Cross-cultural Diagnostic Validity of the Multilingual Naming Test (MINT) in a Sample of Older Adults

OBJECTIVE

We aimed to evaluate the psychometric properties and diagnostic accuracy of the 32-item version of the Multilingual Naming Test (MINT) in participants from 2 ethnic groups (European Americans [EA; n = 106] and Hispanic Americans [HA; n = 175]) with 3 diagnostic groups (cognitively normal [CN], n = 94, mild cognitive impairment [MCI], n = 148, and dementia, n = 39).

METHOD

An Item Response Theory model was used to evaluate items across ethnicity and language groups (Spanish and English), resulting in a 24-item version. We analyzed the MINT discriminant and predictive validity across diagnostic groups.

RESULTS

A total of 8 items were differentially difficult between languages in the 32-item version of the MINT. EA scored significantly higher than HA, but the difference was not significant when removing those 8 items (controlling for Education). The Receiver Operating Characteristics showed that the MINT had poor accuracy when identifying CN participants and was acceptable in identifying dementia participants but unacceptable in classifying MCI participants. Finally, we tested the association between MINT scores and magnetic resonance imaging volumetric measures of language-related areas in the temporal and frontal lobes. The 32-item MINT in English and Spanish and the 24-item MINT in Spanish were significantly correlated with the bilateral middle temporal gyrus. The left fusiform gyrus correlated with MINT scores regardless of language and MINT version. We also found differential correlations depending on the language of administration.

CONCLUSIONS

Our results highlight the importance of analyzing cross-cultural samples when implementing clinical neuropsychological tests such as the MINT.

CNS involvement in myotonic dystrophy type 1: does sex play a role?

Introduction

Myotonic dystrophy type 1 (DM1) is a hereditary neuromuscular disorder affecting the central nervous system (CNS). Although sex differences have been explored in other neuromuscular disorders, research on this topic in DM1 remains limited. The present study aims to analyze sex differences (both the patient's and disease-transmitting parent's sex) with a focus on CNS outcomes.

Methods

Retrospective data from 146 non-congenital DM1 patients were analyzed, including clinical, molecular, neuropsychological, and neuroradiological data. Sex and inheritance pattern differences were analyzed using t-tests, and ANOVA analyses were conducted to address the interactions.

Results

Overall, no significant sex differences were observed except in certain cognitive domains. However, individuals with maternal inheritance showed larger CTG expansion size, lower estimated IQs, and poorer performance on visual memory, executive functions, and language domains than those with paternal inheritance. Notably, IQ performance was independently influenced by inheritance pattern and CTG expansion.

Discussion

This study is the first to delve into sex differences in DM1 with a focus on CNS outcomes. While the results revealed the absence of a sex-specific clinic-molecular profile, more substantial CNS differences were observed between patients with maternal and paternal inheritance patterns. The hypothetical existence of genomic imprinting and its potential mechanism are discussed. These findings hold potential implications for aiding clinical management by improving genetic counseling and predicting disease severity and prognosis.

Understanding language and cognition after brain surgery - Tumour grade, fine-grained assessment tools and, most of all, individualized approach

Cognitive performance influences the quality of life and survival of people with glioma. Thus, a detailed neuropsychological and language evaluation is essential. In this work, we tested if an analysis of errors in naming can indicate semantic and/or phonological impairments in 87 awake brain surgery patients. Secondly, we explored how language and cognition change after brain tumour resection. Finally, we checked if low-tumour grade had a protective effect on cognition. Our results indicated that naming errors can be useful to monitor semantic and phonological processing, as their number correlated with scores on tasks developed by our team for testing these domains. Secondly, we showed that - although an analysis at a whole group level indicates a decline in language functions - significantly more individual patients improve or remain stable when compared to the ones who declined. Finally, we observed that having LGG, when compared with HGG, favours patients' outcome after surgery, most probably due to brain plasticity mechanisms. We provide new evidence of the importance of applying a broader neuropsychological assessment and an analysis of naming errors in patients with glioma. Our approach may potentially ensure better detection of cognitive deficits and contribute to better postoperative outcomes. Our study also shows that an individualized approach in post-surgical follow-ups can reveal reassuring results showing that significantly more patients remain stable or improve and can be a promising avenue for similar reports. Finally, the study captures that plasticity mechanisms may act as protective in LGG versus HGG after surgery.

Cognitive improvement following endovascular embolization in patients with intracranial dural arteriovenous fistula: The Neuropsychology in dural ArterIal Fistula (NAIF) Study

BACKGROUND

Cognitive improvement after endovascular embolization of an intracranial dural arteriovenous fistula (dAVF) remains unexplored. We aim to investigate cognitive changes following endovascular embolization of dAVFs.

METHODS

Neuropsychology in dural ArterIal Fistula (NAIF) was a prospective multicentric study including patients with an angiographic diagnosis of dAVF who underwent endovascular embolization over the course of 4 years. A complete neuropsychological evaluation comprising five cognitive domains (attention and executive functions, memory, language, praxis, gnosis) was performed at baseline and 3 months follow-up. Mean Z scores for cognitive tests were compared pre- and post-treatment using paired sample t-tests, where higher Z scores indicate better cognition. Effect sizes were computed as Cohen's d.

RESULTS

A total of 32 patients (mean age 61.1±15.4 years, 10 (31.3%) females) were included. Patients exhibited improved performance in attention and executive functions: executive functions-attention (+0.282, P=0.009, d=0.29), executive functions-fluencies (+0.283, P=0.029, d=0.4), and executive functions-processing speed (+0.471, P=0.039, d=0.41). There was an increase in memory: verbal learning and verbal delayed recall scores (+0.513, P<0.001, d=0.55, and +0.385, P=0.001, d=0.41, respectively), while verbal recognition parameters (+0.839, P=0.086, d=0.37) and visual memory (delayed recall) (+0.430, P=0.060, d=0.35) displayed trends toward improved performance. Regarding language, there was significant overall improvement (+0.300, P=0.014, d=0.24), but neither praxis nor gnosis changed significantly. These cognitive outcomes were independent of the severity (measured as Cognard classification), and no patient experienced cognitive worsening.

CONCLUSION

This study suggests that endovascular embolization confers cognitive benefits on dAVF patients undergoing endovascular embolization and may be beneficial even for patients with a low risk of hemorrhage.

Visuoconstructional impairment in DM1: exploring underlying cognitive processes through the Rey complex figure

INTRODUCTION

Among the cognitive difficulties shown by myotonic dystrophy type 1 (DM1) patients, visuoconstructional impairment - specifically measured with the Rey-Osterrieth Complex Figure Test (RCFT) - is particularly notable. This study aimed to analyze the performance of DM1 patients and healthy controls (HC) in the RCFT, using different correction systems in order to explore the cognitive processes underlying the poor performance and its associations with other signs and symptoms.

METHODS

Data from 66 DM1 patients and 68 HC were included in this study. All participants had a comprehensive neuropsychological assessment, including the RCFT, which was scored using both the traditional Osterrieth and the Boston Qualitative Scoring System (BQSS) procedures. ANCOVA and Spearman's correlation analyses were conducted.

RESULTS

DM1 Patients obtained significantly poorer scores than HC on the RCFT using both correction systems. Regarding BQSS, patients performed worse than HC in both main indexes (Copy Presence Accuracy-CPA and Organization-ORG), and specifically on scores of Configural accuracy, Planning, and Perseveration. Both main indexes - but especially CPA - showed significant and strong correlations with several clinical and cognitive variables.

CONCLUSIONS

Both visuoconstruction and organizational impairments underlie the poor RCFT performance in DM1. Moreover, visuoconstruction ability appears to be sensitive to the clinical hallmarks of DM1 patients. The RCFT is proposed as a gold standard in DM1 assessment and the merits of using alternative scoring systems are discussed.

Expressive recall and recognition as complementary measures to assess novel word learning ability in aphasia

Novel word learning ability has been associated with language treatment outcomes in people with aphasia (PWA), and its assessment could inform prognosis and rehabilitation. We used a brief experimental task to examine novel word learning in PWA, determine the value of phonological cueing in assessing learning outcomes, and identify factors that modulate learning ability. Twelve PWA and nineteen healthy controls completed the task, and recall and recognition tests of learning ability. Most PWA showed comparable learning outcomes to those of the healthy controls. Learning assessed via expressive recall was more clearly evidenced with phonological cues. Better single word processing abilities and phonological short-term memory and higher integrity of the left inferior frontal gyrus were related to better learning performance. Brief learning tasks like this one are clinically feasible and hold promise as screening tools of verbal learning in PWA once validated and evaluated for their capacity to predict treatment outcomes.

Impact of COVID-19 infection on cognition and its association with neurological symptoms

OBJECTIVE

To characterize the cognitive profile following COVID-19 infection and its possible association to clinical symptoms, emotional disturbance, biomarkers, and disease severity.

METHODS

This was a single-center cross-sectional cohort study. Subjects between 20- and 60-year old with confirmed COVID-19 infection were included. Evaluation was performed between April 2020 and July 2021. Patients with previous cognitive impairment and other neurological or severe psychiatric disorders were excluded. Demographic and laboratory data were extracted from the medical records.

RESULTS

Altogether 200 patients were included, 85 subjects were female (42.3%), and mean age was 49.12 years (SD: 7.84). Patients were classified into four groups: nonhospitalized (NH, n = 21), hospitalized without intensive care unit (ICU) nor oxygen therapy (HOSP, n = 42), hospitalized without ICU but with oxygen therapy (OXY, n = 107), and ICU (ICU, n = 31) patients. NH group was younger (p = .026). No significant differences were found in any test performed attending severity of illness (p > .05). A total of 55 patients reported subjective cognitive complaints (SCC). Subjects with neurological symptoms (NS) performed worse in trail making test B (p = .013), digits backwards (p = .006), letter&numbers (p = .002), symbol digit modalities test (p = .016), and Stroop color (p = .010) tests.

CONCLUSIONS

OXY patients and females referred more SCC associated with symptoms of anxiety and depression. Objective cognitive performance was unrelated to SCC. No cognitive impairment was found regarding the severity of COVID-19 infection. Results suggest that NS such as headache, anosmia, and dysgeusia during infection were a risk factor for later cognitive deficits. Tests assessing attention, processing speed, and executive function were the most sensitive in detecting cognitive changes in these patients.

Background Music and Memory in Mild Cognitive Impairment: The Role of Interindividual Differences

BACKGROUND

Recent research has shown that background music may improve memory consolidation and retrieval. Nevertheless, in the clinical conditions preceding dementia such as mild cognitive impairment (MCI), there is no current evidence speaking to what effect background music during memory tasks has on impaired cognition.

OBJECTIVE

Across three experiments, we investigated if background music is able to improve memory performance, the most impacted cognitive domain in amnestic MCI.

METHODS

We tested the effect of background music by using a face recognition memory task in patients with amnestic MCI. In Experiment 1, we tested the effect of background music on memory when it was played solely during an encoding phase. In Experiment 2, we explored effects of background music when played during both encoding and recognition phases. In Experiment 3, we explored the role of musically induced arousal on memory.

RESULTS

The main finding from these three experiments was that background music played during a memory task did not improve or worsen participant performance. However, when exposed to high-arousal music, memory performance was predicted by individual mood regulation. For low-arousal music conditions, there was a negative relationship between rating scores for music pleasantness and performance on the memory task.

CONCLUSION

Our results suggest that the benefits of background music on memory in individuals with MCI are modulated by interindividual preferences towards music.

Bilingual Primary Progressive Aphasia: A Scoping Review of Assessment and Treatment Practices

BACKGROUND

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by speech and/or language impairment with relatively spared cognition. Research investigating behavioral speech-language intervention and methods for cognitive-linguistic assessment in PPA has predominantly centered around monolingual speakers. This gap hinders the widespread adoption of evidence-based approaches and exacerbates the inequities faced by culturally and linguistically diverse populations living with PPA.

OBJECTIVE

This scoping review synthesizes the current evidence for assessment and treatment practices in bilingual PPA as well as the operationalization of bilingualism in PPA.

METHODS

Arksey & O'Malley's scoping review methodology was utilized. Information was extracted from each study and entered into a data-charting template designed to capture information regarding operationalization of bilingualism in PPA and assessment and treatment practices.

RESULTS

Of the 16 identified studies, 14 reported the results of assessments conducted in both languages. Three studies reported positive naming treatment outcomes. Thirteen studies included English-speaking participants, revealing linguistic bias. Most studies reported age of acquisition, proficiency, and patterns of language use rather than providing an operational definition for bilingualism.

CONCLUSIONS

Neither formal assessment measures nor clear guidelines for assessment of bilingual PPA currently exist; however, language-specific measures are emerging. Speech-language intervention in bilingual PPA has been relatively unexplored, representing a significant gap in the literature. In order to improve diagnostic and treatment options for bilingual PPA, targeted efforts to increase representation of bilinguals from various sociocultural contexts, as well as those who speak a variety of language pairs, is necessary.

NEURONORMA Cognitive Battery Associations with Cerebrospinal Fluid Amyloid-β and Tau Levels in the Continuum of Alzheimer's Disease

BACKGROUND

Neuropsychological assessments are essential to define the cognitive profile and contribute to the diagnosis of Alzheimer's disease (AD). The progress in knowledge about the pathophysiological process of the disease has allowed conceptualizing AD through biomarkers as a biological continuum that encompasses different clinical stages.

OBJECTIVE

To explore the association between cerebrospinal fluid (CSF) biomarkers of AD and cognition using the NEURONORMA battery, in a sample of cognitively unimpaired (CU), mild cognitive impaired (MCI), and mild dementia of the Alzheimer type (DAT) subjects, and to characterize the cognitive profiles in MCI subjects classified by A/T/N system.

METHODS

42 CU, 35 MCI, and 35 mild DAT were assessed using the NEURONORMA battery. Core AD biomarkers [amyloid-β42 (Aβ42) peptide, total tau (t-tau), and phosphorylated tau 181 (p-tau181)] proteins were measured in CSF. Correlation coefficients, multivariate regression, and effect sizes were calculated. We explored the age- and education-adjusted cognitive profiles by A/T/N variants within the MCI group.

RESULTS

Cognitive outcomes were directly associated with CSF Aβ42 and inversely with CSF tau measures. We found differences in both biomarkers and cognitive outcomes comparing all pairs except for CSF measures between cognitively impaired groups. The highest effect size was in memory tasks and biomarkers ratios. Lower performances were in memory and executive domains in MCI subjects with AD pathology (A+T+N±) compared to those with normal levels of AD biomarkers (A- T- N).

CONCLUSION

This study provides further evidence of the validity of Spanish NEURONORMA cognitive battery to characterize cognitive impairment in the AD pathological continuum.

Naming ability assessment in neurocognitive disorders: a clinician's perspective

BACKGROUND

Detecting impaired naming capacity is valuable in diagnosing neurocognitive disorders (ND). A. clinical practice- oriented overview of naming tests validated in ND is not available yet. Here, features of naming tests with validated utility in ND which are open access or available for purchase are succinctly presented and compared.

METHODS

Searches were carried out across Pubmed, Medline and Google Scholar. Additional studies were identified by searching reference lists. Only peer-reviewed journal articles were eligible. A narrative- and tabullar synthesis was used to summarize different aspects of the naming assessment instruments used in patients with ND such as stimuli type, administration time, assessment parameters and accessibility. Based on computational word frequency calculations, the tests were compared in terms of the average frequency of their linguistic content.

RESULTS

Twelve naming tests, relying either on visual or auditory stimuli have been validated in ND. Their content and administration time vary between three and 60 items and one and 20 minutes, respectively. The average frequency of the words of each considered test was two or lower, pointing to low frequency of most items. In all but one test, scoring systems are exclusively based on correctly named items. Seven instruments are open access and four are available in more than one language.

CONCLUSIONS

Gaining insights into naming tests' characteristics may catalyze the wide incorporation of those with short administration time but high diagnostic accuracy into the diagnostic workup of ND at primary healthcare and of extensive, visual or auditory ones into the diagnostic endeavors of memory clinics, as well as of secondary and tertiary brain healthcare settings.

Regression-Based Normative Data for Independent and Cognitively Active Spanish Older Adults: Verbal Fluency Tests and Boston Naming Test

An increased cognitive reserve is associated with changes in the pattern of cognitive decline during aging. Thus, normative data adapted to the characteristics of the target population are needed to reduce the possibility of false diagnoses. The aim of this work was to develop normative data for the Phonemic Verbal Fluency test, the Semantic Verbal Fluency test and the Boston Naming Test (BNT).

METHOD

Regression-based normative data were calculated from a sample of 118 non-depressed, cognitively active, independent community-dwelling adults aged 55 or older (64.4% women) from SABIEX (University for Seniors at the Universidad Miguel Hernández de Elche). Raw scores were regressed on age, sex, and education.

RESULTS

The effects of age and education varied across neuropsychological measures. No effect of sex was found in any of the tests assessed. Statistically significant differences were found in the proportion of low scores using SABIEX or population-based normative datasets. The level of agreement identifying individuals labeled as showing one or more low scores was only fair-to-good.

CONCLUSIONS

Normative data obtained from the general population might not be sensitive to identify low scores in cognitively active older adults, increasing the risk of misdiagnoses. A friendly calculator is available for neuropsychological assessment.

Resting state electroencephalographic rhythms are affected by immediately preceding memory demands in cognitively unimpaired elderly and patients with mild cognitive impairment

Experiments on event-related electroencephalographic oscillations in aged people typically include blocks of cognitive tasks with a few minutes of interval between them. The present exploratory study tested the effect of being engaged on cognitive tasks over the resting state cortical arousal after task completion, and whether it differs according to the level of the participant’s cognitive decline. To investigate this issue, we used a local database including data in 30 healthy cognitively unimpaired (CU) persons and 40 matched patients with amnestic mild cognitive impairment (aMCI). They had been involved in 2 memory tasks for about 40 min and underwent resting-state electroencephalographic (rsEEG) recording after 5 min from the task end. eLORETA freeware estimated rsEEG alpha source activity as an index of general cortical arousal. In the CU but not aMCI group, there was a negative correlation between memory tasks performance and posterior rsEEG alpha source activity. The better the memory tasks performance, the lower the posterior alpha activity (i.e., higher cortical arousal). There was also a negative correlation between neuropsychological test scores of global cognitive status and alpha source activity. These results suggest that engagement in memory tasks may perturb background brain arousal for more than 5 min after the tasks end, and that this effect are dependent on participants global cognitive status. Future studies in CU and aMCI groups may cross-validate and extend these results with experiments including (1) rsEEG recordings before memory tasks and (2) post-tasks rsEEG recordings after 5, 15, and 30 min.

Culture Effects on the Chinese Version Boston Naming Test Performance and the Normative Data in the Native Chinese-Speaking Elders in Mainland China

Background

The Chinese version of Boston Naming Test (BNT-C) is administered in China widely. However, the neuropsychological parameter of BNT-C in native Chinese-speaking elders in mainland China has not been explored systematically. The aim of this study was to explore cultural influences on BNT-C performance and establish norms among native Chinese-speaking elders in Beijing.

Methods

A total of 161 native, Chinese-speaking, cognitively normal elders aged ≥55 years were enrolled from various communities in Beijing. The BNT-C was conducted on all the participants. The internal consistency, participants' familiarity, and naming accuracy were analyzed and compared with data from Chinese areas outside the mainland and from American published previously. The influencing factors and stratified norms for BNT-C were established.

Results

The BNT-C showed good internal consistency (α = 0.738). Strong correlation between naming accuracy and object familiarity was found (r = 0.962, P < 0.001). Participants' familiarity and correct naming rate for many items were notably different between the Chinese-speaking elders and English-speaking elders in America. The difference in some items' correct naming rate also existed between Beijing, Taiwan, and Hongkong. Higher education was associated with higher scores, whereas age and gender had no effect on BNT-C performance. The recommended norms of total naming scores for elders with education ≤ 9 and >9 years were 16 and 23, respectively.

Conclusion

The participants' familiarity with BNT items differed between different cultures, which further affected the naming accuracy and total scores. The education stratified norms established here are helpful for the better application of BNT-C in mainland China.

Profile of cognitive impairment in late-stage Parkinson's disease

INTRODUCTION

The profile of cognitive impairment associated with the late stages of Parkinson's disease (LSPD) is rarely reported. Its characterization is necessary to better understand the cognitive changes that occur as the disease progresses and to better contribute to its management.

METHODS

In this cross-sectional study, we characterized the cognitive profile of LSPD patients using the comprehensive assessment methodology proposed by the International Parkinson and Movement Disorders Society Task Force. The association of clinical and demographic variables with dementia diagnosis was also investigated using binary logistic regression analysis.

RESULTS

Eighty-four LSPD patients were included (age 75.4 ± 6.9; disease duration 16.9 ± 7.5). Fifty-four (64.3%) were classified as demented and presented a global impairment cognitive profile. In the nondemented group (N = 30), 25 (83.3%) LSPD patients met the diagnostic criteria for mild cognitive impairment, mostly with multiple domain impairment (96.0%) and a heterogeneous profile. Memory was the most frequent and severely impaired cognitive domain in both groups. Disease disability, orientation, complex order comprehension, verbal learning, and visuoconstructive abilities were significantly associated with dementia diagnosis (p < .05).

CONCLUSIONS

Cognitive impairment in multiple domains was common in LSPD patients. The most frequent and prominent deficits were in the memory domain, with a strong interference from attention impairment. Disease disability, orientation, complex order comprehension, verbal learning, and visuoconstructive abilities proved to be important determinants for dementia diagnosis.

The cognitive and psychiatric subacute impairment in severe Covid-19

Neurologic impairment persisting months after acute severe SARS-CoV-2 infection has been described because of several pathogenic mechanisms, including persistent systemic inflammation. The objective of this study is to analyze the selective involvement of the different cognitive domains and the existence of related biomarkers. Cross-sectional multicentric study of patients who survived severe infection with SARS-CoV-2 consecutively recruited between 90 and 120 days after hospital discharge. All patients underwent an exhaustive study of cognitive functions as well as plasma determination of pro-inflammatory, neurotrophic factors and light-chain neurofilaments. A principal component analysis extracted the main independent characteristics of the syndrome. 152 patients were recruited. The results of our study preferential involvement of episodic and working memory, executive functions, and attention and relatively less affectation of other cortical functions. In addition, anxiety and depression pictures are constant in our cohort. Several plasma chemokines concentrations were elevated compared with both, a non-SARS-Cov2 infected cohort of neurological outpatients or a control healthy general population. Severe Covid-19 patients can develop an amnesic and dysexecutive syndrome with neuropsychiatric manifestations. We do not know if the deficits detected can persist in the long term and if this can trigger or accelerate the onset of neurodegenerative diseases.

Validation and Norms for a Recognition Task for the Spanish Version of the Free and Cued Selective Reminding Test

OBJECTIVE

The aim of the present work was to develop and validate a recognition task to be used with the Spanish version of the 16 items Free and Cued Selective Reminding Test (FCSRT).

METHOD

A total of 96 (67.7% women) cognitively healthy, functionally independent community-dwelling participants aged 55 years or older underwent a comprehensive neuropsychological assessment. A recognition task for the FCSRT was developed that included the original 16 items, 16 semantically related items, and eight unrelated foils. Indices of discriminability (d') and response bias (C), as well as 95% confidence intervals for chance-level responding were calculated.

RESULTS

On average, our sample was 65.71 years old (SD = 6.68, range: 55-87), had 11.39 years of formal education (SD = 3.37, range: 3-19), and a Mini-Mental State Examination score = 28.42 (SD = 1.49, range: 25-30). Recognition scores did not differ statistically between sexes, nor did they correlate with demographics. Participants scored at ceiling levels (mean number of Hits = 15.52, SD = 0.906, mean number of False Alarms = 0.27, SD = 0.589). All the participants scored above chance levels.

CONCLUSIONS

Normative data from a novel recognition task for the Spanish version of the FCSRT are provided for use in clinical and research settings. Including a recognition task in the assessment of memory functioning might help uncover the pattern of memory impairments in older adults, and can help improve the memory profile of people with amnestic Mild Cognitive Impairment. Future research is warranted to validate and expand the recognition task.

Language in Behavioral Variant Frontotemporal Dementia: Another Stone to Be Turned in Latin America

Beyond canonical deficits in social cognition and interpersonal conduct, behavioral variant frontotemporal dementia (bvFTD) involves language difficulties in a substantial proportion of cases. However, since most evidence comes from high-income countries, the scope and relevance of language deficits in Latin American bvFTD samples remain poorly understood. As a first step toward reversing this scenario, we review studies reporting language measures in Latin American bvFTD cohorts relative to other groups. We identified 24 papers meeting systematic criteria, mainly targeting phonemic and semantic fluency, naming, semantic processing, and comprehension skills. The evidence shows widespread impairments in these domains, often related to overall cognitive disturbances. Some of these deficits may be as severe as in other diseases where they are more widely acknowledged, such as Alzheimer's disease. Considering the prevalence and informativeness of language deficits in bvFTD patients from other world regions, the need arises for more systematic research in Latin America, ideally spanning multiple domains, in diverse languages and dialects, with validated batteries. We outline key challenges and pathways of progress in this direction, laying the ground for a new regional research agenda on the disorder.

Psychogenic nonepileptic seizures: The effect of accurate diagnosis on cognition

OBJECTIVE

Much remains to be elucidated about the cognitive profile of patients with psychogenic nonepileptic seizures (PNES) and about how this changes over time and compares to that of patients with epilepsy. The aim of this study was to study the neuropsychological profile of patients with PNES and an age-matched group of patients with temporal lobe epilepsy (TLE) during admission to a video electroencephalography monitoring unit (VEMU) and 1 year after discharge.

METHODS

Patients diagnosed with PNES or TLE at a VEMU were prospectively recruited. Neuropsychological, demographic, clinical, and treatment variables were collected at baseline and 1 year. To minimize multiple comparisons, scores from different cognitive tests were computed for attention and psychomotor speed, verbal memory, visual memory, language, and executive function. A global cognitive impairment index (GCII) was also created. Post hoc analyses were conducted to identify clinical variables that might mediate the differences observed in cognition over time between the groups. These included seizure frequency, number of antiseizure medication (ASM), number of psychotropic drugs, depression, and quality of life.

RESULTS

We studied 24 patients with PNES and 24 patients with TLE. The groups performed similarly in the baseline neuropsychological tests. There was a significant time (baseline to 1-year follow-up) by group (PNES vs TLE) interaction for the GCII (p = 0.006), language (p = 0.04), and executive function (p = 0.013), with PNES patients showing improvement and TLE patients remaining stable. The time by group interaction for attention and psychomotor speed showed a trend toward significance (p = 0.056), Reduction in number of ASM was associated with improved cognition in PNES patients at 1 year.

CONCLUSION

PNES patients showed improved cognition at 1 year of follow-up, particularly in language and executive functions. This finding shows the potential benefits of an early, accurate diagnosis, which range from improved cognition to better management.

Ubiquinol Supplementation Improves Gender-Dependent Cerebral Vasoreactivity and Ameliorates Chronic Inflammation and Endothelial Dysfunction in Patients with Mild Cognitive Impairment

Ubiquinol can protect endothelial cells from multiple mechanisms that cause endothelial damage and vascular dysfunction, thus contributing to dementia. A total of 69 participants diagnosed with mild cognitive impairment (MCI) received either 200 mg/day ubiquinol (Ub) or placebo for 1 year. Cognitive assessment of patients was performed at baseline and after 1 year of follow-up. Patients' cerebral vasoreactivity was examined using transcranial Doppler sonography, and levels of Ub and lipopolysaccharide (LPS) in plasma samples were quantified. Cell viability and necrotic cell death were determined using the microvascular endothelial cell line bEnd3. Coenzyme Q10 (CoQ) levels increased in patients supplemented for 1 year with ubiquinol versus baseline and the placebo group, although higher levels were observed in male patients. The higher cCoQ concentration in male patients improved cerebral vasoreactivity CRV and reduced inflammation, although the effect of Ub supplementation on neurological improvement was negligible in this study. Furthermore, plasma from Ub-supplemented patients improved the viability of endothelial cells, although only in T2DM and hypertensive patients. This suggests that ubiquinol supplementation could be recommended to reach a concentration of 5 μg/mL in plasma in MCI patients as a complement to conventional treatment.

Major Surgery Affects Memory in Individuals with Cerebral Amyloid-β Pathology

BACKGROUND

Major surgery has been associated with perioperative neurocognitive disorders (PND), but the contributing factors and long-term prognosis are uncertain. We hypothesize that preclinical Alzheimer's disease (AD) might predispose to cognitive deterioration after surgery.

OBJECTIVE

To analyze the effect of amyloid-β on the cognitive trajectory after orthopedic surgery in a sample of non-demented subjects.

METHODS

Non-demented individuals older than 65 years that were on the waiting list for orthopedic surgery with spinal anesthesia underwent a neuropsychological assessment before and after surgery. During surgery, cerebrospinal fluid samples were obtained to determine AD biomarkers.

RESULTS

Cumulative incidence of PND was 55.2%during a mean follow-up of nine months. The most affected cognitive domains were executive function and constructional praxis. The presence of abnormal levels of amyloid-β was associated to a postoperative impairment in verbal and visual memory tests. According to their AD biomarker profile, participants were categorized as either Amyloid Positive (A+) or Amyloid Negative (A-). The incidence of PND did not differ between both groups. The A- group showed a tendency similar to the global sample, worsening in executive function tests and improving on memory scales due to practice effects. In contrast, the A + group showed a notable worsening on memory performance.

CONCLUSION

Our findings support the hypothesis that surgery may promote or accelerate memory decline in cognitively asymptomatic subjects with brain amyloid-β deposits.

Enriched Music-supported Therapy for chronic stroke patients: a study protocol of a randomised controlled trial

BACKGROUND

Residual motor deficits of the upper limb in patients with chronic stroke are common and have a negative impact on autonomy, participation and quality of life. Music-Supported Therapy (MST) is an effective intervention to enhance motor and cognitive function, emotional well-being and quality of life in chronic stroke patients. We have adapted the original MST training protocol to a home-based intervention, which incorporates increased training intensity and variability, group sessions, and optimisation of learning to promote autonomy and motivation.

METHODS

A randomised controlled trial will be conducted to test the effectiveness of this enriched MST (eMST) protocol in improving motor functions, cognition, emotional well-being and quality of life of chronic stroke patients when compared to a program of home-based exercises utilizing the Graded Repetitive Arm Supplementary Program (GRASP). Sixty stroke patients will be recruited and randomly allocated to an eMST group (n = 30) or a control GRASP intervention group (n = 30). Patients will be evaluated before and after a 10-week intervention, as well as at 3-month follow-up. The primary outcome of the study is the functionality of the paretic upper limb measured with the Action Research Arm Test. Secondary outcomes include other motor and cognitive functions, emotional well-being and quality of life measures as well as self-regulation and self-efficacy outcomes.

DISCUSSION

We hypothesize that patients treated with eMST will show larger improvements in their motor and cognitive functions, emotional well-being and quality of life than patients treated with a home-based GRASP intervention.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov and identified as NCT04507542 on 8 August 2020.

Cognitive and Behavioral Profiles of Left and Right Semantic Dementia: Differential Diagnosis with Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease

BACKGROUND

Semantic dementia (SD) is a subtype of frontotemporal dementia (FTD) characterized by semantic memory loss and preserved abilities of other cognitive functions. The clinical manifestations of SD require a differential diagnosis with Alzheimer's disease (AD), especially those with early onset, and behavioral variant FTD (bvFTD).

OBJECTIVE

The present study aimed to compare cognitive performances and neuropsychiatric symptoms in a population of AD, bvFTD, and left and right SD defined with the support of molecular imaging (amyloid and 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography) and assessed the accuracy of different neuropsychological markers in distinguishing these neurodegenerative diseases.

METHODS

Eighty-seven participants (32 AD, 20 bvFTD, and 35 SD (17 Left-SD and 18 Right-SD) completed a comprehensive neuropsychological battery that included memory, language, attention and executive functions, visuospatial function, visuoconstructional skills, and tasks designed specifically to evaluate prosopagnosia and facial emotions recognition. The Neuropsychiatric Inventory was administered to assess neuropsychiatric symptoms.

RESULTS

An episodic memory test that included semantic cues, a visuospatial test (both impaired in AD), a naming test and a prosopagnosia task (both impaired in SD) were the four most valuable cognitive metrics for the differential diagnosis between groups. Several behavioral abnormalities were differentially present, of which aggression, self-care (both more frequent in bvFTD), and eating habits, specifically overeating and altered dietary preference (more frequent in SD), were the most valuable in group discrimination.

CONCLUSION

Our study highlights the value of a comprehensive neuropsychological and neuropsychiatric evaluation for the differential diagnosis between FTD syndromes and AD.

Comparative Cognitive Effects of Choreographed Exercise and Multimodal Physical Therapy in Older Adults with Amnestic Mild Cognitive Impairment: Randomized Clinical Trial

Background:

Recent research on mild cognitive impairment (MCI) has primarily focused on searching for measures to prevent or delay the progression of MCI to dementia. Physical exercise has shown to be effective in the prevention of age-related cognitive decline in elderly adults with MCI. However, the most effective type and dose of exercise for the improvement of cognition are yet to be determined.

Objective:

To compare the cognitive effects of choreographed exercise (Choreography group) with a multimodal physical therapy program (Physical Therapy group) in elderly adults with amnestic MCI, a population with an increased risk of developing dementia.

Methods:

We conducted a randomized clinical trial with two parallel groups under allocation concealment and assessor blinding. Participants were allocated into Choreography or Physical Therapy group and performed exercises twice per week in 60-minute sessions during 12 weeks.

Results:

Thirty-six participants with amnestic MCI, ages 65 to 85, were assessed at baseline and after 12 weeks of intervention, by comprehensive validated neuropsychological and physical assessments. A Repeated measures General Lineal Model showed statistically significant differences in cognitive and physical outcomes. Both groups significantly improved in visual delayed recall. The Choreography group exhibited significantly more benefits on verbal recognition memory than the Physical Therapy group.

Conclusion:

Greater cognitive benefits were achieved in the choreographic intervention than in the multimodal physical therapy, mainly in those functions more related to the risk of conversion to dementia. Additional studies are needed to confirm whether the observed effects are related to delayed onset of Alzheimer’s disease in elderly adults with amnestic MCI.

The black box of global aphasia: Neuroanatomical underpinnings of remission from acute global aphasia with preserved inner language function

OBJECTIVE

We studied an unusual case of global aphasia (GA) occurring after brain tumor removal and remitting one-month after surgery. After recovering, the patient reported on her experience during the episode, which suggested a partial preservation of language abilities (such as semantic processing) and the presence of inner speech (IS) despite a failure in overt speech production. Thus, we explored the role of IS and preserved language functions in the acute phase and investigated the neuroanatomical underpinnings of this severe breakdown in language processing.

METHOD

A neuropsychological and language assessment tapping into language production, comprehension, attention and working memory was carried out both before and three months after surgery. In the acute stage a simplified protocol was tailored to assess the limited language abilities and further explore patient's performance on different semantic tasks. The neuroanatomical dimension of these abrupt changes was provided by perioperative structural neuroimaging.

RESULTS

Language and neuropsychological performance were normal/close to normal both before and three months after surgery. In the acute stage, the patient presented severe difficulties with comprehension, production and repetition, whereas she was able to correctly perform tasks that requested conceptual analysis and non-verbal operations. After recovering, the patient reported that she had been able to internally formulate her thoughts despite her overt phonological errors during the episode. Structural neuroimaging revealed that an extra-axial blood collection affected the middle frontal areas during the acute stage and that the white matter circuitry was left-lateralized before surgery.

CONCLUSIONS

We deemed that the global aphasia episode was produced by a combination of the post-operative extra-axial blood collection directly impacting left middle frontal areas and a left-lateralization of the arcuate and/or uncinated fasciculi before surgery. Additionally, we advocate for a comprehensive evaluation of linguistic function that includes the assessment of IS and non-expressive language functions in similar cases.

Normative Data for Test of Verbal Fluency and Naming on Ecuadorian Adult Population

Objective: To generate normative data for verbal fluency and naming test in an Ecuadorian adult population. Methods: The sample consisted of 322 healthy adults (18-84 years old) recruited from Quito, Ecuador. The verbal fluency and Boston Naming Test (BNT) were administered as part of a larger comprehensive neuropsychological battery. Multiple linear regression analyses were used to generate the normative data taking into account age, education, and sex. Results: For phonological verbal fluency, results indicated that only education was significantly related to the performance of the letters "A," "S," and "M." However, the performance on the letter "F" was significantly associated with age and education. For semantic fluency, the performance on "animals" was significantly influenced by age, quadratic age, and education, whereas that for "fruits" was explained by quadratic age, education, and sex. The performance on the BNT was significantly influenced by age and education. A Microsoft Excel-based calculator was created to help clinicians to obtain the normative data on this test. Conclusion: This normative data will help neuropsychologist in Ecuador to use these tests both in research and in their clinical practice to improve the diagnosis of cognitive deficits in the population.

Validation of the Neuronorma battery for neuropsychological assessment in multiple sclerosis

BACKGROUND

Cognitive dysfunction is prevalent among patients with multiple sclerosis (MS). In recent years, several (generally brief) neuropsychological batteries have been proposed for cognitive assessment. There is a need for comprehensive batteries providing complete cognitive assessment of patients with MS. The Neuronorma battery includes several standardised neuropsychological tests examining the main cognitive domains, and is available in several countries. The aim of this study was to validate the battery for cognitive assessment in a sample of patients with MS and healthy controls, and to find the most appropriate criteria for defining cognitive impairment using this battery.

METHODS

Five hundred and sixty participants (280 with MS and 280 controls matched for age, sex, and years of education) were included. Inter-group differences were calculated using the Mann-Whitney U test and effect sizes with Cohen's d. Several criteria for definition of cognitive impairment were evaluated, according to different cut-off points, and the number of tests and cognitive domains impaired. Receiver operating characteristic curves with 95% confidence intervals were estimated and they were compared using the DeLong method.

RESULTS

Patients with MS showed poorer performance in almost all cognitive tests, with large effect sizes for the Symbol Digit Modalities Test and Judgement of Line Orientation, and moderate effects for Digit Span Backward, the Corsi test, Trail Making Test, Free and Cued Selective Reminding Test, Rey-Osterrieth Complex Figure (recall), verbal fluency (P words), and the Stroop Color-Word Interference Test. The area under the curve was superior for classification by cognitive domain than for the mean scaled score of the tests or the number of tests showing impairment according to different cut-off points for the adjusted scaled scores.

CONCLUSIONS

Our study validates the Neuronorma battery for cognitive assessment of patients with MS. The battery is currently available in several countries with reliable normative data, and may be useful in both the clinical and the research settings when comprehensive neuropsychological examination is warranted.

The Sant Pau Initiative on Neurodegeneration (SPIN) cohort: A data set for biomarker discovery and validation in neurodegenerative disorders

Introduction

The SPIN (Sant Pau Initiative on Neurodegeneration) cohort is a multimodal biomarker platform designed for neurodegenerative disease research following an integrative approach.

Methods

Participants of the SPIN cohort provide informed consent to donate blood and cerebrospinal fluid samples, receive detailed neurological and neuropsychological evaluations, and undergo a structural 3T brain MRI scan. A subset also undergoes other functional or imaging studies (video-polysomnogram, ¹⁸F-fluorodeoxyglucose PET, amyloid PET, Tau PET). Participants are followed annually for a minimum of 4 years, with repeated cerebrospinal fluid collection and imaging studies performed every other year, and brain donation is encouraged.

Results

The integration of clinical, neuropsychological, genetic, biochemical, imaging, and neuropathological information and the harmonization of protocols under the same umbrella allows the discovery and validation of key biomarkers across several neurodegenerative diseases.

Discussion

We describe our particular 10-year experience and how different research projects were unified under an umbrella biomarker program, which might be of help to other research teams pursuing similar approaches.

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The SPIN cohort is a multimodal biomarker program for research in neurodegeneration.

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We describe how research projects were unified under an umbrella biomarker program.

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Integrating clinical and biological data allows discovery and validation of markers.

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As a clinical group, we keep the SPIN cohort focused in patient-oriented research.

White-matter pathways and semantic processing: intrasurgical and lesion-symptom mapping evidence

In the present study, we aimed to test the association between the correct function of the left ventral white matter pathways and semantic processing (dual stream models for language processing, Hickok & Poeppel, 2004), using a new set of language tasks during intraoperative electrical stimulation at white matter level. Additionally, we evaluated brain regions needed for correct performance on the different semantic tasks using lesion-symptom analyses (voxel lesion-symptom mapping and track-wise lesion analysis) in a sample of 62 candidates for the awake brain surgery. We found that electrical stimulation in the vicinity of the inferior longitudinal and inferior fronto-occipital fasciculi disturbed performance on semantic processing tasks. Individuals presented with significantly more semantic paraphasias during brain tumor resection than during the electrical stimulation at the cortex level. Track-wise analyses confirmed the role of these left ventral pathways in semantic processing: a significant relationship was observed between the probability of inferior fronto-occipital fasciculus disconnection/damage and the semantic matching tasks, as well as the number of semantic paraphasias in naming. Importantly, the same analyses for the total score of the Boston Naming Test confirmed significant relationships between this test score and the integrity of the inferior fronto-occipital, inferior longitudinal and uncinate fasciculi. This was further supported by the results of VLSM analyses showing a significant relationship between BNT and the presence of lesion within left middle and inferior temporal gyri. The present findings provide new intraoperative evidence for the role of the white-matter ventral pathways in semantic processing, while at the same time emphasizing the need to include a broader assessment of semantic-conceptual aspects during the awake neurosurgical intervention. This approach will ensure better preservation of functional tissue in the tumoral vicinity and therefore substantially diminish post-surgical language impairments.

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Direct electrical stimulation on the ventral white matter disrupts semantic processing.

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Track-wise analyses confirm intraoperative findings.

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Semantic matching a good candidate for monitoring in brain tumor surgeries.

Relationship between depressive symptomatology and cognitive performance in older people

Objective:

To analyze the relationship of depressive symptoms with differentiated components of cognitive function in older adults using the Neuronorma.Co protocol.

Methodology:

We analyzed the cognitive performance of 144 adults, 58.3% women, with an average age of 68.1 ± 11.2 years. A factor analysis of main components was performed to identify independent factors of cognitive function. Multiple linear regression analysis was used to estimate the type and strength of association between depressive symptoms and neurocognitive performance components.

Results:

Seven differentiated components of cognitive performance were identified. In the multivariate analysis, interference control and language were affected by the total score on the Yesavage Geriatric Depression Scale.

Conclusions:

The presence and intensity of depressive symptoms is associated with a lower performance in tasks dependent on executive control.

Comparison between FCSRT and LASSI-L to Detect Early Stage Alzheimer's Disease

BACKGROUND

The Free and Cued Selective Reminding Test (FCSRT) is the most accurate test for the diagnosis of prodromal Alzheimer's disease (AD). Recently, a novel cognitive test, the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L), has been developed in order to provide an early diagnosis.

OBJECTIVE

To compare the diagnostic accuracy of the FCSRT and the LASSI-L for the diagnosis of AD in its preclinical and prodromal stages using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) as a reference.

METHODS

Fifty patients consulting for subjective memory complaints without functional impairment and at risk for AD were enrolled and evaluated using FCSRT, LASSI-L, and FDG-PET. Participants were evaluated using a comprehensive neurological and neuropsychological protocol and were assessed with the FCSRT and LASSI-L. FDG-PET was acquired concomitantly and used for classification of patients as AD or non-AD according to brain metabolism using both visual and semi-quantitative methods.

RESULTS

LASSI-L scores allowed a better classification of patients as AD/non-AD in comparison to FCSRT. Logistic regression analysis showed delayed recall and failure to recovery from proactive semantic interference from LASSI-L as independent statistically significant predictors, obtaining an area under the curve of 0.894. This area under the curve provided a better discrimination than the best FCSRT score (total delayed recall, area under the curve 0.708, p = 0.029).

CONCLUSIONS

The LASSI-L, a cognitive stress test, was superior to FCSRT in the prediction of AD features on FDG-PET. This emphasizes the possibility to advance toward an earlier diagnosis of AD from a clinical perspective.

Shortened Version of the Token Test: Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Shortened Version of the Token Test in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Shortened Version of the Token Test as part of a larger neuropsychological battery. Shortened Version of the Token Test total scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age in all countries, such that score increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Puerto Rico. Models showed that children whose parent(s) had a MLPE >12 years obtained higher score compared to children whose parents had a MLPE ≤12 years in Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Puerto Rico, and Spain. The child's sex did not have an effect in the Shortened Version of the Token Test total score for any of the countries.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the Shortened Version of the Token Test when used in pediatric populations.

Item analysis of the Spanish version of the Boston Naming Test with a Spanish speaking adult population from Colombia

OBJECTIVE

The Boston Naming Test (BNT) is a widely used measure of confrontation naming ability that has been criticized for its questionable construct validity for non-English speakers. This study investigated item difficulty and construct validity of the Spanish version of the BNT to assess cultural and linguistic impact on performance.

METHODS

Subjects were 1298 healthy Spanish speaking adults from Colombia. They were administered the 60- and 15-item Spanish version of the BNT. A Rasch analysis was computed to assess dimensionality, item hierarchy, targeting, reliability, and item fit.

RESULTS

Both versions of the BNT satisfied requirements for unidimensionality. Although internal consistency was excellent for the 60-item BNT, order of difficulty did not increase consistently with item number and there were a number of items that did not fit the Rasch model. For the 15-item BNT, a total of 5 items changed position on the item hierarchy with 7 poor fitting items. Internal consistency was acceptable.

CONCLUSIONS

Construct validity of the BNT remains a concern when it is administered to non-English speaking populations. Similar to previous findings, the order of item presentation did not correspond with increasing item difficulty, and both versions were inadequate at assessing high naming ability.

Effect of education on listening comprehension of sentences on healthy elderly: analysis of number of correct responses and task execution time

PURPOSE

To analyze the effect of education on sentence listening comprehension on cognitively healthy elderly.

METHODS

A total of 111 healthy elderly, aged 60-80 years of both genders were divided into two groups according to educational level: low education (0-8 years of formal education) and high education (≥9 years of formal education). The participants were assessed using the Revised Token Test, an instrument that supports the evaluation of auditory comprehension of orders with different working memory and syntactic complexity demands. The indicators used for performance analysis were the number of correct responses (accuracy analysis) and task execution time (temporal analysis) in the different blocks.

RESULTS

The low educated group had a lower number of correct responses than the high educated group on all blocks of the test. In the temporal analysis, participants with low education had longer execution time for commands on the first four blocks related to working memory. However, the two groups had similar execution time for blocks more related to syntactic comprehension.

CONCLUSION

Education influenced sentence listening comprehension on elderly. Temporal analysis allowed to infer over the relationship between comprehension and other cognitive abilities, and to observe that the low educated elderly did not use effective compensation strategies to improve their performances on the task. Therefore, low educational level, associated with aging, may potentialize the risks for language decline.

Screening for Specific Language Impairment in Preschool Children: Evaluating a Screening Procedure Including the Token Test

Specific language impairment (SLI) comprises impairments in receptive and/or expressive language. Aim of this study was to evaluate a screening for SLI. 61 children with SLI (SLI-children, age-range 4-6 years) and 61 matched typically developing controls were tested for receptive language ability (Token Test-TT) and for intelligence (Wechsler Preschool-and-Primary-Scale-of-Intelligence-WPPSI). Group differences were analyzed using t tests, as well as direct and stepwise discriminant analyses. The predictive value of the WPPSI with respect to TT performance was analyzed using regression analyses. SLI-children performed significantly worse on both TT and WPPSI ([Formula: see text]). The TT alone yielded an overall classification rate of 79%, the TT and the WPPSI together yielded an overall classification rate of 80%. TT performance was significantly predicted by verbal intelligence in SLI-children and nonverbal intelligence in controls whilst WPPSI subtest arithmetic was predictive in both groups. Without further research, the Token Test cannot be seen as a valid and sufficient tool for the screening of SLI in preschool children but rather as a tool for the assessment of more general intellectual capacities. SLI-children at this age already show impairments typically associated with SLI which indicates the necessity of early developmental support or training. Token Test performance is possibly an indicator for a more general developmental factor rather than an exclusive indicator for language difficulties.

The profession of neuropsychology in Spain: results of a national survey

OBJECTIVE

To examine the current status of professional neuropsychology in Spain, with particular focus on the areas of professional training, current work situation, evaluation and diagnostic practice, rehabilitation, teaching, and research.

METHODS

Three hundred and thirty-nine self-identified professionals in neuropsychology from Spain completed an online survey between July and December of 2013. Respondents had an average age of 35.8 years and 77% were women.

RESULTS

Ninety-seven percent of the respondents identified as psychologists; 82% of the sample had a master's degree, and 33% a doctoral degree. The majority (91%) received their neuropsychological training at a graduate level; 88% engaged in neuropsychological evaluation, 59% in rehabilitation, 50% in research, and 40% in teaching. Average number of hours per week dedicated to work in neuropsychology was 29.7, with 28% of the respondents reporting working in hospitals, 17% in not-for-profit rehabilitation centers, 15% in universities, and 14% in private clinics. Clinicians primarily work with individuals with stroke, traumatic brain injury, and dementia. The top perceived barriers to development of neuropsychology in Spain included lack of clinical and academic training opportunities, and negative attitude toward professional collaboration.

CONCLUSIONS

The field of neuropsychology in Spain is young and rapidly growing. There is a need to regulate professional neuropsychology, improve graduate curricula, enhance existing clinical training, develop professional certification programs, validate and create normative data for existing neuropsychological tests, and create new, culturally relevant instruments.

Addenbrooke's Cognitive Examination-Revised: Effects of Education and Age. Normative Data for the Spanish Speaking Population

OBJECTIVE

Addenbrooke's Cognitive Examination-Revised is a brief test battery for the detection and classification of mild cognitive impairment and dementia. The aims were to investigate the influence of age and education on the Spanish version of the ACE-R and to propose normative data for the Spanish speaking population.

METHOD

Three hundred thirty-four normal healthy volunteers were included in the study. They were classified in three age groups (48-64, 65-75, and 75-89 years of age) and four educational level groups (≤3; 4-8; 9-12, and ≥13 years of education). They were assessed with the version of ACE-R validated in Argentina with some modifications in order to adapt it to the Spanish population.

RESULTS

Significant differences were obtained between all age groups in Total ACE-R, Memory, Fluency, and Language indexes. Differences were observed among the 48-64 and 76-89 age groups in the Attention-Orientation and Visuospatial indexes. Regarding education, significant difference between ≤3 years of education and the remaining groups were obtained in Total ACE-R and in all the indexes. Additionally, the group of 4-8 years of education performed significantly worse than the 9-12 and ≥13 groups in Total, Memory, Fluency, and Language indexes. Adjusted scores by education were obtained and percentiles for each age group were calculated.

CONCLUSIONS

The results show that both age and education have an important effect on ACE-R performance. Consequently, age and education should be taken into account when interpreting results in ACE-R to improve diagnostic accuracy.

A Maltese adaptation of the Boston Naming Test: A shortened version

The Boston Naming Test (BNT) is the most widely used naming test worldwide in research and clinical settings. This study aimed to develop a method for adapting the BNT to suit different linguistic and cultural characteristics using the example of Maltese in a bilingual context. In addition, it investigated the effects in Malta of age and level of education on naming performance. The words of the BNT were first translated into Maltese. The test was then piloted to establish target and alternative responses. Naming performance data were later collected from individuals of different ages and levels of education. Only 38 BNT items had at least 70% name agreement. Main effects of age and education were found. A Maltese adaptation was proposed using 38 items and lenient scoring. Similar procedures may be used in other bilingual populations. The study suggests that normative data should be stratified according to age and education.

Cortical plasticity catalyzed by prehabilitation enables extensive resection of brain tumors in eloquent areas

OBJECTIVE The extent of resection is the most important prognostic factor following brain glioma surgery. However, eloquent areas within tumors limit the extent of resection and, thus, critically affect outcomes. The authors hypothesized that presurgical suppression of the eloquent areas within a tumor by continuous cortical electrical stimulation, coupled with appropriate behavioral training ("prehabilitation"), would induce plastic reorganization and enable a more extensive resection. METHODS The authors report on 5 patients harboring gliomas involving eloquent brain areas within tumors as identified on intraoperative stimulation mapping. A grid of electrodes was placed over the residual tumor, and continuous cortical electrical stimulation was targeted to the functional areas. The stimulation intensity was adjusted daily to provoke a mild functional impairment while the function was intensively trained. RESULTS The stimulation intensity required to impair function increased progressively in all patients, and all underwent another operation a mean of 33.6 days later (range 27-37 days), when the maximal stimulation voltage in all active contacts induced no functional deficit. In all cases, a substantially more extensive resection of the tumor was possible. Intraoperative mapping and functional MRI demonstrated a plastic reorganization, and most previously demonstrated eloquent areas within the tumor were silent, while there was new functional activation of brain areas in the same region or toward the contralateral hemisphere. CONCLUSIONS Prehabilitation with continuous cortical electrical stimulation and appropriate behavioral training prior to surgery in patients with WHO Grade II and III gliomas affecting eloquent areas accelerate plastic changes. This can help maximize tumor resection and, thus, improve survival while maintaining function.

Healthy Aging and Compensation of Sentence Comprehension Auditory Deficits

Objectives. To analyze the effect of aging on sentence auditory comprehension and to study the relationship between this language skill and cognitive functions (attention, working memory, and executive functions). Methods. A total of 90 healthy subjects were divided into three groups: adults (50–59 years), young-old (60–69 years), and old-old (70–80 years). Subjects were assessed using the Revised Token Test. The measures used for performance analysis were number of correct answers (accuracy) and execution time of commands on the different subtests. Results. Regarding accuracy, groups showed similar performance on the first blocks, but the young-old and old-old performed worse than adults on blocks 9 and 10. With respect to execution time, groups differed from block 2 (i.e., the groups differed for all blocks, except for block 1), with the worst performance observed in the old-old group, followed by that of the young-old group. Therefore, the elderly required more time to attain performance similar to that of adults, showing that time measurements are more sensitive for detecting the effects of age. Sentence comprehension ability is correlated with cognitive test performance, especially for global cognition and working memory tests. Conclusions. Healthy aging is characterized by the ability to compensate for difficulties in linguistic processing, which allows the elderly to maintain functional communication.

Test Your Memory is sensitive to cognitive change but lacks prospective validity

OBJECTIVE

To determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state.

METHODS

This longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2 ± 15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score ≤ 1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale.

RESULTS

Sixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, -0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, -0.19 to -0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms.

CONCLUSIONS

While the TYM lacks prospective validity, it is sensitive to changes in cognitive state.

[Standardization of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination]

OBJECTIVE

To explore the relationship between scores on the Test Your Memory (TYM) battery and findings from a more exhaustive neurocognitive assessment.

METHODS

The TYM and fourteen psychometric tests were administered to 84 subjects aged 50 or older who attended an outpatient neurology clinic due to cognitive symptoms. Each patient's cognitive state was determined independently from his/her score on the TYM (CDR 0, n=25; CDR 0.5, n=45; CDR 1, n=14). We analysed concurrent validity of TYM scores and results from the psychometric tests, as well as the degree of concordance between the two types of measurement, by contrasting normalised data from each instrument.

RESULTS

Although the intraclass correlation coefficient was 0.67 (confidence interval 95%, 0.53-0.77), analysis of the Bland-Altman plot and the curve on the survival-agreement plot (Luiz et al. method) demonstrates that the individual distances between the two methods exhibit excessive dispersion from a clinical viewpoint. TYM-based predictions of the mean z-score on psychometric tests differed substantially from real results in 30% of the subjects. Concordance of 95% can only be achieved by accepting absolute inter-instrument differences of up to 0.87 as identical values. Furthermore, the TYM underestimates cognitive performance for low values and overestimates it for high values.

CONCLUSIONS

The TYM is a cognitive screening test which should not be used to predict results on psychometric tests or to detect cognitive changes in clinical trials.

Culture qualitatively but not quantitatively influences performance in the Boston naming test in a chinese-speaking population

Background/Aims

The Boston Naming Test (BNT) is the most frequently administered confrontational naming test, but the cultural background of the patients may influence their performance in the BNT. The aim of this study was to identify differences in performance in the BNT between a Chinese population in Taiwan, Chinese populations in other areas and a Caucasian population.

Methods

A total of 264 native, Chinese-speaking, cognitively normal elders aged >60 years were enrolled in our study and conducted the 30-item Chinese version of the BNT. Another 10 BNT studies were categorized, analyzed and compared with the present study.

Results

Higher education was associated with higher scores, whereas age and gender had no effect on performance in the BNT. The score of the Chinese-speaking population was equivalent to the English-speaking population. A disparity in difficulties with items was not only apparent between the Taiwanese and Caucasian populations, but also between the Chinese-speaking populations in the different geographic areas.

Conclusion

For the most part, the impact of culture on performance in the BNT may not be quantitative but qualitative. Attention should be paid to a potential effect of culture on difficulties with items when administering the BNT to non-English-speaking populations. Understanding differences in performance in the BNT in distinct cultural settings improves the clinical application of the BNT.

Cut-off scores of a brief neuropsychological battery (NBACE) for Spanish individual adults older than 44 years old

The neuropsychological battery used in Fundació ACE (NBACE) is a relatively brief, and easy to administer, test battery that was designed to detect cognitive impairment in the adulthood. The NBACE includes measures of cognitive information processing speed, orientation, attention, verbal learning and memory, language, visuoperception, praxis and executive functions. The aim of the present study was to establish the cut-off scores for impairment for different levels of age and education that could be useful in the cognitive assessment of Spanish subjects who are at risk for cognitive impairment, especially dementia. Data from 1018 patients with a mild dementia syndrome, and 512 cognitively healthy subjects, older than 44 years, from the Memory Clinic of Fundació ACE (Barcelona, Spain) were analyzed. In the whole sample, cut-off scores and sensitivity/specificity values were calculated for six conditions after combining 3 age ranges (44 to 64; 65 to 74; and older than 74 years old) by 2 educational levels (until Elementary school; and more than Elementary school). Moreover, general cut-offs are reported for Catalan and Spanish speakers. The results showed that most of NBACE tests reached good sensitivity and specificity values, except for Ideomotor praxis, Repetition and Verbal Comprehension tests, which had a ceiling effect. Word List Learning from the Wechsler Memory Scale-III and Semantic Verbal Fluency were the most useful tests to discriminate between cognitively healthy and demented subjects. The NBACE has been shown to be a useful tool able to detect cognitive impairment, especially dementia, in older than 44 years Spanish persons.

Virgin olive oil supplementation and long-term cognition: the PREDIMED-NAVARRA randomized, trial

OBJECTIVE

To assess the effect on cognition of a controlled intervention testing Mediterranean diets (MedDiet).

DESIGN

Randomized trial after 6.5 years of nutritional intervention.

SETTING

Eight primary care centers affiliated to the University of Navarra.

PARTICIPANTS

A random subsample of 285 participants (95 randomly allocated to each of 3 groups) of the PREDIMED-NAVARRA trial. All of them were at high vascular risk (44.8% men, 74.1±5.7 years at cognitive evaluation).

INTERVENTIONS

Nutritional intervention comparing two MedDiets (supplemented with extra-virgin olive oil [EVOO] or mixed nuts) versus a low-fat control diet. Participants received intensive education to increase adherence to the intended intervention. Participants allocated to the MedDiet groups received EVOO (1 l/week) or 30 g/day of mixed nuts. Dietary habits were evaluated using a validated 137-item food frequency questionnaire (FFQ). Additionally, adherence to MedDiet was appraised using a 14-item questionnaire both at baseline and yearly thereafter.

MEASUREMENTS

Cognitive performance as a main outcome and cognitive status (normal, mild cognitive impairment [MCI] or dementia) as a secondary outcome were evaluated by two neurologists blinded to group assignment after 6.5 years of nutritional intervention.

RESULTS

Better post-trial cognitive performance versus control in all cognitive domains and significantly better performance across fluency and memory tasks were observed for participants allocated to the MedDiet+EVOO group. After adjustment for sex, age, education, apolipoprotein E genotype, family history of cognitive impairment/dementia, smoking, physical activity, body mass index, hypertension, dyslipidaemia, diabetes, alcohol and total energy intake, this group also showed lower MCI (OR=0.34 95% CI: 0.12-0.97) compared with control group. Participants assigned to MedDiet+Nuts group did not differ from controls.

CONCLUSION

A long-term intervention with an EVOO-rich MedDiet resulted in a better cognitive function in comparison with a control diet. However, non-significant differences were found for most cognitive domains. Participants allocated to an EVOO-rich MedDiet had less MCI than controls.