relationship was found between severity of memory complaints and memory performance. In both age groups, memory complaints were strongly related to affective status, mainly to the severity of anxious symptomatology. Memory complaints were related to gender in younger subjects, and to subjective assessment of well-being in older. Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age.

Quality of life and Parkinson's disease: Translation and validation of the US Parkinson's Disease Questionnaire (PDQ-39)

Article

Jul 1999

Parkinson's disease is a common progressive neurodegenerative disorder affecting an estimated 4 million people worldwide. A number of general health status measures exist but few fully capture the subjective evaluation of life quality associated with Parkinson's disease. We report here the results of: (1) translating the British PDQ-39 into a US version, (2) validity and reliability of the new US PDQ-39 questionnaire, and (3) parallel validation analyses following the method published in the development of the British version of the PDQ-39. Data were collected by postal survey on 150 patients recruited from neurology clinics in the Seattle area. A short, generic health status measure (SF-36) was used to test convergent validity, and a three-day test-retest assessed the reliability of the PDQ-39. The US version of the PDQ-39 demonstrated acceptable internal consistency (alpha = 0.51 to 0.96) and proved to be reproducible (0.86 to 0.96). Subscales of the PDQ-39 showed convergence with like scales of the SF-36 and was able to discriminate between levels of symptom severity.

The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy

Article

Nov 1999
EPILEPSY RES

The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. From three epilepsy centers in the USA, 138 patients were recruited. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Mood States, POMS). Memory performance scores were weakly correlated with perceived cognitive functioning (r =0.22, P < 0.01). Perceived cognitive functioning was strongly correlated with mood (r = - 0.75, P < 0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (P < 0.02); however, the explained variance for RBMT and POMS combined (R2 = 0.58) is only slightly higher than the predictive value for the POMS score alone (R2 = 0.56). Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.

Subjective versus objective memory change after temporal lobe epilepsy surgery

Article

Nov 1999

To examine subjective versus objective memory change after anterior temporal lobectomy (ATL). A prospective, controlled study. Controls included 39 unoperated patients with intractable temporal lobe epilepsy (TLE) who were administered a series of cognitive and health-related quality of life measures at baseline and at 12-month follow-up intervals. The surgery sample included 65 patients with intractable, focal TLE who had undergone either a right or left ATL. These patients were tested preoperatively and at 6-month follow-up intervals. Subjective and objective memory change was quantified using a newly developed methodology to control for practice effect and regression to the mean. Measures of subjective and objective memory change were not significantly related in the surgery sample. Prevalence of significant subjective memory decline 1 year after surgery ranged from 3 to 7%, whereas prevalence of significant objective memory decline ranged from 26 to 55%. Postoperative levels of emotional distress significantly predicted self-reported memory decline 1 year after ATL. Postoperative medication side effect and seizure outcome were also related significantly to subjective memory change in patients who had undergone left ATL. Subjective and objective memory change after temporal lobectomy are not related. Complaints of significant memory decline after ATL are infrequent and may serve as a marker for depression or other mood disorder rather than organically based memory decline.

Trail Making Test, Part B as a Measure of Executive Control: Validation Using a Set-Switching Paradigm

Article

Aug 2000

Recent controversy surrounds the use of the Trail Making Test as a measure of cognitive flexibility, given that the Trail Making Test, Part B (TMT-B) also differs from Part A (TMT-A) in factors of motor control and perceptual complexity. The present study compared performance in the TMT and a set-switching task in order to test the assumption that cognitive flexibility is captured in TMT-B performance. Set-switching tasks have low motor and perceptual selection demands, and therefore provide a clearer index of executive function. In this study, participants made category judgments for digits, letters, or symbols across a series of trials, and performance for consecutive same-task trials was compared with task-switch trials. Results of the set-switching task indicated significant switch cost, but only for the situation of task alternation (e.g., an ABA series), suggesting that task-set inhibition may play a role in this effect. Alternating-switch cost was significantly correlated with TMT-B performance, especially with the TMT-B to TMT-A ratio (B/A). Cost for alternating switches was especially large for participants with B/A ratio > 3. These results provide direct evidence that the B/A ratio of performance in the TMT provides an index of executive function.

The perception of memory failures in patients with epilepsy

Article

Nov 2001

The aim of the study is to evaluate the correlation between subjective memory complaints and neuropsychological tests in the epilepsy population. We administered a Self Report Memory Questionnaire, based on possible everyday memory failures, two questionnaires on anxiety and depression and a battery of cognitive tests to 150 patients with epilepsy (n=100 with partial epilepsy, n=50 with idiopathic generalized epilepsy) and a control group (n=50). A discrepancy between the results of the memory questionnaire and the cognitive tests was found in the epilepsy patients: the Self Report Memory Questionnaire did not show any correlation with the psychological tests. The same discrepancy was not seen in the controls, where the memory questionnaire was related to two verbal memory tests. Furthermore, patients with epilepsy reported greater difficulties on the Self Report Memory Questionnaire than the controls (P < 0.05). It appeared that the tendency to overstate memory problems was mainly related to anxiety and depression, but was not connected with the type of epilepsy, nor with its duration (in years). Seizure frequency, on the other hand, seemed to greatly influence mood, which in turn is probably affect subjective memory perception.

Persistence of cognitive impairment in geriatric patients following antidepressant treatment: A randomized, double-blind clinical trial with nortriptyline and paroxetine

Article

Mar 2003
J PSYCHIATR RES

Cognitive dysfunction is common in older persons suffering from a major depression. However, the degree to which this dysfunction is reversible with successful treatment of the depression remains uncertain. The present study examined the effects that treatment (randomized double-blind design) with either an SSRI (paroxetine) or a tricyclic antidepressant (nortriptyline) had on cognition in older depressed patients. The patients' performance was compared to that of a group of normal controls of similar age and education. Patients and controls were administered measures of working memory, information-processing speed, episodic memory and attention five times over the course of a 12 week trial. At baseline, the patients performed more poorly than the elderly controls on all cognitive measures. While the patients' performance did improve over the course of their treatment, the magnitude of this improvement did not exceed that produced in the elderly controls by practice alone. The same pattern of results was evident in both intent-to-treat and responder analyses. Thus, there was no evidence that the depressed patients' cognitive performance normalized after response to antidepressant therapy. Neither the patients' age at onset nor their baseline level of cognitive functioning influenced the amount by which their performance improved over the 12 week trial. There was no difference between paroxetine and nortriptyline in the amount of cognitive change associated with treatment. The present results suggest that cognitive dysfunction persists in older depressed patients even after their mood disorder has responded to antidepressant medications.

My mind is as clear as it used to be: A pilot study illustrating the difficulties of employing a single-item subjective screen to detect cognitive impairment in outpatients with cancer

Article

Aug 2003
J PAIN SYMPTOM MANAG

Oncology patients often complain that their "mind does not seem to be clear." This subjective perception, sometimes referred to as "chemo brain," may be due to situational stressors, psychological disorders, organic factors, or effects of neurotoxic medications. Cognitive decline cannot only diminish quality of life, but can also interfere with a patient's ability to make decisions regarding complex treatment issues. The current study investigated the utility of using item 11 of the Zung Self-Rating Depression Screen (ZSDS) as a cognitive screen. A sample of 61 ambulatory cancer patients completed this study. Participants were recruited from four sites of Community Cancer Care, Inc., in Indiana. A battery of cognitive instruments and psychosocial inventories was administered in a standardized order. The sample had a mean age of 58.6 years and comprised 57.4% (n=35) women and 42.6% (n=26) men. Item 11 of the ZSDS was not significantly correlated to the cognitive measures. Correlates of the perception of cognitive impairment were the Dementia Rating Scale (DRS) Attention Scale (r=-0.26, P<0.05) and the ZSDS total score (r=-0.29, P<0.05). Patients' perceptions of having a cognitive impairment determined by item 11 of the ZSDS was predicted by total score on the ZSDS (F=42.5, P<0.001), age (F=26.0, P<0.001), and score on the Stroop test (F=19.8, P<0.001). Analysis of sensitivity and specificity indicated that the single-item screen used in this study is not an accurate means for identifying oncology patients with actual cognitive impairment. We conclude that while the perception of cognitive impairment is common in cancer patients, there may be problems in interpreting the nature of these complaints, particularly in separating them from depressive preoccupation.

Pseudo-Dementia

Article

Feb 1961

L G KILOH

Accuracy of self-reported neuropsychological functioning in individuals with epileptic or psychogenic nonepileptic seizures

Article

May 2004

The aim of this study was to determine the degree to which subjective ratings of neurocognitive ability accurately reflect objectively measured neuropsychological functioning in patients diagnosed with epileptic (ES, n = 45) or psychogenic nonepileptic (PNES; n = 37) seizures. Patients received a battery of neuropsychological tests, measures of current mood state, and the Quality of Life In Epilepsy-89 questionnaire. Results indicated that subjective ratings of neuropsychological functioning were only partially accurate within each group. Patients with ES accurately rated their memory function, but overestimated language and attention abilities. Patients with PNES accurately rated attention, but underestimated memory and overestimated language. In both groups, poorer self-reported neurocognitive functioning was strongly related to poorer mood state; however, mood state did not predict objectively measured neurocognitive abilities. Given the inaccuracies that exist in patient self-report, results highlight the importance of a comprehensive neuropsychological assessment when evaluating the neurocognitive status of individuals with seizures.

Subjective Memory Complaints and Objective Memory Impairment in the Vienna-Transdanube Aging Community

Article

Mar 2004

To help answer the question of whether subjective memory complaints are a useful feature in classification systems addressing early stages of Alzheimer's disease. A cross-sectional investigation in the context of a community-based cohort study. Vienna, Transdanube-a geographically defined, urban, working-class area. Three hundred two nondemented 75-year-olds were examined with regard to subjective memory complaints and objective memory performance. The patients were divided into two groups with respect to subjective memory complaints and into two groups with respect to memory performance on the Fuld Object Memory Evaluation. The percentage of individuals with memory complaints who also had objective memory impairment and the percentage of individuals with objective memory impairment who also complained about their memory were measured. One-tenth (10.6%) (95% confidence interval (CI)=7.7-14.7) of community based sample of 75-year-old subjects complained about their memory. There was no difference between complainers and noncomplainers with regard to actual memory performance. Only 6.3% (95% CI=0.16-30.2) of memory-impaired subjects complained about their proven memory impairment. About 94% (95% CI=69.8-99.8) of memory-impaired individuals do not complain about memory problems. Subjective memory complaints may not be a useful feature in current diagnostic criteria of mild cognitive impairment.

Test-Retest Reliability of Component Process Variables Within the Hopkins Verbal Learning Test-Revised

Article

Mar 2005
ASSESSMENT

Emerging data support the construct validity of component process variables of learning and memory within the Hopkins Verbal Learning Test-Revised (HVLT-R; Brandt & Benedict, 2001); however, the test-retest reliabilities of such measures are heretofore largely unknown. This study reveals generally modest-to-low 1-year test-retest stability for several key HVLT-R component process variables (e.g., semantic clustering) in 41 healthy, younger adults. These findings are discussed in relation to issues of clinical practice and research design in neuropsychological assessment.

Effects of sertraline on depressive symptoms and attentional and executive functions in Major Depression

Article

Jan 2005

Reports on the severity and reversibility of cognitive disturbances in major depression in the literature diverge due to methodological biases. The present study, using a precise methodology, examined attention and executive functions in 20 relatively young, depressed patients presenting a first or second episode of unipolar major depression without psychotic or melancholic characteristics and all being treated with the same psychopharmacological treatment (sertraline) to investigate the changes in potential attentional and executive loss during a subacute period of treatment of 7 weeks. We compared their performance with a group of 26 control subjects who were administered the same cognitive tests. This study confirmed psychomotor slowing associated with attentional and executive disturbance in adults with major depression. Conscious attentional interference for words with a negative emotional valence also was shown. After the first weeks of treatment, the effect of the antidepressant treatment with sertraline was accompanied by a beneficial effect on psychomotor slowing on attentional and executive functions.

Subjective Memory Complaints, White-Matter Lesions, Depressive Symptoms, and Cognition in Elderly Patients

Article

Sep 2005
AM J GERIAT PSYCHIAT

Subjective memory complaints (SMC) and cerebral white-matter lesions (WML) are very prevalent among elderly subjects, but their clinical significance is controversial. The authors sought to determine whether SMCs are related to WML, independently of the presence of depressive symptoms, which are known to be associated with both. The relationship between SMC and cognition was also examined. This is a cross-sectional study on 60 elderly subjects without dementia. All subjects underwent FLAIR and T2-weighted axial MRI scans, a memory-complaint questionnaire, a geriatric depression scale, and a comprehensive cognitive assessment. Multiple linear regression showed that although the best correlate of SMC was the severity of depressive symptoms, SMC and WML were strongly correlated. Objective cognitive performance was not significantly associated with SMC after adjusting for WML and mood. The presence of a history of late-onset depression was a strong correlate of WML severity, even after adjusting for age, gender, and education. Complaints of cognitive decline are significantly associated with the severity of WML, independently of level of cognition and depression.

Interpreting patient/informant discrepancies of reported cognitive symptoms in MS

Article

Oct 2005

Although numerous studies have shown that brain-damaged patients tend to underestimate neuropsychological (NP) impairment when self-ratings are compared to informant ratings, the meaning of such discrepancies is not well studied in multiple sclerosis (MS). We compared patient self- and informant-report questionnaire ratings of NP functioning in 122 MS patients and 37 age- and education-matched normal controls. In addition to completing the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), participants underwent NP testing and assessment of depression, personality, and neuropsychiatric symptoms. Based on the normal distribution of discrepancy scores, patients were classified according to whether they overestimated or underestimated their cognitive ability, relative to informant ratings. ANOVAs comparing test scores derived from overestimators, underestimators, and accurate estimators were significant for multiple measures of cognitive function, depression, personality, and neuropsychiatric symptoms. Overestimators were characterized by less depression and conscientiousness, and greater degrees of cognitive impairment, euphoric behavioral disinhibition, and unemployment as compared to underestimators. We conclude that patient/informant discrepancy scores on the MSNQ are associated with the aforementioned neuropsychiatric features, and that the MSNQ has potential utility for predicting euphoria and disinhibition syndromes in MS.

A cross-sectional study of subjective complaints in patients with epilepsy who seem to be well-controlled with anti-epileptic drugs

Article

Jul 2006
SEIZURE-EUR J EPILEP

Side-effects of anti-epileptic drugs (AEDs) may be overlooked in patients with epilepsy in everyday clinical practice. The aim of this study was to assess the prevalence and severity of subjective complaints in patients who were considered to be well-controlled and to assess whether these complaints are related to medication, personality traits, or other determinants. We included patients with epilepsy who were considered to be well-controlled in a cross-sectional study in seven hospitals in the Netherlands. Their medication had not been changed for six months and an apparent reason to change the medication was lacking at the time of enrolment. Subjective complaints were assessed with a 46-item questionnaire. Using multivariable linear regression modeling, we assessed whether patient characteristics, epilepsy characteristics, medication, quality of life (Qolie-10), and personality traits (SCL-90) explained the presence and severity of complaints. Of 173 included patients, 67% reported moderate to severe subjective complaints on the questionnaire. Cognitive complaints were reported most frequently. Multivariate modeling showed that 61% of the variance in reported complaints could be explained by included determinants. The prevalence and severity of complaints was associated with AED polytherapy and higher scores on psycho neuroticism. Patients who were considered to be well-controlled proved to report an unexpectedly high number of subjective complaints. Both medication and aspects of personality contributed to the level of complaints. Our study illustrates that subjective side-effects are easily overlooked in everyday clinical practice, possibly because in practice a generally phrased question is used to detect side-effects.

Subjective memory and mood of Hong Kong Chinese adults with epilepsy

Article

Sep 2006

Clinicians are often confronted with the self-report of memory difficulties by patients. This study explored the possible correlates of subjective memory in 67 adult Chinese patients with epilepsy in Hong Kong. These correlates include epilepsy-related factors, mood state, and actual performance on neuropsychological tests. Results suggested that there exists no significant systematic relationship between subjective and illness-related factors such as seizure frequency, age at onset, and medication. Instead, stepwise regression analysis revealed that mood (anxiety) explained about 17% of the variance of subjective memory difficulties, whereas performance on a memory test accounted for only 8% of the variance. Findings are discussed in the light of the need to attend to the anxiety of patients with epilepsy in the process of rehabilitation.

Does Self-perceived Mood Predict More Variance in Cognitive Performance Than Clinician-Rated Symptoms in Schizophrenia?

Article

Nov 2006
SCHIZOPHRENIA BULL

Symptoms are known to account for a small variance in some cognitive functions in schizophrenia, but the influence of self-perceived mood remains largely unknown. The authors examined the influence of subjective mood states, psychopathology, and depressive symptoms in cognitive performance in a single investigation in schizophrenia. A group of 40 stable medicated patients with schizophrenia (20 men, 20 women) and 30 healthy comparison subjects (15 men, 15 women) were assessed on neurocognitive measures of verbal abilities, attention, executive functioning, language, memory, motor functioning, and information processing. All subjects provided self-ratings of mood prior to cognitive testing. Patients were also rated on psychopathology and depressive symptoms. Patients performed worse than comparison subjects on most cognitive domains. Within the patient group, subjective feelings of depression-dejection, fatigue-inertia, confusion, and tension-anxiety predicted (controlling for symptoms) poor performance on measures of attention, executive function, and verbal memory. In the same group of patients, clinician-rated symptoms of psychopathology and depression predicted significantly poor performance only on tests of motor function. In comparison subjects, vigor related to better, and fatigue and inertia to worse, spatial motor performance. Self-perceived negative mood state may be a better predictor of cognitive deficits than clinician-rated symptoms in chronic schizophrenia patients.

The relationship between perceived and objective cognitive functioning in multiple sclerosis

Article

Sep 2006

The relationship between perceived cognitive functioning and objective cognitive functioning was studied in 221 patients with multiple sclerosis. Perceptions of global cognitive functioning as well as perceptions of performance on specific cognitive tests were assessed. Patients' perceptions of global cognitive functioning in their daily lives were unrelated to their objective performance on the full cognitive test battery. However, patients' perceptions of their performance on specific tasks correlated with their objective performance on those tasks, even though they underestimated their performance on these tasks. The present study also evaluated predictors of patients' perceived cognitive functioning. Depression, anxiety, fatigue, and level of disability predicted perceptions of global cognitive functioning, whereas objective cognitive performance did not. These results add to our understanding of patients' expressed concerns regarding their cognitive functioning in the wake of multiple sclerosis, suggesting that such concerns should be interpreted with caution by clinicians.

Cognitve effects of lamotrigine compared with topiramate in patient with epilepsy

Article

Sep 2006
NEUROLOGY

To compare the cognitive effects of lamotrigine vs topiramate as adjunctive therapy in adults with epilepsy. A multicenter, double-blind, randomized, prospective study was conducted in adults with partial seizures. Lamotrigine or topiramate was introduced as an adjunctive therapy to carbamazepine or phenytoin and titrated over 8 weeks to target doses. These drugs were maintained another 8 weeks (maintenance phase) without dosage changes. The primary endpoint was change from screening to the end of the maintenance phase in a combined analysis of standardized measures of cognition (Controlled Oral Word Association Task [COWA]; Stroop Color-Word Interference; Digit Cancellation; Lafayette Grooved Pegboard, dominant hand; Rey Auditory Verbal Learning Test, delayed recall; and Symbol-Digit Modalities test). For the primary endpoint, cognitive performance at the end of the maintenance phase was better with lamotrigine than with topiramate (415.3 vs 315.1; p < 0.001). On the individual cognitive tests, performance was better with lamotrigine than with topiramate in mean changes from screening on the COWA (p < 0.001), Stroop Color-Word Interference (p = 0.038), and Symbol-Digit Modalities tests (p < 0.001). The treatment effect exceeded the minimum clinically important difference for the COWA and the Symbol-Digit Modalities test. Mean changes from screening in the Performance-On-Line test simulating driving skills reflected better performance with lamotrigine than with topiramate (p = 0.021). The median percentage change from baseline in seizure frequency was lower with lamotrigine than with topiramate during the escalation phase (-80% vs -100%; p = 0.028) but not during the maintenance phase (-75% vs -100%; p = 0.062). The frequencies of cognitive adverse events and of premature withdrawals related to cognitive decline were higher with topiramate than with lamotrigine (6% vs 0%; p = 0.013). Lamotrigine had significantly less impact than topiramate on measures of cognition when used as adjunctive therapy for partial seizures.

A Cross-Sectional Study to Investigate Long-Term Cognitive Function in People with Treated Pituitary Cushing's Disease

Article

Nov 2006

It has been proposed that exposure to high levels of endogenous steroids in untreated pituitary Cushing's disease damages hippocampal structures leading to impairment in learning and memory processes. We hypothesised that patients with treated pituitary Cushing's disease would perform significantly worse on tests of cognitive ability than those with nonfunctioning pituitary adenomas. Sixteen adults with pituitary Cushing's disease (PCD) and 16 adults with non-functioning pituitary adenomas (NFA) undertook the following comprehensive neuropsychological assessments: National Adult Reading Test (NART: premorbid abilities), California Verbal Learning Test (CVLT 2 UK: learning and recall), Stroop (executive functioning), Trail-Making Test (TMT: executive functioning and attention), Adult Memory and Information Processing Battery (AMIPB: Information Processing Speed and Story Recall subtests). There was no significant difference in premorbid IQ scores (NFA mean=101 SD=13; PCD mean=102, SD=13), in verbal learning nor any significant difference in the percentage of verbal material retained in story recall (AMIPB). Performance on higher executive tasks Stroop and TMT and on measures of information processing was similar. However, there were significant decrements between some mean scores for both groups and published normative data with a clear association between higher HADS depression scores and impaired objective memory and attention which was not specific to PCD. We found no difference in cognitive function between patients with PCD and NFA. The results suggest a discrepancy between patients' subjective perception of functional cognitive impairments and objective findings on psychometric testing and point to the influence of affective symptoms on cognitive performance, particularly in Cushing's disease.

Neuropsychological and neurophysiologic effects of carbamazepine and levetiracetam

Article

Nov 2007
NEUROLOGY

The relative effects of levetiracetam (LEV) and carbamazepine (CBZ) on cognitive and neurophysiologic measures are uncertain. The effects of LEV and CBZ were compared in healthy adults using a randomized, double-blind, two-period crossover design. Outcome measures included 11 standard neuropsychological tests and the score from a cognitive-neurophysiologic test of attention and memory. Evaluations were conducted at screening, baseline pre-drug treatment, end of each maintenance phase (4 weeks), and end of each washout period after drug treatment. A total of 28 adults (17 women) with mean age of 33 years (range 18 to 51) completed the study. Mean maintenance doses (+/-SD) were CBZ = 564 mg/day (110) and LEV = 2,000 mg/day (0). CBZ was adjusted to mid-range therapeutic level. Mean serum levels (+/-SD) were CBZ = 7.5 mcg/mL (1.5) and LEV = 32.2 mcg/mL (11.2). An overall composite score including all measures revealed worse effects for CBZ compared to LEV (p <or= 0.001) in the primary analysis and for CBZ (p <or= 0.001) and LEV (p <or= 0.05) compared to non-drug in secondary analyses. Across the 34 individual variables, CBZ was worse than LEV on 44% (15/34); none favored CBZ. Compared to the non-drug average, CBZ was worse for 76% (26/34), and LEV was worse for 12% (4 of 34). Sensitivity and specificity of standard neuropsychological tests and the cognitive-neurophysiologic test were determined to direct future studies; detection was most accurate by the cognitive-neurophysiologic test. Levetiracetam produces fewer untoward neuropsychological and neurophysiologic effects than carbamazepine in monotherapy at the dosages and timeframes employed in this study.

Confusion Over Measures of Evidence ( p 's) Versus Errors ( α 's) in Classical Statistical Testing

Article

Feb 2003
AM STAT

Confusion surrounding the reporting and interpretation of results of classical statistical tests is widespread among applied researchers, most of whom erroneously believe that such tests are prescribed by a single coherent theory of statistical inference. This is not the case: Classical statistical testing is an anonymous hybrid of the competing and frequently contradictory approaches formulated by R. A. Fisher on the one hand, and Jerzy Neyman and Egon Pearson on the other. In particular, there is a widespread failure to appreciate the incompatibility of Fisher's evidential p value with the Type I error rate, a, of NeymanPearson statistical orthodoxy. The distinction between evidence (p's) and error (a's) is not trivial. Instead, it reflects the fundamental differences between Fisher's ideas on significance testing and inductive inference, and Neyman-Pearson's views on hypothesis testing and inductive behavior. The emphasis of the article is to expose this incompatibility, but we also briefly note a possible reconciliation.

PubMed: 14455934] Marino et al. Page 10 Epilepsy Behav Author manuscript; available in PMC 2010 March 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript 38 Effects of sertraline on depressive symptoms and attentional and executive functions in major depression

336-51

Lg Kiloh
Pseudo-Dementia
S Adam
B Gillain
X Seron
R Bruyer
Seghers

Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand 1961;37:336–51. [PubMed: 14455934] Marino et al. Page 10 Epilepsy Behav. Author manuscript; available in PMC 2010 March 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript 38. Constant EL, Adam S, Gillain B, Seron X, Bruyer R, Seghers A. Effects of sertraline on depressive symptoms and attentional and executive functions in major depression. Depress Anxiety 2005;21(2): 78–89. [PubMed: 15884090]

Subjective memory complaints, white-matter lesions, depressive symptoms, and cognition in elderly patients

Jan 2005
665

Minett

Subjective Perception of Cognition is Related to Mood and Not Performance

Abstract

No full-text available

Recommended publications

Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers

Subjective preference for lamotrigine or topiramate in healthy volunteers: Relationship to cognitive...