Longitudinal assessment of chemotherapy-induced brain connectivity changes in cerebral white matter and its correlation with cognitive functioning using the GQI

Objective

Breast cancer was the most prevalent type of cancer and had the highest incidence rate among women worldwide. The wide use of adjuvant chemotherapy might have a detrimental effect on the human brain and result in chemotherapy-related cognitive impairment (CICI) among breast cancer patients. Furthermore, prior to chemotherapy, patients reported cancer-related cognitive impairment (CRCI), which might be due to physiological factors or mood symptoms. The present longitudinal study aimed to investigate microstructural and macroscale white matter alterations by generalized q-sampling imaging (GQI).

Methods

The participants were categorized into a pre-chemotherapy group (BB) if they were diagnosed with primary breast cancer and an age-matched noncancer control group (HC). Some participants returned for follow-up assessment. In the present follow up study, 28 matched pairs of BB/BBF (follow up after chemotherapy) individuals and 28 matched pairs of HC/HCF (follow up) individuals were included. We then used GQI and graph theoretical analysis (GTA) to detect microstructural alterations in the whole brain. In addition, we evaluated the relationship between longitudinal changes in GQI indices and neuropsychological tests as well as psychiatric comorbidity.

Findings

The results showed that disruption of white matter integrity occurred in the default mode network (DMN) of patients after chemotherapy, such as in the corpus callosum (CC) and middle frontal gyrus (MFG). Furthermore, weaker connections between brain regions and lower segregation ability were observed in the post-chemotherapy group. Significant correlations were observed between neuropsychological tests and white matter tracts of the CC, MFG, posterior limb of the internal capsule (PLIC) and superior longitudinal fasciculus (SLF).

Conclusion

The results provided evidence of white matter alterations in breast cancer patients, and they may serve as potential imaging markers of cognitive changes. In the future, the study may be beneficial to create and evaluate strategies designed to maintain or improve cognitive function in breast cancer patients undergoing chemotherapy.

Clinical and neuropsychological characterization of SuperAgers residing in Delhi and National Capital Region of India-A cross-sectional study

Introduction

SuperAgers (SA) are older adults who exhibit cognitive capacities comparable to individuals who are three or more decades younger than them. The current study aimed to identify the characteristics of Indian SA by categorizing 55 older adults into SA and Typical Older Adults (TOA) and comparing their performance with a group of 50 younger participants (YP) (aged 25-50).

Methods

A total of 105 participants were recruited after obtaining informed written consent. The cognitive abilities of the participants were assessed using Wechsler Adult Intelligence Scale (WAIS)-IVINDIA, Color Trails Test, Boston Naming Test (BNT), and Rey Auditory Verbal Learning Test.

Results

SA outperformed TOA in all cognitive assessments (P < 0.001) and surpassed YP in BNT and WAIS-IV. SA's delayed recall scores were notably higher (12.29 ± 1.51) than TOA (6.32 ± 1.44).

Conclusion

SA excelled in all cognitive domains demonstrating resilience to age-related cognitive decline. This study highlights Indian SuperAgers' exceptional cognitive prowess.

Hybrid surgery can improve neurocognitive function in patients with internal carotid artery occlusion

Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischaemic attack and cerebral infarction. Hybrid surgery (HS) improves cerebral perfusion, but its impact on neurocognitive function has been controversial. Patients with symptomatic chronic ICAO treated by hybrid surgery or medical treatment from 2016 to 2019 were included. We recorded and analysed the clinical characteristics, angiographic data, outcomes and cognitive status. Functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-Cognitive Subtest (ADAS-cog), verbal fluency, and Colour Trail test Parts 1 and 2, were administered. Significant improvements in the ADAS (before, 7.5 ± 6.2 versus after, 5.2 ± 5.7; P = 0.022), MMSE (before, 25.5 ± 2.8 versus after, 28.1 ± 2.3; P = 0.013), and Colour Trail test Part 1 (before, 118.3 ± 26.5 versus after, 96.2 ± 23.1; P = 0.016) were observed six months after HS. Moreover, the abovementioned postprocedure scales were ameliorated in the HS group. This study found that in patients with multiple symptomatic ICAO and objective ipsilateral ischaemia, successful HS leads to improvement in the scores of three cognitive tests.

Assessing cognitive function in longitudinal studies of ageing worldwide: some practical considerations

Over 55 million people live with dementia worldwide. With 40% of modifiable risk factors estimated to contribute to dementia, the potential for prevention is high, and preventive measures, at an early stage of cognitive decline, are likely to positively influence future dementia trends. Countries need reliable health data and adequate measurement tools to quantify, monitor and track early changes in cognitive capacity in the general population. Many cognitive tests exist; however, there is no consensus to date about which instruments should be employed, and important variations in measurement have been observed. In this narrative review, we present a number of cognitive tests that have been used in nationally representative population-based longitudinal studies of ageing. Longitudinal panel studies of ageing represent critical platforms towards capturing the process of cognitive ageing and understanding associated risk and protective factors. We highlight optimal measures for use at a population level and for cross-country comparisons, taking into consideration instrument reliability, validity, duration, ease of administration, costs, literacy and numeracy requirements, adaptability to sensory and fine motor impairments and portability to different cultural and linguistic milieux. Drawing upon the strengths and limitations of each of these tests, and the experience gained and lessons learnt from conducting a nationally representative study of ageing, we indicate a comprehensive battery of tests for the assessment of cognitive capacity, designed to facilitate its standardised operationalisation worldwide.

Differential Impact of Brain Network Efficiency on Poststroke Motor and Attentional Deficits

BACKGROUND

Most studies on stroke have been designed to examine one deficit in isolation; yet, survivors often have multiple deficits in different domains. While the mechanisms underlying multiple-domain deficits remain poorly understood, network-theoretical methods may open new avenues of understanding.

METHODS

Fifty subacute stroke patients (7±3days poststroke) underwent diffusion-weighted magnetic resonance imaging and a battery of clinical tests of motor and cognitive functions. We defined indices of impairment in strength, dexterity, and attention. We also computed imaging-based probabilistic tractography and whole-brain connectomes. To efficiently integrate inputs from different sources, brain networks rely on a rich-club of a few hub nodes. Lesions harm efficiency, particularly when they target the rich-club. Overlaying individual lesion masks onto the tractograms enabled us to split the connectomes into their affected and unaffected parts and associate them to impairment.

RESULTS

We computed efficiency of the unaffected connectome and found it was more strongly correlated to impairment in strength, dexterity, and attention than efficiency of the total connectome. The magnitude of the correlation between efficiency and impairment followed the order attention>dexterity ≈ strength (strength: |r|=.03, P=0.02, dexterity: |r|=.30, P=0.05, attention: |r|=.55, P<0.001). Network weights associated with the rich-club were more strongly correlated to efficiency than non-rich-club weights.

CONCLUSIONS

Attentional impairment is more sensitive to disruption of coordinated networks between brain regions than motor impairment, which is sensitive to disruption of localized networks. Providing more accurate reflections of actually functioning parts of the network enables the incorporation of information about the impact of brain lesions on connectomics contributing to a better understanding of underlying stroke mechanisms.

Normative data for the Color Trails Test in middle-aged and elderly Quebec-French people

OBJECTIVE

Despite the widespread use of the Color Trails Test (CTT) in clinical and research settings, information regarding the impact of sociodemographic variables on test performance in Quebec-French adults and elderly people is non-existent. This study aimed to establish French-Quebec normative data for error scores and completion time on all test trials (CTT1 and CTT2) taking into account the impact of age, education, and sex on test performance.

METHOD

The sample consisted of 169 community-dwelling and healthy Quebec-French individuals aged between 50 and 90 years and having between 6 and 21 years of formal education.

RESULTS

Regression analyses indicated that age was associated with completion time on CTT1 and CTT2. Spearman correlations also revealed that age was positively associated with error scores (CTT1 errors, CTT2 number errors, CTT2 near-misses) and index interference. Education was marginally associated with CTT1 but was not associated with CTT2 completion time or interference index. Education was only associated with the number of errors in the CTT2. Finally, sex was not associated with any variables. Equations to calculate Z scores and percentiles are presented.

CONCLUSIONS

Norms for the CTT will ease the interpretation of executive functioning in Quebec-French adults and the elderly and favor accurate discrimination between normal and pathological cognitive states.

Factors Influencing the Executive Functions of Male and Female Cadets

Executive functions (EFs) are related to human abilities that allow individuals to achieve planned goals, contribute to creativity and the analysis of new ideas, and allow for adaptation to new situations in daily life. Thorough analyses of the factors affecting EFs can aid in the development of appropriate training programs for various social and professional groups, including the military. The purpose of this study was to determine the factors affecting the EFs of cadets (18 women and 108 men) studying at a military academy in Poland after the first and second terms of military training, and to investigate gender differences in the level of EFs, shooting performance (SP), and components of physical fitness (PF). The Neuropsychological Color Trails Test (CTT-2) was used to determine some of the EFs of the test subjects. Meanwhile, the level of SP was represented by the score achieved during marksmanship training implemented during military training. Assessment of the subjects' PF was guided by the principles of the Health-Related Fitness assessment concept, i.e., health-related fitness. Differences between men and women in specific variables were calculated using the Mann-Whitney U test for independent samples, whilst the relationship between variables was analyzed using the best subset regression method. The results revealed that cadets' EFs were influenced by their SP and their level of strength. However, there were no significant differences between male and female cadets in the levels of EFs or SP.

A normative study of the Color Trails Test in the adult Indian population

The Color Trails Test (CTT) is a neuropsychological measure assessing for frontal and executive functioning, while also minimizing the cultural and language barriers inherent in similar measures such as the Trail Making Test (TMT). This study establishes convergent validity for the CTT in the Indian population by comparing participant performance on the CTT and TMT. It also generates culturally appropriate normative data for CTT-Form A among the Indian adult population. Six-hundred and sixty-nine cognitively healthy, community-dwelling individuals between ages 18 and 69 participated in the study and were stratified based on age, gender, and educational attainment. Participant performance on the CTT and TMT were correlated to establish convergent validity. Strong correlation was found between TMT-A and CTT-1 (r = 0.61) and between TMT-B and CTT-2 (r = 0.66). An analysis of variance test was used to determine the mean and standard deviation for each stratified participant group. Further analysis found that age and educational attainment significantly impact participant performance on CTT-1 [F(4, 649) = 4.395, p = 0.002], whereas gender, age, and educational attainment significantly impact participant performance on CTT-2 [F(4,649) = 2.446, p = 0.045]. Normative data generated from this study has important clinical implications and contributes to the growing body of culturally appropriate normative data available for the Indian population.

Executive Function Level in Cadets’ Shooting Performance

Executive functions (EF) are crucial to a person’s unique abilities, enabling one to achieve goals, adapt to new situations and manage social interactions. EF are also very important for the effective performance of military tasks including the shooting performance (SP) of soldiers. The aim of this study was to investigate the association of EF with SP and gender differences in the level of these traits among cadets of the General Tadeusz Kosciuszko Military University of Land Forces in Wroclaw i.e., 156 persons (19 females and 137 males). The level of EF and processes related to attention was measured with usage of the Color Trails Test (CTT-1 and CTT-2). SP was assessed on the basis of scores from four different small arms and rifle shootings at a fixed target and at emerging targets. The relations between explained and explanatory variables were assessed using Spearman correlation. The variation in the mean values of CTT scores and SP of men and women was compared using the Mann–Whitney U test for independent samples. The results of the present study did not reveal any significant differences between women and men in the level of EF and SP. The key finding of the present study is that the higher SP of males in all shooting events of the study and of females in pistol shooting were significantly correlated with higher executive functions.

The relationship between cognitive function and performance in instrumental activities of daily living in older adults

Introduction

Deficits in cognition have been found to be associated with problems in performing daily activities; however, it is unknown what specific domains of cognition are related to each daily activity.

Method

Thirty-six occupational therapists identified the 20 most important instrumental activities of daily living for older adults and the cognitive demands required. Thirty-two older adults rated the perceived mental effort when performing these activities. They were assessed on their cognitive functions. Descriptive statistics were used to report the results. The Pearson correlation coefficient was used to identify relationships between cognitive functions and perceived mental effort.

Results

Activities relating to ‘communication’, ‘financial management’, ‘health management’ and ‘safety and emergency management’ require more cognitive demands. Results from the older adults showed the highest significant correlations in immediate memory and ‘paying bills’ ( r = 0.54), delayed memory and ‘following emergency procedures’ and ‘paying bills’ ( rs = 0.52), and executive functioning and ‘making and keeping medical appointments’ ( r = −0.49).

Conclusion

Findings contribute to the emerging understanding of specific cognitive domains related to the instrumental activities of daily living. The results can be used to reframe and improve intervention strategies for individuals with cognitive decline to maintain or improve performance in daily activities.

Brain-predicted age difference score is related to specific cognitive functions: a multi-site replication analysis

Brain-predicted age difference scores are calculated by subtracting chronological age from 'brain' age, which is estimated using neuroimaging data. Positive scores reflect accelerated ageing and are associated with increased mortality risk and poorer physical function. To date, however, the relationship between brain-predicted age difference scores and specific cognitive functions has not been systematically examined using appropriate statistical methods. First, applying machine learning to 1359 T1-weighted MRI scans, we predicted the relationship between chronological age and voxel-wise grey matter data. This model was then applied to MRI data from three independent datasets, significantly predicting chronological age in each dataset: Dokuz Eylül University (n = 175), the Cognitive Reserve/Reference Ability Neural Network study (n = 380), and The Irish Longitudinal Study on Ageing (n = 487). Each independent dataset had rich neuropsychological data. Brain-predicted age difference scores were significantly negatively correlated with performance on measures of general cognitive status (two datasets); processing speed, visual attention, and cognitive flexibility (three datasets); visual attention and cognitive flexibility (two datasets); and semantic verbal fluency (two datasets). As such, there is firm evidence of correlations between increased brain-predicted age differences and reduced cognitive function in some domains that are implicated in cognitive ageing.

A selective review of the ability for variants of the Trail Making Test to assess cognitive impairment

The Trail Making Test (TMT) is a popular neuropsychological test derived from the Army Individual Test Battery, which was used by the U.S. Army. Its content was obviously designed within the English cultural context. Consequently, there is ongoing debate regarding TMT's applicability on non-English speaking population. The objective of this study was to selectively review the major variants of TMT that had been created to address this issue, including color trail test (CTT), shape trail test (STT), and language-specific versions of TMT. Meanwhile, functional magnetic resonance imaging (fMRI) can be conducted along with TMT to clarify the brain activity underlying TMT performance. This review drew conclusions on the clinical utility of these TMT variants. All research articles reviewed were published in English-language, peer-reviewed journals.

Symbol Digit Modalities Test: Greek Normative Data for the Oral and Written Version and Discriminative Validity in Patients with Multiple Sclerosis

OBJECTIVES

The purpose of this study was to generate normative data on the Symbol Digits Modalities Test (SDMT) for the written and oral versions in the Greek adult population. We also investigated the test's validity in discriminating the performance of healthy adults from two groups of adults diagnosed with relapsing remitting (RRMS) and secondary progressive (SPMS) multiple sclerosis.

METHOD

The sample consisted of 609 healthy men and women between the ages of 18 and 65. All participants were monolingual native Greek adult speakers. Each healthy participant was administered either the written (n = 460) or oral (n = 149) versions of the SDMT. Discriminant validity was examined by comparing 35 healthy participants who had completed the oral version of the SDMT to 35 age - and education-matched RRMS and SPMS patients.

RESULTS

Linear regression models explained between 36% and 55% of the variance in the SDMT oral and written version scores. Age was the strongest predictor of difference in SDMT written and oral version performance, followed by education that also accounted for a further proportion of the SDMT variance. On the contrary, gender was found not to contribute significantly to the variance in the SDMT for either the written or the oral versions. As a result, age- and education-adjusted norms were generated. Regarding the tests discriminative validity, we found that both MS patient groups scored significantly lower than the healthy group.

CONCLUSIONS

This is the first study to provide comprehensive normative data for the SDMT in the adult population in Greece, impacting the future practice of neuropsychological assessment in this country.

Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia

ABSTRACTBackground:Pharmacological interventions for Lewy body dementia (LBD), especially for its non-cognitive symptoms, are limited in their efficacy and tolerability. Clinicians are often uncertain about non-pharmacological interventions and their efficacy in managing cognitive and non-cognitive symptoms of LBD. Therefore, we aimed to systematically review the existing literature on non-pharmacological interventions for people with LBD.

METHODS

We carried out a systematic search using six databases. All human studies examining impact of any non-pharmacological intervention on LBD were assessed for cognitive, physical, psychiatric, and quality-of-life outcomes. Study quality was assessed by Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the CARE criteria checklist.

RESULTS

Prevailing evidence supporting the efficacy of non-pharmacological interventions is weak. We screened 1,647 papers. Fifteen studies (n = 61) including 11 case reports were found eligible for this systematic review. Interventions and reported outcomes were heterogeneous. Deep brain stimulation of the nucleus basalis of Meynert reportedly conferred cognitive benefit. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have been reported to ameliorate depressive symptoms. Transcranial direct current stimulation was observed to improve attention. Exercise-based interventions reportedly improve various clinically important outcomes. Spaced retrieval memory training and environmental intervention for "mirror sign" have also been reported.

CONCLUSIONS

Several non-pharmacological interventions have been studied in LBD. Although evidence supporting their efficacy is not robust, prevailing preliminary evidence and limitations of available pharmacological interventions indicate the need to consider appropriate non-pharmacological interventions, while planning comprehensive care of LBD patients. Larger trials evaluating the efficacy of non-pharmacological interventions for LBD are needed.

The relationship between natural outdoor environments and cognitive functioning and its mediators

BACKGROUND

Urban residents may experience cognitive fatigue and little opportunity for mental restoration due to a lack of access to nature. Natural outdoor environments (NOE) are thought to be beneficial for cognitive functioning, but underlying mechanisms are not clear.

OBJECTIVES

To investigate the long-term association between NOE and cognitive function, and its potential mediators.

METHODS

This cross-sectional study was based on adult participants of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in Barcelona, Spain; Doetinchem, the Netherlands; and Stoke-on-Trent, United Kingdom. We assessed residential distance to NOE, residential surrounding greenness, perceived amount of neighborhood NOE, and engagement with NOE. Cognitive function was assessed with the Color Trails Test (CTT). Mediation analysis was undertaken following Baron and Kenny.

RESULTS

Each 100m increase in residential distance to NOE was associated with a longer CTT completion time of 1.50% (95% CI 0.13, 2.89). No associations were found for other NOE indicators and cognitive function. Neighborhood social cohesion was (marginally) significantly associated with both residential distance to NOE and CTT completion time, but no evidence for mediation was found. Nor were there indications for mediation by physical activity, social interaction with neighbors, loneliness, mental health, air pollution worries, or noise annoyance.

CONCLUSIONS

Our findings provide some indication that proximity to nature may benefit cognitive function. We could not establish which mechanisms may explain this relationship.

Driving Trail Making Test part B: a variant of the TMT-B

[Purpose] The Trail Making Test part B (TMT-B) is used in evaluating driving abilities and includes testing for the executive function. A driving simulator version of this test (DTMT-B) was developed to measure drivers’ executive abilities in three-dimensional space. The purpose of the present study was to assess the validity of the DTMT-B for driving assessment. [Subjects] Thirty stroke patients and 65 healthy subjects were recruited. [Methods] Participants performed the TMT-B and DTMT-B. The DTMT-B was run on a driving simulator in which the individual performed a task on virtual roads connecting the lettered and numbered TMT-B points by simulated driving instead of connecting them with lines as in the paper or computerized TMT-B. Intra-class correlation coefficients (ICCs) were used to assess validities. Significant correlations were found between the TMT-B and DTMT-B. [Results] Participants performed the TMT-B and DTMT-B. Intra-class correlation coefficients (ICCs) were used to assess validities. Significant correlations were found between the TMT-B and DTMT-B. [Conclusion] The results suggest that the DTMT-B may be useful as part of driver screening assessment using a driving simulator for stroke patients and that it may also be used to assess the executive functions for healthy people.

Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test

Objective

The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C.

Methods

We recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C.

Results

Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference.

Conclusion

Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

Normative values of cognitive and physical function in older adults: findings from the Irish Longitudinal Study on Ageing

OBJECTIVES

To provide normative values of tests of cognitive and physical function based on a large sample representative of the population of Ireland aged 50 and older.

DESIGN

Data were used from the first wave of The Irish Longitudinal Study on Ageing (TILDA), a prospective cohort study that includes a comprehensive health assessment.

SETTING

Health assessment was undertaken at one of two dedicated health assessment centers or in the study participant's home if travel was not practicable.

PARTICIPANTS

Five thousand eight hundred ninety-seven members of a nationally representative sample of the community-living population of Ireland aged 50 and older. Those with severe cognitive impairment, dementia, or Parkinson's disease were excluded.

MEASUREMENTS

Measurements included height and weight, normal walking speed, Timed Up-and-Go, handgrip strength, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Color Trails Test, and bone mineral density. Normative values were estimated using generalized additive models for location shape and scale (GAMLSS) and are presented as percentiles, means, and standard deviations.

RESULTS

Generalized additive models for location shape and scale fit the observed data well for each measure, leading to reliable estimates of normative values. Performance on all tasks decreased with age. Educational attainment was a strong determinant of performance on all cognitive tests. Tests of walking speed were dependent on height. Distribution of body mass index did not change with age, owing to simultaneous declines in weight and height.

CONCLUSION

Normative values were found for tests of many aspects of cognitive and physical function based on a representative sample of the general older Irish population.

Assessing Cognitive Functioning in Older Patients: The Why, Who, What, and How

In the coming years, speech-language pathologists (SLPs) can expect the numbers of older patients on their caseloads to increase. Epidemiological data indicate that the elderly represent one of the fastest growing segments of the U.S. population as national life expectancy continues to increase (U.S. Census Bureau, 2011). Unfortunately, as people age, they become more vulnerable to medical conditions and diseases (e.g., hypertension, Alzheimer's disease, Parkinson's disease) that compromise the integrity of their brain structures and functioning (Alzheimer's Association, 2011; Roger et al., 2010). These conditions and diseases negatively affect our cognitive and communication abilities. In this article, I will focus on cognitive assessment, an important component of service provision to older patients. More specifically, I will review the rationale, issues, and procedures pertaining to evaluating attention, memory, and executive functioning abilities in older patients.