Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis.

Objective: This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). Methods: Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. Results: Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (β = .36, p     

Ability of counselors to detect cognitive impairment among substance-abusing patients: An examination of diagnostic efficiency.

Counselors (N?=?12) in 1 of 2 substance abuse treatment facilities were asked to identify which of their patients (N ?=?97) had general neurocognitive impairment. Counselors were required to base their judgements on information collected from patients during psychosocial history gathering, clinical interviews, physical examinations, brief cognitive screening tests, and substance abuse severity evaluations, but not on neuropsychological test results. All patients were subsequently administered a neuropsychological test battery. Diagnostic agreement between counselors' impressions of patients' cognitive status and patients' actual neuropsychological test performance was poor. Subsequent analyses revealed counselors' impressions about patients' neuropsychological functioning were based on information that did not reliably discriminate between cognitively impaired and intact patients (e.g., years of education and self-reported symptoms of cognitive dysfunction). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between cognitive deficits and everyday functional activities in multiple sclerosis.

Considerable evidence indicates that cognitive dysfunction and impairments in everyday life activities are common in multiple sclerosis (MS). However, the relationship between these cognitive and functional deficits has not been thoroughly investigated. The purpose of this study was to examine the role of cognitive dysfunction in the functional status of individuals with MS. Participants were 74 adults with MS and 35 healthy comparison participants (HCs) who underwent neuropsychological testing and completed the Executive Functions Performance Test (EFPT; Baum, Morrison, Hahn, & Edwards, 2003), an objective measure of everyday life activities. Between-groups comparisons and correlational analyses were conducted to examine the relationship between cognition and functional capacity. Significant differences in EFPT performance were revealed between individuals with MS with and without cognitive impairment and HCs. In individuals with MS, performance on cognitive constructs was related to performance on the EFPT. Furthermore, a linear regression model comprised of indices of cognitive functioning explained a significant portion of the variance in everyday life activities. Findings suggest that individuals with and without cognitive impairment differ in functional status and that aspects of cognition are predictive of functional status in MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis.

Administered the WAIS and an expanded Halstead-Reitan Neuropsychological Test Battery (HRB) to 100 (mean age 37.38 yrs) patients with relapsing-remitting (n?=?57) or chronic-progressive (n?=?43) courses of multiple sclerosis (MS) and to 100 normal controls to assess neuropsychological functioning in MS Ss. Both MS groups were clinically stable at the times of testing. Results indicate that both MS groups showed significant neuropsychological impairment, relative to controls, but chronic-progressive MS was associated with greater impairment in each major ability domain (cognitive, sensory, and motor) than was relapsing-remitting MS. In particular, only minimal cognitive impairment was noted in relapsing-remitting MS Ss, whereas chronic-progressive Ss showed impairment on the majority of cognitive test measures from the expanded HRB. Degree of neuropsychological impairment was significantly correlated with MS duration but was unrelated to medication status. MS subgroup differences on the test battery could not be attributed to duration of illness, indicating that disease course is an important independent determinant of neuropsychological impairment in MS. Disability ratings from clinical neurological examinations were highly correlated with motor and sensory performances on neuropsychologial testing, but clinical exams were inadequate in predicting Ss' cognitive status. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological dysfunction and aggression among female federal inmates.

In this study, the authors investigated the relationship between neuropsychological dysfunction and aggression in female inmates. Participants included 555 female inmates from two low-security federal institutions. Aggression was measured by the Buss-Perry Aggression Questionnaire-Short Form. Neuropsychological dysfunction was measured by the Neuropsychological Dysfunction scale of the Coolidge Axis II Inventory and questions on the Psychology Services Intake Questionnaire. Results indicate this sample's neuropsychological functioning. Consistent with studies of male inmates, findings support the relationship between self-reported aggression and neuropsychological dysfunction, identifying female inmates' neuropsychological functioning as an important part of understanding their behavior and providing appropriate treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A defensive response set and the relation between cognitive and emotional functioning: a replication

This study was designed to examine the hypothesis that a defensive self-report response set tends to attenuate the strength of the relationship between self-reported emotional functioning and cognitive tests, particularly the functioning of verbal memory. 75 patients with end-stage lung disease were administered the MMPI and a cognitive test battery as part of a psychosocial evaluation for transplantation. Patients were separated into defensive and nondefensive groups using the MMPI F - K Gough Dissimulation index (raw score F minus K < or = -15). Cognitive factor scores were generated and correlated with non-K-corrected raw scores of MMPI Scales 2, 7, and 8. Correlation coefficients were compared across groups. As predicted, increases on Scales 2 and 7 were significantly associated with decreased functioning of verbal memory (r = -.35 and -.34, respectively) among the nondefensive group but were unrelated in the defensive group. It is argued that the attenuation of the relationship between self-reported emotional status and verbal memory functioning is, in part, due to a restricted range of symptom endorsement on the MMPI among the defensive group. These findings replicate those previously reported using a sample of patients with cardiac disease.     

Behavioral facilitation: A cognitive model of individual differences in approach motivation.

Approach motivation consists of the active, engaged pursuit of one's goals. The purpose of the present three studies (N = 258) was to examine whether approach motivation could be cognitively modeled, thereby providing process-based insights into personality functioning. Behavioral facilitation was assessed in terms of faster (or facilitated) reaction time with practice. As hypothesized, such tendencies predicted higher levels of approach motivation, higher levels of positive affect, and lower levels of depressive symptoms and did so across cognitive, behavioral, self-reported, and peer-reported outcomes. Tendencies toward behavioral facilitation, on the other hand, did not correlate with self-reported traits (Study 1) and did not predict avoidance motivation or negative affect (all studies). The results indicate a systematic relationship between behavioral facilitation in cognitive tasks and approach motivation in daily life. Results are discussed in terms of the benefits of modeling the cognitive processes hypothesized to underlie individual differences motivation, affect, and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: A structural equation model analysis.

The main objective of this study was to use structural equation modeling (SEM) to clarify the relationship between subjective cognitive complaints and neuropsychological functioning in 160 adults with HIV infection. Participants completed questionnaires assessing cognitive complaints, symptoms of depression, and HIV-related medical symptoms. Neuropsychological tests included measures of attention, verbal fluency, psychomotor skills, learning, memory, and executive skills. SEM was used to test models of the relationships among cognitive complaints, mood, and medical symptoms with neuropsychological functioning. The model indicated that although depressed mood (β = 0.32, p     

Occult ectopic ACTH secretion due to recurrent lung carcinoid: long-term control of hypercortisolism by continuous subcutaneous infusion of octreotide

OBJECTIVES: Patients with chronic fatigue syndrome complain of physical and mental fatigue that is worsened by exertion. It was predicted that the cognitive and motor responses to vigorous exercise in patients with chronic fatigue syndrome would differ from those in depressed and healthy controls. METHODS: Ten patients with chronic fatigue syndrome, 10 with depressive illness, and 10 healthy controls completed cognitive and muscle strength testing before and after a treadmill exercise test. Measures of cardiovascular functioning and perceived effort, fatigue, and mood were taken during each stage of testing. RESULTS: Depressed patients performed worst on cognitive tests at baseline. During the treadmill test, patients with chronic fatigue syndrome had higher ratings of perceived effort and fatigue than both control groups, whereas patients with depression reported lower mood. After exertion, patients with chronic fatigue syndrome showed a greater decrease than healthy controls on everyday tests of focused (p=0.02) and sustained (p=0.001) attention, as well as greater deterioration than depressed patients on the focused attention task (p=0.03). No between group differences were found in cardiovascular or symptom measures taken during the cognitive testing. CONCLUSIONS: Patients with chronic fatigue syndrome show a specific sensitivity to the effects of exertion on effortful cognitive functioning. This occurs despite subjective and objective evidence of effort allocation in chronic fatigue syndrome, suggesting that patients have reduced working memory capacity, or a greater demand to monitor cognitive processes, or both. Further insight into the pathophysiology of the core complaints in chronic fatigue syndrome is likely to be realised by studying the effects of exercise on other aspects of everyday functioning.     

A twin study of cognitive function in chronic fatigue syndrome: The effects of sudden illness onset.

Variable reports of neuropsychological deficits in individuals with chronic fatigue syndrome (CFS) may, in part, be attributable to methodological limitations. In this study, these limitations were addressed by controlling for genetic and environmental influences and by assessing the effects of comorbid depression and mode of illness onset. Specifically, the researchers conducted a co-twin control study of 22 pairs of monozygotic twins, in which 1 twin met strict criteria for CFS and the co-twin was healthy. Twins underwent a structured psychiatric interview and comprehensive neuropsychological assessment evaluating 6 cognitive domains. Results indicated that twin groups had similar intellectual and visual memory functioning, but fatigued twins exhibited decreases in motor functions (p = .05), speed of information processing (p = .02), verbal memory (p = .02), and executive functioning (p = .01). Major depression did not affect neuropsychological functioning among fatigued twins, although twins with sudden illness onset demonstrated slowed information processing compared with those with gradual onset (p = .01). Sudden onset CFS was associated with reduced speed of information processing. If confirmed, these findings suggest the need to distinguish illness onset in future CFS studies and may have implications for treatment, cognitive rehabilitation, and disability determination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of cognitive impairment in relapsing–remitting multiple sclerosis and their relationship to neuropathology on magnetic resonance images.

Several reviews (J. M. Peyser & C. M. Poser, 1986; S. M. Rao, 1986) have suggested that multiple sclerosis (MS) results in cognitive impairment in learning and memory, abstract reasoning, information-processing efficiency, and often visual–spatial ability. MS patients may undergo idiosyncratic cognitive changes dependent on the site of white matter lesions. In the present study, researchers used cluster analysis on the neuropsychological data from a group of mildly disabled relapsing–remitting MS patients (n&≠&?77) and a well-matched control group (n&≠&?9). In those MS patients identified with unequivocal cognitive impairment, the majority clustered into groups with a specific deficit in 1 or 2 areas of cognitive functioning, with normal performance in others. On magnetic resonance imaging, an association was obtained between 2 lesion sites and 2 cognitive tests. Impairment in visual–spatial ability, as assessed by the Benton Visual Retention Test, was associated with lesions in the genu of the corpus callosum (CC) and with more lesions throughout the CC. Impaired performance on Paired Associates, a test of learning and memory, was associated with a lesion in the deep white matter of the left parietal lobe… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological functioning and determinants of morning alertness in patients with obstructive sleep apnea syndrome

Neuropsychological functioning is reported to be impaired in patients suffering from obstructive sleep apnea syndrome (OSAS). This syndrome is characterized by nocturnal respiratory disturbances, blood oxygen desaturations, sleep fragmentation, and excessive daytime sleepiness. Opinions are divided concerning the exact relationship between the observed cognitive deficits, nocturnal hypoxia, sleep disruption, and impaired daytime alertness. In the present study, morning neuropsychological function of 26 moderate to severe middle-aged sleep apneics is compared to that of 22 primary insomniacs. There were no performance differences on a range of neuropsychological tests among the two patient groups. In addition, the data suggest that morning alertness impairment, which is closely associated with a lack of slow wave sleep (SWS) and rapid eye movement (REM) sleep, is of major importance in inducing poorer cognitive performance in patients with moderate to severe sleep apnea.     

Sympathetic burst activity: characteristics and significance

This study investigated response bias in self-reported history of factors relevant to the assessment of traumatic brain injury, toxic brain injury and related emotional distress. Response bias refers to systematic error in self-report data. A total of 446 subjects (comprising 131 litigating and 315 non-litigating adults from five locations in the United States) completed a symptom questionnaire. Data were obtained from university faculty and students, from patients in clinics specializing in physiatry neurology, and family medicine, and from plaintiffs undergoing forensic neuropsychological evaluations. Comparisons were made for litigant and non litigant ratings of their past and current cognitive and emotional functioning, including life in general, ability to concentrate, memory, depression, anxiety, alcohol, drugs, ability to work or attend school, irritability, headaches, confusion, self-esteem, and fatigue. Although there is no basis for hypothesizing plaintiffs to be healthier than the general population, plaintiffs rated their pre-injury functioning superior to non-plaintiffs. These findings suggest that response biases need to be taken into account by forensic examiners when relying on litigants' self-reports of pre-injury status.     

Interactions between self-reported alcohol outcome expectancies and cognitive functioning in the prediction of alcohol use and associated problems: A further examination.

A recent debate regarding the theoretical distinction between explicit and implicit cognitive processes relevant to alcohol-related behaviors was strongly shaped by empirical findings from dual-process models (Moss & Albery, 2009; Wiers & Stacy, 2010; Moss & Albery, 2010). Specifically, as part of a broader discussion, Wiers & Stacy (2010) contended that alcohol-related behaviors are better predicted by self-reported alcohol expectancies for individuals with good executive control and verbal abilities relative to those without such abilities. The purpose of the current paper is to further test whether self-reported alcohol outcome expectancies are moderated by measures of cognitive functioning. Using multiple indices of alcohol use, alcohol-related consequences, self-reported alcohol outcome expectancies, and cognitive functioning, both cross-sectional and longitudinal analyses were conducted in a prospective sample of 489 individuals at varying risk for alcohol use disorders. Results from a series of regression analyses testing interactions between self-reported alcohol expectancies and cognitive functioning showed minimal support for the hypothesized pattern discussed by Wiers and Stacy, 2010 regarding self-reported alcohol outcome expectancies. The overall rates of significance were consistent with Type I error rates and a substantial proportion of the significant interactions were inconsistent with previous findings. Thus, the conclusion that cognitive measures consistently moderate the relation between self-reported alcohol expectancies and alcohol use and outcomes should be tempered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Triphenyltin acetate toxicity: a biochemical and ultrastructural study on mouse thymocytes

Eighty-five subjects at various stages of human immunodeficiency virus (HIV-1) infection and 39 seronegative controls underwent neurological and neuropsychological evaluation to assess the relationship between cognitive test results and subjective complaints (cognitive, affective, motor, and other). The effect of psychiatric disorders on the association between cognitive performance and complaints of the patients was also examined. Patients with symptomatic infection had higher frequency of complaints than subjects at asymptomatic stage. Detailed neuropsychological examination confirmed a strong association between poor verbal memory and cognitive complaints. Poor performance on cognitive speed and flexibility was associated with motor complaints and motor abnormalities. These associations were not explained by psychiatric disorders or elevated depression questionnaire scores. Our observations indicate that, especially in symptomatic HIV-1 infection cognitive changes reported by patients often reflect "objective" cognitive decline, and may be the earliest signs of HIV-1 associated cognitive disorder. No direct relationship was observed between "subjective" complaints and neuropsychological performance of asymptomatic subjects. Understanding the significance of reported cognitive changes have important therapeutic implications.     

The Relationship Between Neuropsychological Functioning and Driving Ability in Dementia: A Meta-Analysis.

A meta-analysis of 27 primary studies was conducted to examine the relationship between neuropsychological functioning and driving ability for adults with dementia. When studies using a control group were included, the relationship between cognitive measures and on-road or non-road driving measures was significant for all reported domains; mean correlations ranged from .35 to .65. Caregiver reports of driving ability and cognitive variables were correlated significantly only on measures of mental status and visuospatial skills. When studies using a control group were excluded, moderate mean correlations were observed for visuospatial skills and on-road or non-road measures, and for mental status with non-road tests. Other effects were small or nonsignificant. Implications for basing driving recommendations on neuropsychological testing are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serial neuropsychological assessment and magnetic resonance imaging analysis in multiple sclerosis

OBJECTIVE: To assess the correlation between cognitive dysfunction and disease burden in multiple sclerosis (MS) during a 1-year period. DESIGN: The Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis was performed at entrance and 1 year. Patients underwent at least 20 proton density (range, 20-24) and T2-weighted axial magnetic resonance imaging (MRI) brain scans except for stable patients who were scanned monthly. Magnetic resonance imaging was evaluated using computer-automated, 3-dimensional volumetric analysis. SETTING: A research clinic of a university hospital. PATIENTS: Forty-four patients with MS of the following disease categories: relapsing-remitting (14), relapsing-remitting progressive (12), chronic progressive (13), and stable (5). MAIN OUTCOME MEASURES: The relationships between scores on the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and brain to intracranial cavity volume ratio) were assessed using linear regression. These MRI measures were also compared with cognitive status at 1 year using analysis of variance. RESULTS: Overall, there was no decline in mean cognitive test performance during 1 year. Significant correlations were found between baseline neuropsychological test scores of nonverbal memory, information-processing speed, and attention and both MRI measures. Patients with chronic progressive MS demonstrated the strongest correlations. At 1 year, change in information-processing speed and attention correlated with change in total lesion volume. The mean increase in total lesion volume was 5.7 mL for 4 patients whose cognitive status worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable. CONCLUSIONS: During a 1-year period mean cognitive performance did not worsen. Automated volumetric MRI measures of total lesion volume and brain to intracranial cavity volume ratio correlated with neuropsychological performance, especially in patients with chronic progressive MS. Worsening MRI lesion burden correlated with cognitive decline.     

Age-related practice effects across longitudinal neuropsychological assessments in older people with schizophrenia.

Objective: The relationship between aging and practice effects on longitudinal neuropsychological assessments was investigated in middle-aged and older people with schizophrenia and healthy controls. Method: Older people with schizophrenia (n = 107; M age = 56.1) and age-comparable nonpsychiatric controls (n = 107; M age = 57.7) were scheduled to receive annual assessments on a comprehensive battery of neuropsychological tests for an average of 2.5 years (range 11 months to 4 years). Mixed-model analyses were used to separately examine the effects of practice and age on test performance. Results: Number of prior assessments (practice) was associated with significant performance improvement across assessments, whereas older age was associated with significant decline in performance. The groups did not differ significantly in extent of age-related cognitive decline, but a three-way interaction among group, age, and practice was found, such that greater age-related decline in practice effects were found for older people with schizophrenia relative to nonpsychiatric participants. Conclusions: This study did not find any evidence of neurodegenerative age-related decline in neuropsychological abilities in middle-aged and older people with schizophrenia, but older age was associated with diminished ability to benefit from repeated exposure to cognitive tasks in people with schizophrenia. Cognitive impairment in schizophrenia may combine with cognitive decline associated with normal aging to reduce practice effects in older patients. These findings have important implications for the design of studies examining the longitudinal trajectory of cognitive functioning across the life span of people with schizophrenia, as well as clinical trials that attempt to demonstrate cognitive enhancement in these individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nature, diagnosis and treatment of post-concussion syndrome

INTRODUCTION: The relationship between brief loss of consciousness, subsequent cognitive and emotional complaints, and impact on daily functioning continues to be hotly debated. DEVELOPMENT: In this paper the strong variability about prevalence of the postconcussional syndrome found in several studies is outstanding and the main issues of this disagreement are suggested. Recent neuroimaging techniques are discussed and some neuropsychological measures are suggested. CONCLUSIONS: Currents models (organic/psychogenic) of postconcussional symptoms are reviewed, and a multifactorial model which integrates biological factors with the relevance of neuropsychological deficits--attention, memory, speed of information processing--and coping process is proposed. Finally, according with this model, we conclude with some suggestions to improve neuropsychological intervention and medical treatment of these patients.     

Neuropsychological functioning in older insomniacs with or without obstructive sleep apnea.

The relationships between neuropsychological functioning and sleep loss, sleep apnea, and hypoxemia were examined. Forty-five older insomniacs (M age?=?64.6 yrs) with or without sleep apnea were administered neuropsychological tests after 1 night of nocturnal monitoring in a sleep laboratory. The results showed few differences on cognitive and psychomotor performance between individuals with sleep disruptions alone compared with those whose insomnia was associated with sleep apnea and hypoxemia. There were no significant relationships between nocturnal sleep and respiratory variables and daytime functioning. Furthermore, cognitive and psychomotor performance in older insomniacs with or without sleep apnea revealed minimal impairment compared with age-matched normative data. The results suggest that when the severity of sleep disruptions is controlled, there are minimal differences in neuropsychological functioning of older adults with mild to moderate sleep apnea compared with those without apnea. (PsycINFO Database Record (c) 2010 APA, all rights reserved)