Cognitive and neurologic predictors of functional impairment in vascular dementia

OBJECTIVE

The purpose of this study is to investigate associations between executive dysfunction, neuroimaging findings, and functional impairment in patients with vascular dementia (VaD).

METHODS

Twenty-nine VaD patients completed the Dementia Rating Scale and underwent MRI scanning to generate quantitative ratings of subcortical hyperintensities (SH) and cortical volume. Patients' caregivers completed items from the Lawton and Brody Activities of Daily Living Questionnaire, designed to measure instrumental activities of daily living (IADLs). The authors hypothesized that performance on the Initiation/Perseveration (IP) subscale, a measure of executive abilities, and SH would significantly predict levels of IADLs.

RESULTS

A hierarchical multiple-regression analysis revealed that IP and SH accounted for 42% of the variance in IADLs; IP alone accounted for 28%, and SH accounted for 14% beyond the contribution made by IP.

CONCLUSION

Findings indicate that specific cognitive and neuropathological factors are associated with functional impairment in VaD.

Dementia severity and pattern of cognitive performance in vascular dementia

We evaluated the influence of dementia severity on cognitive performance in two groups of individuals with vascular dementia (VaD). Performance on the Mini-Mental State Exam (MMSE) was used to determine dementia severity. Tests of executive function, psychomotor speed, memory, language, and visuospatial function were administered. As expected, individuals with severe VaD (MMSE < 18) performed significantly more poorly than individuals with mild VaD (MMSE > or = 18) on most tests. More important, deficits were evident for both groups in each cognitive domain when compared to normative data. These results indicate that multiple cognitive domains are affected even in mild cases of VaD. Clinicians should be aware that although the presence of "patchy" cognitive deficits may indicate stroke, general cognitive dysfunction may occur in mild cases of VaD.

Performance on the Mattis Dementia Rating Scale in patients with vascular dementia: relationships to neuroimaging findings

Impairment on screening measures such as the Mattis Dementia Rating Scale (MDRS) provides evidence of dementia in patients with cerebrovascular disease. However, the relationships between neuroimaging findings and performance on the MDRS in vascular dementia (VD) have not been determined. In the present study, we examined the relationships between subcortical hyperintensity (SH) volume and whole brain volume (WBV) on the subscales and total score of the MDRS. Results revealed that SH accounted for a significant amount of variance on the Initiation/Perseveration and Construction subscales, whereas WBV accounted for a significant amount of variance on the Memory subscale. The total score on the MDRS was found to be significantly related to WBV but not SH. These results suggest that subcortical damage and brain volume account for different aspects of cognitive decline in VD and that overall cognitive impairment may reflect cortical and subcortical involvement.

Performance on the Hooper Visual Organizational Test in patients diagnosed with subcortical vascular dementia: relation to naming performance

OBJECTIVE

To examine the performance of individuals with vascular dementia (VaD) on the Hooper Visual Organization Test (HVOT) and to determine the influence of naming on HVOT performance in this population.

BACKGROUND

The HVOT is commonly administered to assess visuospatial perception among neurologic patients, but the test requires verbal identification of stimuli as well as spatial ability. Previous studies have examined the influence of naming on the HVOT, but the issue has not been systematically addressed in individuals with subcortical VaD.

METHOD

Individuals with a diagnosis of VaD were administered the HVOT, three additional measures of visuospatial function (Block Design and Picture Completion subtests of the Wechsler Adult Intelligence Scale-Revised, Rey-Osterrieth Complex Figure Test copy trial), and the Boston Naming Test (BNT).

RESULTS

On average, the VaD patients performed poorly compared with normative data on each of the cognitive measures, with the most pronounced deficit evident on the BNT. Regression analyses revealed that more than 60% of the variance in performance on the HVOT was accounted for by performance on the Block Design subtest of the Wechsler Adult Intelligence Scale-Revised; performance on the BNT did not contribute significantly.

CONCLUSIONS

The results suggest that VaD patients perform below expectations on the HVOT and that the measure is robust to naming deficits in this population.

Alcohol and sexual assault

Conservative estimates of sexual assault prevalence suggest that 25 percent of American women have experienced sexual assault, including rape. Approximately one-half of those cases involve alcohol consumption by the perpetrator, victim, or both. Alcohol contributes to sexual assault through multiple pathways, often exacerbating existing risk factors. Beliefs about alcohol's effects on sexual and aggressive behavior, stereotypes about drinking women, and alcohol's effects on cognitive and motor skills contribute to alcohol-involved sexual assault. Despite advances in researchers' understanding of the relationships between alcohol consumption and sexual assault, many questions still need to be addressed in future studies.

What have we learned about cognition in myasthenia gravis?: a review of methods and results

Most individuals with myasthenia gravis (MG) complain of cognitive impairment, but empirical studies of cognition in MG have produced mixed results. In the present review, we critically examined the methodology and results of previous studies that investigated cognition in MG. Results from our review revealed that none of the studies met at least 50% of criteria under review. The most common shortcomings of previous studies included small sample size, no exclusion for visual difficulties in patients, inadequate assessment of mood, and poor control for prednisone use. Despite these methodological difficulties, mild impairments on measures of learning have been identified. These findings need to be replicated with adequate control of potential confounds before any conclusions can be made regarding cognition in this disease. Suggestions for design of future studies are provided.

Alcohol's effects on sexual perception

OBJECTIVE

This study examines hypotheses about alcohol's effects on sexual judgments based on both alcohol and misperception theories. It was hypothesized that gender, alcohol consumption and alcohol expectancy set would influence perceptions of sexuality.

METHOD

Participants were unacquainted women and men (88 dyads) who interacted for 15 minutes within the context of the balanced placebo design. After the conversation ended, participants answered questions about their behavior and their partners' behavior. Conversations were videotaped and coded by trained raters.

RESULTS

Men perceived their female partner and themselves as behaving more sexually than women perceived their male partner and themselves. When alcohol was consumed, both women and men were perceived as behaving more sexually and in a more disinhibited manner than when alcohol was not consumed. Ratings made by members of white and black dyads were largely comparable. Trained observers coded participants' use of active attention and dating availability cues. Both types of cues interacted with alcohol consumption such that intoxicated participants exaggerated the meaning of strong (dating availability) cues and ignored the meaning of ambiguous (active attention) cues when making sexual judgments.

CONCLUSIONS

Supporting past research on gender differences in perceptions of sexuality, men were more sexually attracted to their opposite-sex partner than women were. Both women's and men's sexual judgments were influenced by alcohol consumption but not by alcohol expectancy set. Intoxicated participants' responses to their partners' behavioral cues supported cognitive impairment models of alcohol's effects. The implications of these findings for theories about alcohol's effects on sexuality and for prevention programming are discussed.