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Benito-León J, Lapeña J, García-Vasco L, Cuevas C, Viloria-Porto J, Calvo-Córdoba A, Arrieta-Ortubay E, Ruiz-Ruigómez M, Sánchez-Sánchez C, García-Cena C. Exploring Cognitive Dysfunction in Long COVID Patients: Eye Movement Abnormalities and Frontal-Subcortical Circuits Implications via Eye-Tracking and Machine Learning. Am J Med 2024:S0002-9343(24)00217-1. [PMID: 38583751 DOI: 10.1016/j.amjmed.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/01/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Cognitive dysfunction is regarded as one of the most severe aftereffects following coronavirus disease 2019 (COVID-19). Eye movements, controlled by various brain regions, including the dorsolateral prefrontal cortex and frontal-thalamic circuits, offer a potential metric for evaluating cognitive dysfunction. We aimed to examine the utility of eye movement measurements in identifying cognitive impairments in long COVID patients. METHODS We recruited 40 long COVID patients experiencing subjective cognitive complaints and 40 healthy controls and used a certified eye-tracking medical device to record saccades and antisaccades. Machine learning was applied to enhance the analysis of eye movement data. RESULTS Patients did not differ from the healthy controls regarding age, sex, and years of education. However, the patients' Montreal Cognitive Assessment total score was significantly lower than healthy controls. Most eye movement parameters were significantly worse in patients: the latencies, gain, and velocity of visually and memory-guided saccades, the number of correct memory saccades, the latencies and duration of reflexive saccades, and the number of errors in the antisaccade test. Machine learning permitted distinguishing between long COVID patients experiencing subjective cognitive complaints and healthy controls. CONCLUSION Our findings suggest impairments in frontal subcortical circuits in long COVID patients experiencing subjective cognitive complaints. Eye-tracking, combined with machine learning, offers a novel, efficient way to assess and monitor long COVID patients' cognitive dysfunctions, suggesting its utility in clinical settings for early detection and personalized treatment strategies. Further research is needed to determine the long-term implications of these findings and the reversibility of cognitive dysfunctions.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.
| | - José Lapeña
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Constanza Cuevas
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain
| | - Julie Viloria-Porto
- Magdalena University, Santa Marta, Colombia; ETSIDI-Center for Automation and Robotics UPM-CSIC, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alberto Calvo-Córdoba
- ETSIDI-Center for Automation and Robotics UPM-CSIC, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - María Ruiz-Ruigómez
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Cecilia García-Cena
- ETSIDI-Center for Automation and Robotics UPM-CSIC, Universidad Politécnica de Madrid, Madrid, Spain
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2
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Zhang S, Huang X, An R, Xiao W, Wan Q. The application of saccades to assess cognitive impairment among older adults: a systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:2307-2321. [PMID: 37676429 DOI: 10.1007/s40520-023-02546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Saccade is a novel and feasible method for cognition assessment and has potential to screen older people with cognitive impairment. OBJECTIVES To systematically summarize the evidence and determine whether different saccade parameters can effectively identify patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHODS English and Chinese databases were searched until 19 April 2022. Studies analyzing saccade parameters in older adults with normal cognition, MCI, or AD were included. Two researchers independently performed the screening, data extraction, and quality appraisal. Meta-analyses were conducted and standard mean differences and 95% confidence intervals were estimated with a random effects model. RESULTS Thirty-five studies were included, and 26 studies were pooled for the meta-analysis. The results demonstrated that patients with cognitive impairment exhibited longer latency and lower accuracy rates in the prosaccade and antisaccade tasks, along with lower corrected error rates in the antisaccade tasks. However, the pooled results for antisaccades were more stable, providing the ability to distinguish patients with cognitive impairment among older adults. The results of the subgroup analyses revealed that only the accuracy rates of the antisaccades differed significantly between people with MCI and AD. Regarding the differences between older adults with normal cognition and those with MCI, the effect sizes of latency and the accuracy rates of saccades as well as the corrected error rates of antisaccades were significant. CONCLUSIONS Saccades, especially antisaccades, are a potential screening and assessment tool for distinguishing older adults with MCI or AD from those with normal cognition.
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Affiliation(s)
| | - Xiuxiu Huang
- Peking University School of Nursing, Beijing, China
| | - Ran An
- Peking University School of Nursing, Beijing, China
| | - Weizhong Xiao
- Department of Neurology, Peking University Third Hospital, Beijing, China.
| | - Qiaoqin Wan
- Peking University School of Nursing, Beijing, China.
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Zemla K, Sedek G, Wróbel K, Postepski F, Wojcik GM. Investigating the Impact of Guided Imagery on Stress, Brain Functions, and Attention: A Randomized Trial. SENSORS (BASEL, SWITZERLAND) 2023; 23:6210. [PMID: 37448060 PMCID: PMC10346678 DOI: 10.3390/s23136210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to investigate the potential impact of guided imagery (GI) on attentional control and cognitive performance and to explore the relationship between guided imagery, stress reduction, alpha brainwave activity, and attentional control using common cognitive performance tests. Executive function was assessed through the use of attentional control tests, including the anti-saccade, Stroop, and Go/No-go tasks. Participants underwent a guided imagery session while their brainwave activity was measured, followed by attentional control tests. The study's outcomes provide fresh insights into the influence of guided imagery on brain wave activity, particularly in terms of attentional control. The findings suggest that guided imagery has the potential to enhance attentional control by augmenting the alpha power and reducing stress levels. Given the limited existing research on the specific impact of guided imagery on attention control, the study's findings carry notable significance.
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Affiliation(s)
- Katarzyna Zemla
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (K.Z.)
| | - Grzegorz Sedek
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (K.Z.)
| | - Krzysztof Wróbel
- Department of Neuroinformatics and Biomedical Engineering, Institute of Computer Science, Maria Curie-Sklodowska University, 20-033 Lublin, Poland (F.P.)
| | - Filip Postepski
- Department of Neuroinformatics and Biomedical Engineering, Institute of Computer Science, Maria Curie-Sklodowska University, 20-033 Lublin, Poland (F.P.)
| | - Grzegorz M. Wojcik
- Department of Neuroinformatics and Biomedical Engineering, Institute of Computer Science, Maria Curie-Sklodowska University, 20-033 Lublin, Poland (F.P.)
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4
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Boujelbane MA, Trabelsi K, Boukhris O, Kacem FH, Ammar A, Charfi I, Turki M, Charfeddine S, Bouaziz B, Hakim A, Frikha H, Chabchoub MA, Chtourou H, Glenn JM, Myers JR. The Use of Digital Technology to Assess Cognitive Function in Tunisian Adults. J Alzheimers Dis 2022; 88:1545-1552. [DOI: 10.3233/jad-220398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: There has been increasing evidence and support for the use of digital technology in the cognitive health field. Despite the growing use of innovative digital technology to assess cognitive function, such technology remains scarce in Arabic countries, particularly in Tunisia. Objective: To investigate the effectiveness of a digitally delivered cognitive assessment battery in differentiating varying degrees of cognitive function in older Tunisian adults. Methods: One hundred fifty-five Tunisian older adults (age: 62.24±7.52 years) were assigned to one of four groups: healthy controls (HC), at-risk (AR), mild cognitive impairment (MCI), and Alzheimer’s disease (AD). Participants completed a translated version of the Neurotrack digital cognitive battery. Results: The AD group performed significantly lower on the associative learning (p = 0.01) and associative memory assessments (p = 0.002), than the HC and AR groups. The AD group also performed worse on the inhibition measure (p = 0.008) than the HC, AR, and MCI groups. For recognition memory, the was a significant difference between all four groups (p < 0.0005), with AD having the lowest scores followed by the MCI, AR, and HC groups, respectively. There were no significant differences observed on attention, executive function and processing speed performance between the four groups (p > 0.05). Conclusion: The use of digital technology appears to be a viable solution to current cognitive assessment challenges for assessing cognitive function in a Tunisian population. These findings provide further support for the use of digital technology in cognitive assessment, particularly in understudied populations.
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Affiliation(s)
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Omar Boukhris
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
| | - Faten Hadj Kacem
- Department of Endocrinology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Achraf Ammar
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UPL, UFR STAPS (Faculty of Sport Sciences), Paris Nanterre University, Nanterre, France
| | - Ichrak Charfi
- Diagnostic and Therapeutic Unit for Alzheimer’s Disease and Related Dementias “La Trêve”, Errachid Polyclinic, Sfax, Tunisia
| | - Mouna Turki
- Department of Biochemistry, Faculty of Medicine, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Bassem Bouaziz
- Higher Institute of Computer Science and Multimedia of Sfax, University of Sfax, Sfax, Tunisia
| | - Ahmed Hakim
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Hamdi Frikha
- Department of Endocrinology, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Hamdi Chtourou
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
| | - Jordan M. Glenn
- Neurotrack Technologies, Redwood City, CA, USA
- Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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Chehrehnegar N, Shati M, Esmaeili M, Foroughan M. Executive function deficits in mild cognitive impairment: evidence from saccade tasks. Aging Ment Health 2022; 26:1001-1009. [PMID: 33928806 DOI: 10.1080/13607863.2021.1913471] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Early detection of mild cognitive impairment (MCI) is necessary to prevent irreversible brain damage caused by incipient Alzheimer's disease. It has been showing that amnestic MCI (a-MCI) subjects exhibit subtle deficits in executive function that can be tested using saccade eye movements. Eye-tracking technology is a sensitive method to measure cognitive impairments in dementia and MCI. METHODS In this study, we used eye-tracking technology to explore saccade impairments to distinguish between a-MCI and the variants of reference controls. 21 patients with AD, 40 patients with a-MCI, and 59 normal participants were recruited in current study. We measured saccade reaction time, saccade errors, saccade omission, and uncorrected saccades using anti-saccade and pro-saccade tasks with 'gap' and 'overlap' procedures. These parameters were used as markers of executive function and visual attention deficits.Results: The findings revealed that more errors, more omissions, and fewer corrections characterized the saccade behavior of the a-MCI group compared to the reference group. These eye-tracking characteristics can be considered as inhibitory control and working memory deficits in a-MCI subjects. Our results thus demonstrate the applicability of the anti-saccade task as a cognitive marker in a-MCI. CONCLUSION The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of executive function in aging with cognitive impairments.
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Affiliation(s)
- Negin Chehrehnegar
- Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Mohsen Shati
- Mental Health Research Center, School of Behavioural Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahdieh Esmaeili
- Iranian Research Center on Aging, Gerontology and Geriatric Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, Gerontology and Geriatric Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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McLennan YA, Mosconi MW, McKenzie FJ, Famula J, Krawchuk B, Kim K, Clark CJ, Hessl D, Rivera SM, Simon TJ, Tassone F, Hagerman RJ. Prosaccade and Antisaccade Behavior in Fragile X-Associated Tremor/Ataxia Syndrome Progression. Mov Disord Clin Pract 2022; 9:473-478. [PMID: 35586536 PMCID: PMC9092736 DOI: 10.1002/mdc3.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
Background Quantitative measurement of eye movements can reveal subtle progression in neurodegenerative diseases. Objective To determine if quantitative measurements of eye movements may reveal subtle progression of fragile X-associated tremor and ataxia (FXTAS). Methods Prosaccade (PS) and antisaccade (AS) behavior was analyzed in 25 controls, 57 non-FXTAS carriers, and 46 carriers with FXTAS. Results Symptomatic individuals with FXTAS had longer AS latencies, increased rates of AS errors, and increased AS dysmetria relative to non-FXTAS carriers and controls. These deficits, along with PS latency and velocity, were greater in advanced FXTAS stages. Conclusion AS deficits differentiated FXTAS from non-FXTAS premutation carriers implicating top-down control and frontostriatal deterioration. However, the absence of group differences between non-FXTAS carriers and controls in AS and PS markers suggests saccade performance may not be a sensitive enough measure for detecting conversion to FXTAS, but instead more helpful as translational biomarkers of FXTAS progression.
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Affiliation(s)
- Yingratana A. McLennan
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PediatricsUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Matthew W. Mosconi
- Life Span Institute, Kansas Center for Autism Research and Training, and Clinical Child Psychology ProgramUniversity of KansasLawrenceKansasUSA
| | | | - Jessica Famula
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Bennet Krawchuk
- University of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Kyoungmi Kim
- Department of PsychologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Courtney J. Clark
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PediatricsUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - David Hessl
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- University of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Susan M. Rivera
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PsychologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Tony J. Simon
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- University of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Flora Tassone
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of Biochemistry and Molecular MedicineUniversity of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Randi J. Hagerman
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PediatricsUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
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7
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Corbo I, Casagrande M. Higher-Level Executive Functions in Healthy Elderly and Mild Cognitive Impairment: A Systematic Review. J Clin Med 2022; 11:jcm11051204. [PMID: 35268294 PMCID: PMC8911402 DOI: 10.3390/jcm11051204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Mild Cognitive Impairment (MCI) is a clinical syndrome characterized by a moderate decline in one or more cognitive functions with a preserved autonomy in daily life activities. MCI exhibits cognitive, behavioral, psychological symptoms. The executive functions (EFs) are key functions for everyday life and physical and mental health and allow for the behavior to adapt to external changes. Higher-level executive functions develop from basic EFs (inhibition, working memory, attentional control, and cognitive flexibility). They are planning, reasoning, problem solving, and fluid intelligence (Gf). This systematic review investigates the relationship between higher-level executive functions and healthy and pathological aging, assuming the role of executive functions deficits as a predictor of cognitive decline. The systematic review was conducted according to the PRISMA Statement. A total of 73 studies were identified. The results indicate that 65.8% of the studies confirm significant EFs alterations in MCI (56.8% planning, 50% reasoning, 100% problem solving, 71.4% fluid intelligence). These results seem to highlight a strong prevalence of higher-level executive functions deficits in MCI elderly than in healthy elderly.
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Affiliation(s)
- Ilaria Corbo
- Dipartimento di Psicologia, Università di Roma Sapienza, 00185 Roma, Italy;
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma Sapienza, 00185 Roma, Italy
- Correspondence:
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Waldthaler J, Stock L, Student J, Sommerkorn J, Dowiasch S, Timmermann L. Antisaccades in Parkinson's Disease: A Meta-Analysis. Neuropsychol Rev 2021; 31:628-642. [PMID: 33742354 PMCID: PMC8592977 DOI: 10.1007/s11065-021-09489-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
The usefulness of eye-tracking tasks as potential biomarkers for motor or cognitive disease burden in Parkinson's disease (PD) has been subject of debate for many years. Several studies suggest that the performance in the antisaccade task may be altered in patients with PD and associated with motor disease severity or executive dysfunction. In this meta-analysis, random effects models were used to synthesize the existing evidence on antisaccade error rates and latency in PD. Furthermore, meta-regressions were performed to assess the role of motor and cognitive disease severity, dopaminergic medication and methodological factors. Additionally, the impact of acute levodopa administration and activation of deep brain stimulation was evaluated in two separate sub-analyses.This meta-analysis confirms that antisaccade latency and error rate are significantly increased in PD. Disease duration, Unified Parkinson's disease rating scale score and Hoehn and Yahr stage mediate the effect of PD on antisaccade latency with higher motor burden being associated with increased antisaccade latency.Acute administration of levodopa had no significant effects on antisaccade performance in a small number of eligible studies. Deep brain stimulation in the subthalamic nucleus, on the other hand, may alter the speed accuracy trade-off supporting an increase of impulsivity following deep brain stimulation in PD.According to the results of the meta-analysis, antisaccade latency may provide a potential marker for disease severity and progression in PD which needs further confirmation in longitudinal studies.
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Affiliation(s)
- Josefine Waldthaler
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany.
- CMBB - Center for Mind, Brain and Behavior, Universities Gießen and Marburg, Marburg, Germany.
| | - Lena Stock
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
| | - Justus Student
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
| | - Johanna Sommerkorn
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
| | - Stefan Dowiasch
- CMBB - Center for Mind, Brain and Behavior, Universities Gießen and Marburg, Marburg, Germany
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Thomas RECORDING GmbH, Giessen, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
- CMBB - Center for Mind, Brain and Behavior, Universities Gießen and Marburg, Marburg, Germany
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9
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Guerrero-Molina MP, Rodriguez-López C, Panadés-de Oliveira L, Uriarte-Pérez de Urabayen D, Garzo-Caldas N, García-Cena CE, Saiz-Díaz RA, Benito-León J, Gonzalez de la Aleja J. Antisaccades and memory-guided saccades in genetic generalized epilepsy and temporal lobe epilepsy. Epilepsy Behav 2021; 123:108236. [PMID: 34419714 DOI: 10.1016/j.yebeh.2021.108236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Oculomotor tasks can be used to measure volitional control of behavior sensitive to frontal dysfunction. This study aimed to examine the saccadic eye movement in Genetic Generalized Epilepsy (GGE) which could correlate with the abnormality of the frontal lobe or the thalamo-frontal network. METHODS Twenty-one patients with GGE were compared with 22 patients with Temporal Lobe Epilepsy (TLE) and 39 healthy controls. Visual-guided saccades, Antisaccades, and Memory-guided saccades as oculomotor tasks were performed using a novel gaze-tracker designed for clinical practice use. RESULTS Patients with epilepsy (either GEE or TLE) had similar latency, accuracy, and velocity in visual-guided saccades and memory-guided saccades. Patients with epilepsy had similar latencies and correct antisaccade number. However, healthy volunteers, matched by age, had faster responses and more accurate results than patients with epilepsy. CONCLUSIONS Our investigations did not reveal differences between TLE and GGE patients' groups in visually guided saccades, antisaccades, and memory-guided saccades, thus suggesting that the frontal cortical mechanisms responsible for them are not explicitly impaired in patients with GGE.
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Affiliation(s)
| | | | | | | | | | - Cecilia E García-Cena
- Centre for Automation and Robotics, Universidad Politécnica de Madrid, 28012 Madrid, Spain.
| | - Rosa A Saiz-Díaz
- 12th of October University Hospital, Avenida Córdoba S/N, 28041 Madrid, Spain
| | - Julián Benito-León
- 12th of October University Hospital, Avenida Córdoba S/N, 28041 Madrid, Spain
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10
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Opwonya J, Doan DNT, Kim SG, Kim JI, Ku B, Kim S, Park S, Kim JU. Saccadic Eye Movement in Mild Cognitive Impairment and Alzheimer's Disease: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 32:193-227. [PMID: 33959887 PMCID: PMC9090874 DOI: 10.1007/s11065-021-09495-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
Alzheimer’s disease (AD) is the leading cause of dementia, and mild cognitive impairment (MCI) is considered the transitional state to AD dementia (ADD) and other types of dementia, whose symptoms are accompanied by altered eye movement. In this work, we reviewed the existing literature and conducted a meta-analysis to extract relevant eye movement parameters that are significantly altered owing to ADD and MCI. We conducted a systematic review of 35 eligible original publications in saccade paradigms and a meta-analysis of 27 articles with specified task conditions, which used mainly gap and overlap conditions in both prosaccade and antisaccade paradigms. The meta-analysis revealed that prosaccade and antisaccade latencies and frequency of antisaccade errors showed significant alterations for both MCI and ADD. First, both prosaccade and antisaccade paradigms differentiated patients with ADD and MCI from controls, however, antisaccade paradigms was more effective than prosaccade paradigms in distinguishing patients from controls. Second, during prosaccade in the gap and overlap conditions, patients with ADD had significantly longer latencies than patients with MCI, and the trend was similar during antisaccade in the gap condition as patients with ADD had significantly more errors than patients with MCI. The anti-effect magnitude was similar between controls and patients, and the magnitude of the latency of the gap effect varied among healthy controls and MCI and ADD subjects, but the effect size of the latency remained large in both patients. These findings suggest that, using gap effect, anti-effect, and specific choices of saccade paradigms and conditions, distinctions could be made between MCI and ADD patients as well as between patients and controls.
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Affiliation(s)
- Julius Opwonya
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science and Technology, Daejeon, Republic of Korea
| | - Dieu Ni Thi Doan
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science and Technology, Daejeon, Republic of Korea
| | - Seul Gee Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Joong Il Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Boncho Ku
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Soochan Kim
- Department of Electrical and Electronic Engineering, Hankyong National University, Anseong, Republic of Korea
| | - Sunju Park
- Department of Preventive Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.
| | - Jaeuk U Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
- Korean Convergence Medicine, University of Science and Technology, Daejeon, Republic of Korea.
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11
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Dementia. Neurology 2021. [DOI: 10.1007/978-3-030-55598-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Laurens B, Planche V, Cubizolle S, Declerck L, Dupouy S, Formaglio M, Koric L, Seassau M, Tilikete C, Vighetto A, Ceccaldi M, Tison F. A Spatial Decision Eye-Tracking Task in Patients with Prodromal and Mild Alzheimer’s Disease. J Alzheimers Dis 2019; 71:613-621. [DOI: 10.3233/jad-190549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Brice Laurens
- Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CHU de Bordeaux, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, Bordeaux, France
| | - Vincent Planche
- Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CHU de Bordeaux, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, Bordeaux, France
| | - Stéphanie Cubizolle
- Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Léa Declerck
- Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Sandrine Dupouy
- Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CHU de Bordeaux, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, Bordeaux, France
| | - Maïté Formaglio
- Département de Neurologie cognitive et de Neuro-ophtalmologie, Université Lyon 1 et Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Lejla Koric
- Département de Neurologie et de Neuropsychologie, Aix Marseille Université, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | | | - Caroline Tilikete
- Département de Neurologie cognitive et de Neuro-ophtalmologie, Université Lyon 1 et Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Alain Vighetto
- Département de Neurologie cognitive et de Neuro-ophtalmologie, Université Lyon 1 et Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Mathieu Ceccaldi
- Département de Neurologie et de Neuropsychologie, Aix Marseille Université, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Françcois Tison
- Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CHU de Bordeaux, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, Bordeaux, France
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Bueno APA, Sato JR, Hornberger M. Eye tracking - The overlooked method to measure cognition in neurodegeneration? Neuropsychologia 2019; 133:107191. [PMID: 31521634 DOI: 10.1016/j.neuropsychologia.2019.107191] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/11/2022]
Abstract
Eye tracking (ET) studies are becoming increasingly popular due to rapid methodological and technological advances as well as the development of cost efficient and portable eye trackers. Although historically ET has been mostly employed in psychophysics or developmental cognition studies, there is also promising scope to use ET for movement disorders and measuring cognitive processes in neurodegeneration. Particularly, ET can be a powerful tool for cognitive and neuropsychological assessments of patients with pathologies affecting motor and verbal abilities, as tasks can be adapted without requiring motor (except eye movements) or verbal responses. In this review, we will examine the existing evidence of ET methods in neurodegenerative conditions and its potential clinical impact for cognitive assessment. We highlight that current evidence for ET is mostly focused on diagnostics of cognitive impairments in neurodegenerative disorders, where it is debatable whether it has any more sensitivity or specificity than existing cognitive assessments. By contrast, there is currently a lack of ET studies in more advanced disease stages, when patients' motor and verbal functions can be significantly affected, and standard cognitive assessments are challenging or often not possible. We conclude that ET is a promising method not only for cognitive diagnostics but more importantly, for potential cognitive disease tracking in progressive neurodegenerative conditions.
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Affiliation(s)
- A P A Bueno
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil; - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - J R Sato
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - M Hornberger
- - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK; - Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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14
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Johnen A, Bertoux M. Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond. Front Neurol 2019; 10:594. [PMID: 31231305 PMCID: PMC6568027 DOI: 10.3389/fneur.2019.00594] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.
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Affiliation(s)
- Andreas Johnen
- Section for Neuropsychology, Department of Neurology, University Hospital Münster, Münster, Germany
| | - Maxime Bertoux
- Univ Lille, Inserm UMR 1171 Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
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15
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Abstract
This chapter reviews how recording and analysis of eye movements have been applied to understanding cognitive functioning in patients with neurological disease. Measures derived from the performance of instructed eye movement tests such as the anti-saccade and memory-guided saccade tasks have been shown to be associated with cognitive test performance and the early stages of neurodegenerative disorders including Alzheimer's and Parkinson's disease. Other researchers have taken an ecological approach and recorded the uninstructed pattern of saccades made by patients during performance of established neuropsychological tasks. Studies that have analysed the eye movement strategies used in a number of widely used tests are reviewed, including the Corsi blocks, Tower of London, 'CANTAB' Spatial Working Memory and Brixton Spatial Anticipation test. The findings illustrate that eye movements are not purely in the service of vision, but support visuospatial working memory and forward action planning. Eye movement tests and measures also have potential for application in the assessment and diagnosis of neurological disease and cognitive impairment. Establishing large-scale normative data sets in healthy older adults and use of machine learning multivariate classifier algorithms may be key to further developing eye tracking applications in neuropsychological assessment.
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16
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Playing Super Mario increases oculomotor inhibition and frontal eye field grey matter in older adults. Exp Brain Res 2018; 237:723-733. [DOI: 10.1007/s00221-018-5453-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/06/2018] [Indexed: 01/18/2023]
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Ouerfelli-Ethier J, Elsaeid B, Desgroseilliers J, Munoz DP, Blohm G, Khan AZ. Anti-saccades predict cognitive functions in older adults and patients with Parkinson's disease. PLoS One 2018; 13:e0207589. [PMID: 30485332 PMCID: PMC6261587 DOI: 10.1371/journal.pone.0207589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
A major component of cognitive control is the ability to act flexibly in the environment by either behaving automatically or inhibiting an automatic behaviour. The interleaved pro/anti-saccade task measures cognitive control because the task relies on one's abilities to switch flexibly between pro and anti-saccades, and inhibit automatic saccades during anti-saccade trials. Decline in cognitive control occurs during aging or neurological illnesses such as Parkinson's disease (PD), and indicates decline in other cognitive abilities, such as memory. However, little is known about the relationship between cognitive control and other cognitive processes. Here we investigated whether anti-saccade performance can predict decision-making, visual memory, and pop-out and serial visual search performance. We tested 34 younger adults, 22 older adults, and 20 PD patients on four tasks: an interleaved pro/anti-saccade, a spatial visual memory, a decision-making and two types of visual search (pop-out and serial) tasks. Anti-saccade performance was a good predictor of decision-making and visual memory abilities for both older adults and PD patients, while it predicted visual search performance to a larger extent in PD patients. Our results thus demonstrate the suitability of the interleaved pro/anti-saccade task as a cognitive marker of cognitive control in aging and PD populations.
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Affiliation(s)
| | - Basma Elsaeid
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Julie Desgroseilliers
- Department of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Douglas P. Munoz
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Gunnar Blohm
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
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Serra A, Chisari CG, Matta M. Eye Movement Abnormalities in Multiple Sclerosis: Pathogenesis, Modeling, and Treatment. Front Neurol 2018; 9:31. [PMID: 29467711 PMCID: PMC5807658 DOI: 10.3389/fneur.2018.00031] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/15/2018] [Indexed: 01/13/2023] Open
Abstract
Multiple sclerosis (MS) commonly causes eye movement abnormalities that may have a significant impact on patients’ disability. Inflammatory demyelinating lesions, especially occurring in the posterior fossa, result in a wide range of disorders, spanning from acquired pendular nystagmus (APN) to internuclear ophthalmoplegia (INO), among the most common. As the control of eye movements is well understood in terms of anatomical substrate and underlying physiological network, studying ocular motor abnormalities in MS provides a unique opportunity to gain insights into mechanisms of disease. Quantitative measurement and modeling of eye movement disorders, such as INO, may lead to a better understanding of common symptoms encountered in MS, such as Uhthoff’s phenomenon and fatigue. In turn, the pathophysiology of a range of eye movement abnormalities, such as APN, has been clarified based on correlation of experimental model with lesion localization by neuroimaging in MS. Eye movement disorders have the potential of being utilized as structural and functional biomarkers of early cognitive deficit, and possibly help in assessing disease status and progression, and to serve as platform and functional outcome to test novel therapeutic agents for MS. Knowledge of neuropharmacology applied to eye movement dysfunction has guided testing and use of a number of pharmacological agents to treat some eye movement disorders found in MS, such as APN and other forms of central nystagmus.
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Affiliation(s)
- Alessandro Serra
- Neurology, Louis Stokes VA Medical Center, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH, United States
| | | | - Manuela Matta
- Neurology, Ospedale San Luigi Gonzaga, Orbassano, Italy
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19
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Abstract
The World Alzheimer Report 2016 estimated that 47 million people are living with dementia worldwide (Alzheimer's Disease International, 2016). In the inaugural World Health Organization Ministerial Conference on Global Action against Dementia, six of the top ten research priorities were focused on prevention, identification, and reduction of dementia risk, and on delivery and quality of care for people with dementia and their carers (Shah et al., 2016). While the Lancet Neurology Commission has suggested that even minor advances to delay progression or ameliorate symptoms might have substantial financial and societal benefits (Winblad et al., 2016), advances have been slow.
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20
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Ismail Z, Mortby ME. Cognitive and Neuropsychiatric Screening Tests in Older Adults. MENTAL HEALTH AND ILLNESS WORLDWIDE 2017. [DOI: 10.1007/978-981-10-2414-6_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Jordan K, Fromberger P, von Herder J, Steinkrauss H, Nemetschek R, Witzel J, Müller JL. Impaired Attentional Control in Pedophiles in a Sexual Distractor Task. Front Psychiatry 2016; 7:193. [PMID: 27994559 PMCID: PMC5133255 DOI: 10.3389/fpsyt.2016.00193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 11/18/2016] [Indexed: 12/31/2022] Open
Abstract
Pedophilic disorder, a subtype of paraphilia, is defined as a recurrent sexual interest in prepubescent children, which is characterized by persistent thoughts, fantasies, urges, sexual arousal, or behavior. Besides a deviant sexual preference, sexual preoccupation was found to be a dynamic risk factor for reoffending. Thus, it is conceivable that sex offenders and especially sex offenders against children have difficulties to control their responses to sexual stimuli. In the current study pedophiles, forensic and non-forensic control subjects had to solve a cognitive task, while sexual distractors were presented simultaneously. This kind of task also requires control functions. Therefore, data were analyzed with respect to attentional control while comparing eye movements toward sexual distractors and toward the cognitive task. We were mainly interested in how early (fixation latency) and late (relative fixation time) attentional processes were allocated to both, the cognitive target stimuli and the sexual distractors. Pedophiles demonstrated significantly lower attentional control in the sexual distractor task than both control groups (non-pedophiles). They showed a shorter fixation latency and longer fixation time for sexual distractors than non-pedophiles. Furthermore, pedophiles demonstrated a longer fixation latency and shorter fixation time for cognitive target stimuli. For classification analyses, an attentional control index (ACI) was built, i.e., the difference between eye movements on cognitive target stimuli and sexual distractors. For the ACI of early attentional processes, i.e., fixation latency, a good classification between pedophiles and non-pedophiles was found. We assumed that the measured attentional control represents inhibitory executive functions, specifically interference control. Further studies should examine if low attentional control in pedophiles is due to low motivation to solve the task or rather to a lack of ability to control attention with respect to sexual and/or neutral distractors. Prospectively, this design could be useful to generate hypotheses about clinical important aspects of controllability, the capacity of self-control, and the severity of a paraphilic disorder.
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Affiliation(s)
- Kirsten Jordan
- Department for Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University of Göttingen, Göttingen, Germany
| | - Peter Fromberger
- Department for Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University of Göttingen, Göttingen, Germany
| | - Jakob von Herder
- Department for Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University of Göttingen, Göttingen, Germany
| | - Henrike Steinkrauss
- Department for Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University of Göttingen, Göttingen, Germany
| | - Rebekka Nemetschek
- Department for Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University of Göttingen, Göttingen, Germany
| | - Joachim Witzel
- Central State Forensic Psychiatric Hospital of Saxony-Anhalt, Uchtspringe, Germany
| | - Jürgen L. Müller
- Department for Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University of Göttingen, Göttingen, Germany
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22
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Knox PC, MacCormick IJC, Mbale E, Malewa M, Czanner G, Harding SP. Longitudinal Visuomotor Development in a Malaria Endemic Area: Cerebral Malaria and Beyond. PLoS One 2016; 11:e0164885. [PMID: 27764173 PMCID: PMC5072745 DOI: 10.1371/journal.pone.0164885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 01/17/2023] Open
Abstract
Paediatric cerebral malaria is the most serious complication of Plasmodium falciparum infection. While the majority recover, long-term cognitive impairment has been highlighted as a significant and neglected problem. Persistent or serious deficits in processes such as attention or behavioural inhibition should be manifest in changes to performance on oculomotor tasks. Therefore we investigated the impact of cerebral malaria on the development of reflexive pro-saccades and antisaccades. In a longitudinal study, 47 children previously admitted with retinopathy-confirmed cerebral malaria (mean age at admission 54 months), were compared with 37 local healthy controls (mean ages at first study visit 117 and 110 months respectively). In each of three or four test sessions, over a period of up to 32 months, participants completed 100 prosaccade tasks and 100 antisaccade tasks. Eye movements were recorded using infrared reflectance oculography; prosaccade, correct antisaccade and error prosaccade latency, and antisaccade directional error rate were calculated. Hierarchical linear modelling was used to investigate the effect of age and the influence of cerebral malaria on these parameters. Data were also collected from an independent, older group (mean age 183 months) of 37 local healthy participants in a separate cross-sectional study. Longitudinal data exhibited the expected decrease in latency with age for all saccade types, and a decrease in the antisaccade directional error rate. Hierarchical linear modelling confirmed that age had a statistically significant effect on all parameters (p< = 0.001). However, there were no statistically significant differences between the cerebral malaria and control groups. Combining groups, comparison with the literature demonstrated that antisaccade directional error rate for the Malawi sample was significantly higher than expected, while latencies for all saccade types were indistinguishable from published. The high directional error rate was also confirmed in the older, healthy Malawian participants from the cross sectional study. Our observation of similar oculomotor performance in cerebral malaria and control groups at long follow-up periods suggests that cerebral malaria survivors are not at a generally increased risk of persistent cognitive deficits. Our data raise questions about the prevailing hypothesis that cerebral malaria has gross impacts on the development of processes such as attention and behavioural inhibition. More importantly, our novel finding of a clear difference in antisaccade performance between all of the Malawi participants and published data suggests that the Malawian paediatric population as a whole faces serious challenges to cognitive development beyond cerebral malaria.
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Affiliation(s)
- Paul C. Knox
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
- * E-mail:
| | - Ian J. C. MacCormick
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Blantyre, Malawi
| | - Emme Mbale
- University of Malawi College of Medicine, College of Medicine, P/Bag 360 Chichiri, Blantyre, Malawi
| | - Macpherson Malewa
- University of Malawi College of Medicine, College of Medicine, P/Bag 360 Chichiri, Blantyre, Malawi
| | - Gabriela Czanner
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
- Department of Biostatistics, University of Liverpool, Waterhouse Building, Liverpool, L69 3GL, United Kingdom
| | - Simon P. Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
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Bettcher BM, Mungas D, Patel N, Elofson J, Dutt S, Wynn M, Watson CL, Stephens M, Walsh CM, Kramer JH. Neuroanatomical substrates of executive functions: Beyond prefrontal structures. Neuropsychologia 2016; 85:100-9. [PMID: 26948072 DOI: 10.1016/j.neuropsychologia.2016.03.001] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
Executive functions are often considered lynchpin "frontal lobe tasks", despite accumulating evidence that a broad network of anterior and posterior brain structures supports them. Using a latent variable modelling approach, we assessed whether prefrontal grey matter volumes independently predict executive function performance when statistically differentiated from global atrophy and individual non-frontal lobar volume contributions. We further examined whether fronto-parietal white matter microstructure underlies and independently contributes to executive functions. We developed a latent variable model to decompose lobar grey matter volumes into a global grey matter factor and specific lobar volumes (i.e. prefrontal, parietal, temporal, occipital) that were independent of global grey matter. We then added mean fractional anisotropy (FA) for the superior longitudinal fasciculus (dorsal portion), corpus callosum, and cingulum bundle (dorsal portion) to models that included grey matter volumes related to cognitive variables in previous analyses. Results suggested that the 2-factor model (shifting/inhibition, updating/working memory) plus an information processing speed factor best explained our executive function data in a sample of 202 community dwelling older adults, and was selected as the base measurement model for further analyses. Global grey matter was related to the executive function and speed variables in all four lobar models, but independent contributions of the frontal lobes were not significant. In contrast, when assessing the effect of white matter microstructure, cingulum FA made significant independent contributions to all three executive function and speed variables and corpus callosum FA was independently related to shifting/inhibition and speed. Findings from the current study indicate that while prefrontal grey matter volumes are significantly associated with cognitive neuroscience measures of shifting/inhibition and working memory in healthy older adults, they do not independently predict executive function when statistically isolated from global atrophy and individual non-frontal lobar volume contributions. In contrast, better microstructure of fronto-parietal white matter, namely the corpus callosum and cingulum, continued to predict executive functions after accounting for global grey matter atrophy. These findings contribute to a growing literature suggesting that prefrontal contributions to executive functions cannot be viewed in isolation from more distributed grey and white matter effects in a healthy older adult cohort.
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Affiliation(s)
- Brianne M Bettcher
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States; University of Colorado, Denver Anschutz School of Medicine, Departments of Neurosurgery and Neurology, Rocky Mountain Alzheimer's Disease Center, Aurora, CO, United States.
| | - Dan Mungas
- University of California, Department of Neurology, Davis, CA, United States
| | - Nihar Patel
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Jonathan Elofson
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Shubir Dutt
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Matthew Wynn
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Christa L Watson
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Melanie Stephens
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Christine M Walsh
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
| | - Joel H Kramer
- University of California, San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA, United States
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Abstract
PURPOSE OF REVIEW Executive functions represent a constellation of cognitive abilities that drive goal-oriented behavior and are critical to the ability to adapt to an ever-changing world. This article provides a clinically oriented approach to classifying, localizing, diagnosing, and treating disorders of executive function, which are pervasive in clinical practice. RECENT FINDINGS Executive functions can be split into four distinct components: working memory, inhibition, set shifting, and fluency. These components may be differentially affected in individual patients and act together to guide higher-order cognitive constructs such as planning and organization. Specific bedside and neuropsychological tests can be applied to evaluate components of executive function. While dysexecutive syndromes were first described in patients with frontal lesions, intact executive functioning relies on distributed neural networks that include not only the prefrontal cortex, but also the parietal cortex, basal ganglia, thalamus, and cerebellum. Executive dysfunction arises from injury to any of these regions, their white matter connections, or neurotransmitter systems. Dysexecutive symptoms therefore occur in most neurodegenerative diseases and in many other neurologic, psychiatric, and systemic illnesses. Management approaches are patient specific and should focus on treatment of the underlying cause in parallel with maximizing patient function and safety via occupational therapy and rehabilitation. SUMMARY Executive dysfunction is extremely common in patients with neurologic disorders. Diagnosis and treatment hinge on familiarity with the clinical components and neuroanatomic correlates of these complex, high-order cognitive processes.
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25
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Cognitive and Neuropsychiatric Screening Tests in Older Adults. MENTAL HEALTH AND ILLNESS WORLDWIDE 2016. [DOI: 10.1007/978-981-10-0370-7_16-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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26
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Dementia. Neurology 2016. [DOI: 10.1007/978-3-319-29632-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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27
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Daffner KR, Gale SA, Barrett AM, Boeve BF, Chatterjee A, Coslett HB, D'Esposito M, Finney GR, Gitelman DR, Hart JJ, Lerner AJ, Meador KJ, Pietras AC, Voeller KS, Kaufer DI. Improving clinical cognitive testing: report of the AAN Behavioral Neurology Section Workgroup. Neurology 2015; 85:910-8. [PMID: 26163433 DOI: 10.1212/wnl.0000000000001763] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/07/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the evidence basis of single-domain cognitive tests frequently used by behavioral neurologists in an effort to improve the quality of clinical cognitive assessment. METHODS Behavioral Neurology Section members of the American Academy of Neurology were surveyed about how they conduct clinical cognitive testing, with a particular focus on the Neurobehavioral Status Exam (NBSE). In contrast to general screening cognitive tests, an NBSE consists of tests of individual cognitive domains (e.g., memory or language) that provide a more comprehensive diagnostic assessment. Workgroups for each of 5 cognitive domains (attention, executive function, memory, language, and spatial cognition) conducted evidence-based reviews of frequently used tests. Reviews focused on suitability for office-based clinical practice, including test administration time, accessibility of normative data, disease populations studied, and availability in the public domain. RESULTS Demographic and clinical practice data were obtained from 200 respondents who reported using a wide range of cognitive tests. Based on survey data and ancillary information, between 5 and 15 tests in each cognitive domain were reviewed. Within each domain, several tests are highlighted as being well-suited for an NBSE. CONCLUSIONS We identified frequently used single-domain cognitive tests that are suitable for an NBSE to help make informed choices about clinical cognitive assessment. Some frequently used tests have limited normative data or have not been well-studied in common neurologic disorders. Utilizing standardized cognitive tests, particularly those with normative data based on the individual's age and educational level, can enhance the rigor and utility of clinical cognitive assessment.
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Affiliation(s)
- Kirk R Daffner
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill.
| | - Seth A Gale
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - A M Barrett
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Bradley F Boeve
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Anjan Chatterjee
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - H Branch Coslett
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Mark D'Esposito
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Glen R Finney
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Darren R Gitelman
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - John J Hart
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Alan J Lerner
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Kimford J Meador
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Alison C Pietras
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Kytja S Voeller
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
| | - Daniel I Kaufer
- From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill
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Pillai JA, Bonner-Jackson A. Review of information and communication technology devices for monitoring functional and cognitive decline in Alzheimer's disease clinical trials. JOURNAL OF HEALTHCARE ENGINEERING 2015; 6:71-83. [PMID: 25708378 DOI: 10.1260/2040-2295.6.1.71] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Detecting and monitoring early cognitive impairment in Alzheimer's disease (AD) is a significant need in the field of AD therapeutics. Successful AD clinical trial designs have to overcome challenges related to the subtle nature of early cognitive changes. Continuous unobtrusive assessments using Information and Communication Technology (ICT) devices to capture markers of intra-individual change over time to assess cognitive and functional disability therefore offers significant benefits. We review the literature and provide an overview on randomized clinical trials in AD that use intelligent systems to monitor functional decline, as well as strengths, weaknesses, and future directions for the use of ICTs in a new generation of AD clinical trials.
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Affiliation(s)
- Jagan A Pillai
- Department of Neurology and Lou Ruvo Center, Brain Health Cleveland Clinic, Cleveland, OH, USA
| | - Aaron Bonner-Jackson
- Department of Neurology and Lou Ruvo Center, Brain Health Cleveland Clinic, Cleveland, OH, USA
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Seligman SC, Giovannetti T. The Potential Utility of Eye Movements in the Detection and Characterization of Everyday Functional Difficulties in Mild Cognitive Impairment. Neuropsychol Rev 2015; 25:199-215. [PMID: 25851239 DOI: 10.1007/s11065-015-9283-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Mild cognitive impairment (MCI) refers to the intermediate period between the typical cognitive decline of normal aging and more severe decline associated with dementia, and it is associated with greater risk for progression to dementia. Research has suggested that functional abilities are compromised in MCI, but the degree of impairment and underlying mechanisms remain poorly understood. The development of sensitive measures to assess subtle functional decline poses a major challenge for characterizing functional limitations in MCI. Eye-tracking methodology has been used to describe visual processes in everyday, naturalistic action among healthy older adults as well as several case studies of severely impaired individuals, and it has successfully differentiated healthy older adults from those with MCI on specific visual tasks. These studies highlight the promise of eye-tracking technology as a method to characterize subtle functional decline in MCI. However, to date no studies have examined visual behaviors during completion of naturalistic tasks in MCI. This review describes the current understanding of functional ability in MCI, summarizes findings of eye-tracking studies in healthy individuals, severe impairment, and MCI, and presents future research directions to aid with early identification and prevention of functional decline in disorders of aging.
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Affiliation(s)
- Sarah C Seligman
- Department of Psychology, Temple University, 1701 N. 13th Street, 6th Floor Weiss Hall, Philadelphia, PA, 19122, USA
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Vaidyanathan U, Malone SM, Donnelly JM, Hammer MA, Miller MB, McGue M, Iacono WG. Heritability and molecular genetic basis of antisaccade eye tracking error rate: a genome-wide association study. Psychophysiology 2014; 51:1272-84. [PMID: 25387707 PMCID: PMC4238043 DOI: 10.1111/psyp.12347] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antisaccade deficits reflect abnormalities in executive function linked to various disorders including schizophrenia, externalizing psychopathology, and neurological conditions. We examined the genetic bases of antisaccade error in a sample of community-based twins and parents (N = 4,469). Biometric models showed that about half of the variance in the antisaccade response was due to genetic factors and half due to nonshared environmental factors. Molecular genetic analyses supported these results, showing that the heritability accounted for by common molecular genetic variants approximated biometric estimates. Genome-wide analyses revealed several SNPs as well as two genes-B3GNT7 and NCL-on Chromosome 2 associated with antisaccade error. SNPs and genes hypothesized to be associated with antisaccade error based on prior work, although generating some suggestive findings for MIR137, GRM8, and CACNG2, could not be confirmed.
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Affiliation(s)
- Uma Vaidyanathan
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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31
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Pa J, Dutt S, Mirsky JB, Heuer HW, Keselman P, Kong E, Trujillo A, Gazzaley A, Kramer JH, Seeley WW, Miller BL, Boxer AL. The functional oculomotor network and saccadic cognitive control in healthy elders. Neuroimage 2014; 95:61-8. [PMID: 24675647 DOI: 10.1016/j.neuroimage.2014.03.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/21/2014] [Accepted: 03/17/2014] [Indexed: 12/17/2022] Open
Abstract
Decline in executive function is the most common age-associated cognitive deficit and may be a risk factor for neurodegenerative disease. The antisaccade (AS) task involves inhibition of a prepotent visuomotor response and is a well-validated executive function test in aging and neurodegeneration. We investigated the functional connectivity of the cortical oculomotor network during successful AS performance in healthy elders. Elevated BOLD activity in the right lateral frontal eye field (rlatFEF), a region linked to volume loss in individuals with impaired AS performance, was associated with worse AS performance and weaker network efficiency. In contrast, hub integrity of the right dorsolateral prefrontal cortex (rDLPFC) and anterior cingulate cortex (rACC) was associated with better AS performance. These data suggest that while several right lateral frontal regions are central nodes in the oculomotor network, the rlatFEF demonstrates early neural aberrations and the rDLPFC and rACC continue to support inhibitory cognitive control in healthy elders. We conclude that alterations in AS task functional connectivity, quantified as hub and network efficiency, may be clinically-relevant biomarkers of cognitive decline in executive functioning.
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Affiliation(s)
- Judy Pa
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA.
| | - Shubir Dutt
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Jacob B Mirsky
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Hilary W Heuer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Paul Keselman
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Erwin Kong
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Andrew Trujillo
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Adam Gazzaley
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco, CA 94158, USA.
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Abstract
Executive functions refer to a constellation of higher-level cognitive abilities that enable goal-oriented behavior. The NIH EXAMINER battery was designed to assess executive functions comprehensively and efficiently. Performance can be summarized by a single score, the "Executive Composite," which combines measures of inhibition, set-shifting, fluency, and working memory. We evaluated the ecological validity of the Executive Composite in a sample of 225 mixed neurological patients and controls using the Frontal Systems Behavior Scale (FrSBe), an informant-based measure of real-world executive behavior. In addition, we investigated the neuroanatomical correlates of the Executive Composite using voxel-based morphometry in a sample of 37 participants diagnosed with dementia, mild cognitive impairment, or as neurologically healthy. The Executive Composite accounted for 28% of the variance in Frontal Systems Behavior Scale scores beyond age. Even after including two widely used executive function tests (Trails B and Stroop) as covariates, the Executive Composite remained a significant predictor of real-world behavior. Anatomically, poorer scores on the Executive Composite were associated with smaller right and left dorsolateral prefrontal volumes, brain regions critical for good executive control. Taken together, these results suggest that the Executive Composite measures important aspects of executive function not captured by standard measures and reflects the integrity of frontal systems.
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Executive function in children with attention deficit/hyperactivity disorder: the NIH EXAMINER battery. J Int Neuropsychol Soc 2014; 20:41-51. [PMID: 24103310 PMCID: PMC4425416 DOI: 10.1017/s1355617713001100] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Theories of attention deficit/hyperactivity disorder (ADHD) increasingly highlight the role of neuropsychological impairment in ADHD; however, a consistent and identifiable pattern of performance on tests is not well established. The National Institutes of Health (NIH) Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER) battery provides measures of common variance across multiple executive function tests within specific domains and was used to characterize which executive functions are most affected in children with ADHD. Thirty-two children (24 male), ages 8-15 years (M = 12.02; SD = 2.29), diagnosed with ADHD and no comorbid disorder completed the NIH EXAMINER battery. Sixty age and gender matched healthy controls were chosen from a database of participants enrolled in the NIH EXAMINER multi-site study. Children with ADHD performed worse on the working memory score compared with the controls. No differences were found on the cognitive control or fluency scores. For children with ADHD, poorer working memory performance predicted parent report of child learning problems. Cognitive control and fluency scores did not predict learning problems. In summary, working memory emerges as a primary impairment in children with ADHD who have no comorbid disorders. Furthermore, working memory weaknesses may underlie the academic problems often seen in children with ADHD.
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Abstract
Executive functioning is widely targeted when human cognition is assessed, but there is little consensus on how it should be operationalized and measured. Recognizing the difficulties associated with establishing standard operational definitions of executive functioning, the National Institute of Neurological Disorders and Stroke entered into a contract with the University of California-San Francisco to develop psychometrically robust executive measurement tools that would be accepted by the neurology clinical trials and clinical research communities. This effort, entitled Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER), resulted in a series of tasks targeting working memory, inhibition, set shifting, fluency, insight, planning, social cognition and behavior. We describe battery conceptualization and development, data collection, scale construction based on item response theory, and lay the foundation for studying the battery's utility and validity for specific assessment and research goals.
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Heuer HW, Mirsky JB, Kong EL, Dickerson BC, Miller BL, Kramer JH, Boxer AL. Antisaccade task reflects cortical involvement in mild cognitive impairment. Neurology 2013; 81:1235-43. [PMID: 23986300 DOI: 10.1212/wnl.0b013e3182a6cbfe] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aims of this study were to examine executive dysfunction using an antisaccade (AS) task in normal elderly (NE) and patients with mild cognitive impairment (MCI) and Alzheimer disease (AD) as well as to evaluate the relationship between AS performance and cortical thinning within AD-associated regions. METHODS We recorded eye movements in 182 subjects (NE: 118; MCI: 36; AD: 28) during an AS task. We also performed neuropsychological measures of executive function for comparison. Brain MRI scans were collected on most subjects, and cortical thickness was determined in 9 regions known to exhibit atrophy in AD dementia ("AD signature"). We investigated the relationships between AS and neuropsychological performance, as well as possible correlations between AS performance and cortical thickness. RESULTS AS performance in MCI resembled that in NE; subjects with AD were impaired relative to both MCI and NE. In all subjects, AS performance correlated with neuropsychological measures of executive function, even after controlling for disease severity. In the subjects with MCI but not in NE, cortical thickness in frontoparietal AD signature regions correlated with AS performance. CONCLUSIONS The AS task is a useful measure of executive function across the AD spectrum. In MCI, AS performance may reflect disease burden within cortical brain regions involved in oculomotor control; however, AS impairments in NE may have etiologies other than incipient AD.
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Affiliation(s)
- Hilary W Heuer
- From the Memory and Aging Center (H.W.H., J.B.M., E.L.K., B.L.M., J.H.K., A.L.B.), Department of Neurology, University of California, San Francisco; and Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
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Antoniades C, Ettinger U, Gaymard B, Gilchrist I, Kristjánsson A, Kennard C, John Leigh R, Noorani I, Pouget P, Smyrnis N, Tarnowski A, Zee DS, Carpenter RHS. An internationally standardised antisaccade protocol. Vision Res 2013; 84:1-5. [PMID: 23474300 DOI: 10.1016/j.visres.2013.02.007] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/08/2013] [Accepted: 02/09/2013] [Indexed: 11/29/2022]
Abstract
Detailed measurements of saccadic latency--the time taken to make an eye movement to a suddenly-presented visual target--have proved a valuable source of detailed and quantitative information in a wide range of neurological conditions, as well as shedding light on the mechanisms of decision, currently of intense interest to cognitive neuroscientists. However, there is no doubt that more complex oculomotor tasks, and in particular the antisaccade task in which a participant must make a saccade in the opposite direction to the target, are potentially more sensitive indicators of neurological dysfunction, particularly in neurodegenerative conditions. But two obstacles currently hinder their widespread adoption for this purpose. First, that much of the potential information from antisaccade experiments, notably about latency distribution and amplitude, is typically thrown away. Second, that there is no standardised protocol for carrying out antisaccade experiments, so that results from one laboratory cannot easily be compared with those from another. This paper, the outcome of a recent international meeting of oculomotor scientists and clinicians with an unusually wide experience of such measurements, sets out a proposed protocol for clinical antisaccade trials: its adoption will greatly enhance the clinical and scientific benefits of making these kinds of measurements.
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Affiliation(s)
- Chrystalina Antoniades
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
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Anderson TJ, MacAskill MR. Eye movements in patients with neurodegenerative disorders. Nat Rev Neurol 2013; 9:74-85. [DOI: 10.1038/nrneurol.2012.273] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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The advantages of frontotemporal degeneration drug development (part 2 of frontotemporal degeneration: the next therapeutic frontier). Alzheimers Dement 2012; 9:189-98. [PMID: 23062850 DOI: 10.1016/j.jalz.2012.03.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 03/07/2012] [Indexed: 12/27/2022]
Abstract
Frontotemporal degeneration (FTD) encompasses a spectrum of related neurodegenerative disorders with behavioral, language, and motor phenotypes for which there are currently no effective therapies. This is the second of two articles that summarize the presentations and discussions that occurred at two symposia in 2011 sponsored by the Frontotemporal Degeneration Treatment Study Group, a collaborative group of academic and industry researchers that is devoted to developing treatments for FTD. This article discusses the current status of FTD clinical research that is relevant to the conduct of clinical trials, and why FTD research may be an attractive pathway for developing therapies for neurodegenerative disorders. The clinical and molecular features of FTD, including rapid disease progression and relatively pure molecular pathology, suggest that there are advantages to developing drugs for FTD as compared with other dementias. FTD qualifies as orphan indication, providing additional advantages for drug development. Two recent sets of consensus diagnostic criteria will facilitate the identification of patients with FTD, and a variety of neuropsychological, functional, and behavioral scales have been shown to be sensitive to disease progression. Moreover, quantitative neuroimaging measurements demonstrate progressive brain atrophy in FTD at rates that may surpass Alzheimer's disease. Finally, the similarities between FTD and other neurodegenerative diseases with drug development efforts already underway suggest that FTD researchers will be able to draw on this experience to create a road map for FTD drug development. We conclude that FTD research has reached sufficient maturity to pursue clinical development of specific FTD therapies.
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