Inferior parietal perfusion, lateralization, and neuropsychological dysfunction in Alzheimer's disease

The severity of inferior parietal perfusion deficits in Alzheimer's disease (AD) is strongly associated with global intellectual decline. The relationship to specific losses of neuropsychological functioning, however, is less clear, as is the relative importance of the side (left vs. right) of hemispheric deficit. In this study, 53 patients with probable AD and 35 elderly controls received both a resting 133Xe rCBF measurement and neuropsychological examination. AD patients demonstrated the expected bilateral deficits in inferior parietal perfusion, as well as impairment on measures of mental status, intelligence verbal and visual memory, attention, language, and construction abilities. The severity of this bilateral parietal deficit, in turn, was associated with virtually all of these AD-related neuropsychological impairments, most strongly with declining Performance IQ. Left-sided deficits correlated better with overall declines in IQ, as well as with declining attention and language fluency. Right-sided deficits, on the other hand, correlated best with declines in mental status and--paradoxically--verbal memory and contributed independently to declines in Full Scale and Performance IQ. In terms of the number and strength of their association to neuropsychological measures, left-sided deficits appear much more predicative of cognitive decline in AD. Right-sided deficits, however, may be most important in predicting aspects of performance skill that are only indirectly assessed in standard paper-and-pencil format. Overall, it appears that both sides make significant, but independent contributions to general functional decline in AD, but that left-sided deficits are more closely associated with cognitive decline in measured by most standard neuropsychological measures.     

Effects of sequential neuropsychological testing of an elderly community-based sample

The magnitude and importance of changes in scores of neuropsychological tests on retest in the elderly, especially over long time periods, is not well established. Three neuropsychological tests and one mental status test were initially administered to screen for potential dementia and were readministered to 380 of the surviving individuals 2.4 years later who either failed the screening examination or were an age matched control. Of the 380 women and men aged 65 and older, 56 were diagnosed as having Alzheimer disease (AD), 82 as at risk for developing AD, and 242 as having normal cognition. The present report focuses on changes in test scores between the two visits. In the normal and at risk groups, significant improvements were seen on retest of the Visual Reproduction Test (VRT), the Trails B test, and the Mini-Mental Status examination; verbal fluency decreased, and savings score of the VRT showed small variations. On most tests, scores of the AD group decreased. Practice effects, biases, and other variables may have played a role in the improvements seen in those labeled normal and at risk. If these results are confirmed, savings score of the VRT (which remained stable over time in normals and individuals at risk and decreased in patients with dementia) and verbal fluency (which decreased in all groups) may be better measures of true cognitive performance than the other tests that we evaluated.     

Effects of paint sniffing on neuropsychological test performance.

Examined the effects of paint sniffing on neuropsychological test performance by employing 20 sniffers (mean age 18.5 yrs) and 20 comparable nonsniffers. A wide variety of tests were used as measures (e.g., Finger Tapping Test, Trail Making Test, Stroop Color-Word Test, and Peabody Picture Vocabulary Test). It was found that sniffers were significantly lower than controls in the performance of 11 of the 13 test measures, including tests of motor speed, auditory discrimination, visuomotor functioning, and memory. An important finding was the relation found between duration of paint sniffing and level of test performance. According to the results, the longer a person had been involved in paint sniffing, the lower the performance on the neuropsychological tests. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regional cerebral blood flow measured by 99mTc-HMPAO SPECT differs in subgroups of Alzheimer's disease

Alzheimer's disease (AD) is a heterogeneous entity. Identifying AD subtypes might have impact in patients' response to different treatment strategies. We designed a study to examine regional cerebral blood flow (rCBF) in AD subtypes. To identify AD subtypes, we performed a cluster analysis including performance on memory, language, visuospatial, praxic, and executive functions. The rCBF measured by 99mTc-HMPAO SPECT was referred to the cerebellum. We examined 35 patients fulfilling the NINCDS-ADRDA criteria of probable AD and 13 age and sex-matched healthy cognitively intact controls. AD patients were at the early stage of the disease, their mean Mini-Mental Status (MMS) score (S.D.) was 22.5 (3.6). The cluster analysis revealed two AD subgroups: AD1 (N = 12) and AD2 (N = 23). The subgroups did not differ in age, sex, or global clinical severity as assessed by MMS and Brief Cognitive Rating Scale (BCRS). Both subgroups had equally impaired memory. The AD2 group was inferior to the AD1 group on verbal, visuospatial, praxic, and executive functions. The AD1 group showed reduced rCBF ratios in the temporal and parietal cortices and the amygdala compared to controls. The AD2 group differed from controls in the rCBF ratios of frontal, temporal, parietal, occipital, basal ganglia, and amygdaloid regions bilateral and from AD1 in the rCBF ratios of frontal and temporal cortices. In AD patients, the rCBF ratios did not correlate with MMS or BCRS scores. In contrast, several significant correlations were found between decreases rCBF ratios and impairment of memory and other cognitive functions. In conclusion, a cluster analysis on neuropsychological test performance identified two AD subgroups that differed on the neuropsychological profile and on the rCBF in spite of similar global clinical severity.     

Neuropsychological slowness in obsessive-compulsive patients. Is it confined to tests involving the fronto-subcortical systems?

BACKGROUND: Although it is acknowledged that obsessive-compulsive (OC) patients may be slower than healthy controls in performing neuropsychological tests, speed has usually been treated as a confounding variable. It is possible, however, that the slower performance of OC patients is itself the result of a dysfunction of specific neural circuits (in particular of fronto-subcortical systems). METHOD: A neuropsychological battery including tests sensitive to fronto- and temporo-subcortical dysfunction was administered to a group of OC patients and a group of healthy controls. Each test provided independent indices of accuracy and speed. RESULTS: OC patients were significantly slower than controls only when performing tasks involving the fronto-subcortical systems, whereas they did not differ from controls with respect to accuracy indices. CONCLUSION: It may be that neuropsychological slowness of OC patients is not merely an epiphenomenon of meticulous concern for correct test execution or intrusion of obsessive thoughts, but reflects the dysfunction of fronto-subcortical systems.     

Asymmetries in Global-Local Processing Ability in Elderly People With the Apolipoprotein E-ε4 Allele.

Previous studies have identified cognitive asymmetries in elderly people at increased risk for Alzheimer's disease (AD) by comparing standardized neuropsychological tests of verbal and spatial abilities in both preclinical AD and apolipoprotein ε4+ elderly groups. This prospective study investigated cognitive asymmetries within a single test by comparing cognitively intact elderly (with and without the ε4+ allele) on a learning and memory measure that uses global and local visuospatial stimuli. Both groups demonstrated comparable overall learning and recall. But the ε4+ group had a significantly larger discrepancy between their global and local learning scores and had a greater proportion of individuals with more than a one standard deviation difference between their immediate recall of the global and local elements, relative to the ε4- group. These findings build on previous studies identifying subgroups of elderly people at greater risk for AD who often demonstrate increased cognitive asymmetries relative to groups without significant risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Simulated driving performance of adults with ADHD: Comparisons with alcohol intoxication.

Previous research has demonstrated that adults with attention deficit/hyperactivity disorder (ADHD) are more likely to experience driving-related problems, which suggests that they may exhibit poorer driving performance. However, direct experimental evidence of this hypothesis is limited. The current study involved 2 experiments that evaluated driving performance in adults with ADHD in terms of the types of driving decrements typically associated with alcohol intoxication. Experiment 1 compared the simulated driving performance of 15 adults with ADHD to 23 adult control participants, who performed the task both while sober and intoxicated. Results showed that sober adults with ADHD exhibited decrements in driving performance compared to sober controls, and that the profile of impairment for the sober ADHD group did in fact resemble that of intoxicated drivers at the blood alcohol concentration level for legally impaired driving in the United States. Driving impairment of the intoxicated individuals was characterized by greater deviation of lane position, faster and more abrupt steering maneuvers, and increased speed variability. Experiment 2 was a dose-challenge study in which 8 adults with ADHD and 8 controls performed the driving simulation task under 3 doses of alcohol: 0.65g/kg, 0.45g/kg, and 0.0g/kg (placebo). Results showed that driving performance in both groups was impaired in response to alcohol, and that individuals with ADHD exhibited generally poorer driving performance than did controls across all dose conditions. Together the findings provide compelling evidence to suggest that the cognitive and behavioral deficits associated with ADHD might impair driving performance in such a manner as to resemble that of an alcohol intoxicated driver. Moreover, alcohol might impair the performance of drivers with ADHD in an additive fashion that could considerably compromise their driving skill even at blood alcohol concentrations below the legal limit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preserved cognitive skills in dementia of the Alzheimer type

OBJECTIVE: To describe preserved cognitive skills in patients with dementia. DESIGN: Case series. SETTING: Community clinic. PATIENTS: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and were claimed to retain a cognitive skill. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Standard neuropsychological tests and individualized measures of patient's skilled behaviors. For patients who remained skilled at games, performance was compared with that of normal controls in direct competition. For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. RESULTS: One patient continued to play the trombone in a Dixieland band, although he could not name well-known numbers that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The fifth patient remained a skillful contract bridge player, although he could not name the suits or articulate simple bidding rules. Four patients had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter fluency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing but displayed his skill. CONCLUSIONS: Together with previous studies of preserved piano playing or painting skills, our findings indicate that a broad range of complex cognitive abilities may be preserved in patients with dementia of the Alzheimer type who cannot perform simpler actions.     

Quantitative brain SPECT in Alzheimer's disease and normal aging

To improve the diagnostic utility of brain single-photon emission computed tomography (SPECT) in Alzheimer's disease (AD), we have developed and evaluated an objective method of differentiating patients and healthy elderly controls using a quantitative image analysis protocol. HMPAO-SPECT image datasets from 29 patients with probable AD and 78 age-matched controls were registered to a common anatomic frame of reference. Activity levels within 120 standardized cortical volumes were determined by an automated procedure. Subjects were classified into normal and AD groups by quadratic discriminant analysis using two features: global average activity level and average normalized activity levels within the two clusters of standardized volumes identified as most significantly different in AD by analysis of covariance. The classification used split-half replication to ensure valid results. Classification performance quantified by the area under a binormal ROC curve fitted to the data was 0.923 +/- 0.036; at a threshold likelihood ratio of 1, the sample sensitivity was 91% and specificity was 86%. We conclude that quantitative SPECT accurately distinguishes AD patients from elderly controls.     

Separating forms of neglect using the Apples Test: Validation and functional prediction in chronic and acute stroke.

Objective: We report data on the validation and functional correlates of Apples Test, which attempts to differentiate between different forms of unilateral neglect. Method: Study 1 presents data from 25 participants with chronic brain lesions who completed the Apples Test and another standard measure of neglect (Star Cancellation). The patients' performance relative to 86 controls was assessed and their relative performance across the two tests compared. Study 2 recruited 115 acute hospital stroke patients who completed the Apples Test as part of the Birmingham University Cognitive Screen procedure. We assessed the relations between the different forms of neglect. Study 3 examined neglect type (as measured by the Apples Test) among the acute stroke group in relation to their activities of daily living abilities and affect. Results: In Study 1 Apples Test scores correlated with Star Cancellation performance, while also differentiating between neglect across the page and neglect of parts of objects. Study 2 confirmed the dissociation from Study 1. “Pure” forms of each type of neglect were equally prevalent after right and left hemisphere lesions, while the presence of both deficits was associated with right hemisphere damage. Study 3 showed that each form of neglect also correlated with other measures of cognition. When compared with pure page-based neglect, object-centered neglect was associated with a lower Barthel score (p     

Comparison of neuropsychological functioning in Alzheimer's disease and frontotemporal dementia

Neuropsychological changes distinguishing mild Alzheimer's disease (AD) from frontotemporal dementia (FTD) have been described, but empirical verification of differential cognitive characteristics is lacking. Archival neuropsychological data on 15 FTD patients, 16 AD patients, and 16 controls were compared. Controls outperformed both patient groups on measures of verbal and nonverbal memory, executive ability, and constructional skill, with AD patients showing more widespread memory decline. No differences were found between the 3 groups in confrontation naming, recognition memory, or basic attention. Patient groups differed only in nonverbal memory, with FTD patients performing significantly better than AD patients. However, patient groups also differed in pattern of performance across executive and memory domains. Specifically, AD patients exhibited significantly greater impairment on memory than executive tasks, whereas the opposite pattern characterized the FTD group. These findings suggest that examination of relative rankings of scores across cognitive domains, in addition to interpretation of individual neuropsychological scores, may be useful in differential diagnosis of FTD versus AD.     

Neuropsychological impairment in female alcoholics: Replication and extension.

In 2 separate studies, female alcoholics (N?=?50) performed significantly poorer on 12 neuropsychological tests (e.g., the WAIS and the Bender-Gestalt Test) than female nonalcoholic controls (N?=?50). The pattern of deficit was consistent across studies and similar to that reported for male alcoholics: intact verbal skills but impaired nonverbal abstracting, visual-spatial, and problem-solving abilities. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The subcortical dementia of Huntington's disease

An effect size analysis incorporating meta-analytic principles was used to review neuropsychological findings in patients with Huntington's disease (HD). Studies dating back to 1980 were gathered and the neuropsychological test results from a total of 760 patients with HD, and 943 healthy controls were synthesized using effect size analyses. The results indicate that patients with HD are most deficient on tests of delayed recall, followed by performance on measures of memory acquisition, cognitive flexibility and abstraction, manual dexterity, attention/concentration, performance skill, and, finally, verbal skill. However, patients with HD display core deficits in fronto-subcortical circuits that give rise to a multitude of cognitive deficits. A rank-order list of specific neuropsychological tasks and test variables in order of sensitivity to HD is also provided to aid in the interpretation of the quantitative results.     

Practical intelligence at work: Relationship between aging and cognitive efficiency among managers in a bank environment.

A study was conducted to determine which better predicts performance among bank managers: tacit practical knowledge as assessed by the Tacit Knowledge Inventory for Managers (TKIM) or 2 psychometric measures of reasoning, the Raven's Advanced Progressive Matrices (Raven's) and the Verbal Reasoning subtest of the Differential Aptitude Test (DAT). Two hundred bank managers (43 experts and 157 nonexperts), ages 24–59 years old, participated. Increased age was associated with lower performance in Raven's and the DAT but less so in the TKIM; best performing older managers on average had high levels of tacit knowledge, although they scored lower on psychometric reasoning measures; TKIM predicted managerial skill; DAT and Raven's did not. These results suggest that stabilization of some aspects of intelligence may occur in old age. Implications of the findings for the study of practical intelligence, expertise, and compensatory abilities are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological test performance in patients with dominantly inherited spinocerebellar ataxia: relationship to ataxia severity

To determine whether the cognitive status of patients with dominantly inherited spinocerebellar ataxia (DSCA) might be related to neurologic severity, we administered a comprehensive neuropsychological test battery to 43 patients with DSCA, ranging in ataxia severity from mild to end-stage. As compared with the controls, the mildly ataxic patients scored normally or close to normal as a group on all of the neuropsychological tests. In contrast, approximately one-half of the moderately and all of the severely ataxic patients showed poor performance, independent of age, Hamilton Rating Scale for Depression score, or education, on the Wisconsin Card Sorting Test, suggesting impaired executive system function. In addition, a subgroup of these patients had a neuropsychological profile suggestive of mild generalized cognitive impairment. We conclude that DSCA is not a homogeneous group of disorders with respect to cognitive status and that the neurologic severity of the disorder is a major factor. Impaired executive system function could be explained by damage to olivopontocerebellar system control over cerebral cortical function or to damage to other neuronal systems (especially cholinergic) that degenerate in parallel with the olivopontocerebellar system.     

Speech and language in high-functioning autistic individuals.

Verbal individuals with autism provide an important opportunity for investigating the qualitative nature of speech and language impairments in autism. In this study, a psychometric analysis of the language performance of 62 high-functioning autistic (HFA; Full Scale IQ and Verbal IQ?>?70) participants was compared with that of 50 control participants matched for age, IQ, gender, race, education, and family socioeconomic distribution. Tests were included to compare basic procedural linguistic skills with complex, interpretive linguistic skills. The HFA participants did as well as controls on basic procedural language tests, but significantly less well on tests of complex interpretive language abilities. This profile is consistent with neuropsychological reports of generalized deficits in complex information-processing abilities with preservation of basic skills in the same functional areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptual implicit memory performance in Alzheimer's disease.

Alzheimer's disease (AD) patients often exhibit deficits on conceptual implicit memory tests such as category exemplar generation and word association. However, these tests rely on word production abilities, which are known to be disrupted by AD. The current study assessed conceptual implicit memory performance in AD patients and elderly control participants using a conceptual priming task that did not require word production (i.e., semantic decision). Memory performance was also examined using a category exemplar generation test (i.e., a conceptual priming task that required word production) and a recognition memory test. AD patients exhibited deficits on the semantic decision task, the category exemplar generation task, and the recognition memory task. The results indicate that the conceptual memory deficits observed in AD patients cannot be attributed completely to word production difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between executive cognitive functioning and the adverse consequences of alcohol use in social drinkers

The purpose of this study was to assess the relation between Executive Cognitive Functioning (ECF) and the adverse consequences of alcohol consumption. ECF encompasses "higher order" cognitive abilities involved in goal-directed behavior, such as attentional control, mental flexibility, planning, and self-monitoring. Impaired ECF has been shown to result in a variety of negative consequences, including excessive drug and alcohol use. Subjects were 79 nonalcoholic male social drinkers between 17 to 30 years of age. ECF was measured using three neuropsychological tests: the Wisconsin Card Sorting Test (WCST), the Conditional Associative Learning Test (CAT), and the Sequential Matching Memory Test (SMMT). Adverse drinking consequences were measured using the Drinker Inventory of Consequences (DrInC). The DrInC assesses drinking consequences in five domains: Physical, Intrapersonal, Interpersonal, Social Responsibility, and Impulse Control. Scores from the neuropsychological tests were reduced into two latent variables: one representing the WCST and the other representing the CAT and SMMT. The results indicated that errors on the CAT/SMMT variable were positively related to adverse consequences in each domain, except for physical consequences. A similar association was found between the WCST variable and impulse control consequences. These findings indicate that performance on tests measuring ECF is related to the severity of drinking consequences. Therefore, prevention and treatment outcomes may be improved by incorporating cognitive habilitation into current interventions.     

Neuropsychological effects of depression and age in an elderly sample: A confirmatory study.

Few well-controlled studies have directly examined the relationship of age and depression with neuropsychological function while at the same time examining the possible influence of general medical illness. Toward this end, 44 elderly patients with unipolar major depression were compared with 30 nondepressed controls with a range of neuropsychological tests. The depressed patients evidenced a broad base of deficits relative to controls, as well as more rapid declines with increasing age on tests of complex psychomotor function, copying, and perceptual integration. Overall level of general medical illness had minimal influence on neuropsychological test performance in either group. In light of recent reports contradictory to the findings presented here, the importance of participant selection variables in neuropsychological studies of late-life depression is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management

In a group of 10 subjects, nine schizophrenic patients and one healthy twin (seven men and three women, i.e. two monozygotic twin pairs: two patients and a healthy man and his sick twin brother, one dizygotic pair of two female patients, three male patients and one female patient without their appropriate twin siblings) Halstead-Reitan Neuropsychological Battery (HRNB) was used and partial neuropsychological tests (Wechsler Memory Scale, the Stroop Color-Word Test, Tonal Memory). The parameters of white matter density were evaluated by computed tomography. The fundamental findings include: In our small group numerous statistically significant correlations were found between neuropsychological tests and white matter density. 2. Higher density is associated with poorer neuropsychological efficiency. There are very similar correlations between neuropsychological variables and density parameters in different areas of the brain. 4. The majority of correlations of neuropsychological parameters is from the area of tactile and motor functions. 5. It is striking that there are statistically significant correlations of density with the simultaneous performance of both hands and the performance of the non-dominant hand but not with the performance of the dominant hand alone. 6. Some correlations pertain in addition to density also to the very controversial problem of the brain size of schizophrenic patients. In the investigated group an association between better neuropsychological performance and larger size of the brain was found. All findings will have to be tested in larger groups of patients and healthy subjects.