White matter hyperintensities on magnetic resonance imaging among elderly depressed patients and its association with the severity of depression and cognition

Introduction: Depression in the elderly can have a different pathophysiology and clinical profile, and studies have shown pathological changes in the brain on radio imaging. The present study aimed to find out the association of white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) with the severity of illness and cognition in elderly depressed patients. Methodology: This cross-sectional study included 68 elderly (>60 years of age) depressed patients who had undergone MRI at a tertiary care center, and based on the severity of WMH, they were divided into two groups: no or slight WMH group and moderate or severe WMH group. The severity of depression was assessed using the Hamilton Depression Rating Scale (HAM-D) scale, and neuropsychological assessments were made for testing attention, concentration and executive function. Results: HAM?D scores were found significantly higher in patients with moderate?to?severe WMH groups (22.6 ± 5.2) compared to those with no or slight WMH (16.3 ± 4.2). The cognitive performance evaluated by backward digit span test, Trail making Test A and B, and Color Stroop test was significantly poor in the moderate?to?severe WMH group. Conclusion: Elderly depressed patients having a greater WMH had more severe depression and poor cognitive performance, especially psychomotor and executive functioning. WMH could be a potential marker for the severity of illness and cognition in depression in elderly persons.

Association of glycated haemoglobin (HbA1C) level with working memory on type-2 diabetes mellitus and prediabetic patients

Background: Deleterious effects of diabetic glucose levels on brain structure, have been reported in many studies. Moreover, prediabetic and type-2 diabetes mellitus are associated with lower cognitive function. Author aimed to discover the association of blood glucose and working memory on type 2 diabetic and prediabetic patients.Methods: In this cross-sectional study there are two groups (diabetic and prediabetic) consist of 30 patients each (men 31, women 29). Mean age 40.233±7.862. Blood glucose was measured with HbA1c. All patients were tested with MMSE (Mini Mental State Examination), forward digit span, and backward digit span.Results: There was no difference between diabetic and prediabetic group in MMSE (p 1.000). In diabetic group, mean LDSF (Longest Digit Span Forward) was 5.700±0.877 and there was relation between HbA1c and LDSF (r -0.604). In prediabetic group, mean LDSF was 6.233±0.858 and there was relation between HbA1c and LDSF (r -0.565). There was significant difference between those groups in LDSF (p 0.041). In diabetic group mean LDSB (Longest Digit Span Backward) was 3.767±0.817 and there was relation between HbA1c and LDSB (r -0.545). In prediabetic group, mean LDSB was 4.300±0.750 and there was relation between HbA1c and LDSB (r -0.575). There was significant difference between those groups in LDSB (p 0.024).Conclusions: Results indicated that there was significant difference between diabetic and prediabetic patient in working memory test although there was no difference in general cognitive function.

Indian older adults and the digit span: a preliminary report / Idosos indianos e extensão de dígitos: um relatório preliminar

ABSTRACT: The digit span test is widely used to assess attention and working memory. It is a portable, relatively culture-free and frequently used test. However, the cultural validity of this test, particularly in the Indian older population, is not well established. Objective: This study explores the usefulness of the digit span test for Indian older adults with different levels of education. Methods: Two hundred and fifty-eight community-dwelling healthy normal older adults formed the sample of this study. All study participants were screened using a semi-structured interview schedule, the modified MINI Screen, the Indian version of the Mini-Mental State Examination, a measure of activities of daily living and the digit span test administered verbally. Results: The results indicated that participants with higher educational level performed significantly better than low-educated participants on the digit span test. Participants with low education often struggled with the digit span test and resorted to guessing the digits. Conclusion: Our study clearly demonstrates that the digit span test can be useful for educated participants. However, its usefulness and ecological validity is questionable for those with low education and low literacy, warranting future research.

RESUMO: O teste de span de dígitos é amplamente utilizado para avaliar a atenção e a memória de trabalho. É um teste portátil, relativamente livre de cultura e frequentemente usado. No entanto, a validade cultural deste teste, particularmente na população idosa indiana, não está bem estabelecida. Objetivo: Este estudo explora a utilidade do teste de amplitude de dígitos para idosos indianos com diferentes níveis de educação. Métodos: Duzentos e cinquenta e oito idosos saudáveis ​​normais residentes na comunidade formaram a amostra deste estudo. Todos os participantes da pesquisa foram selecionados usando uma entrevista semiestruturado, MINI Screen modificado, versão indiana do Mini Mental State Examination, uma medida de atividade da vida diária e teste do span de dígitos administrados verbalmente. Resultados: Os resultados indicaram que os participantes com alto nível de escolaridade tiveram desempenho significativamente melhor do que os participantes com baixo nível de escolaridade no teste de amplitude de dígitos. Participantes com baixa escolaridade muitas vezes enfrentaram difficuldades com o teste de amplitude de dígitos e recorreram a adivinhar os dígitos. Conclusão: Nosso estudo demonstra claramente que o teste de amplitude de dígitos pode ser útil para participantes instruídos. No entanto, sua utilidade e validade ecológica são questionáveis ​​para aqueles com baixa escolaridade e letramento, requerendo pesquisas futuras.

The influence of working memory capacity on academic achievement of final year medical students

This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited, 41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from 3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05). The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.

Cognitive Function in Patients with First Lacunar Infarct / 中国康复理论与实践

@#Objective To evaluate the cognitive impairment and the related factors in patients after first lacunar infarct （LI）. Methods96 patients with LI and 40 controls were assessed with mini-mental state examination（MMSE）, digit span test （DST）, verbal fluency test （VFT）and clock drawing test （CDT）. ResultsThe scores of MMSE, DST, VFT and CDT were significantly lower in LI group than in control group (P＜0.05). Cognitive impairment occurred in 37 (38.5%) patients with LI after first stroke. The scores of MMSE, DST, VFT and CDT were lower in the patients with multiple infarcts than with single infarct (P＜0.05), and lower in patients with infarcts affecting the frontal lobe, thalamus and basal ganglia than affecting other area (P＜0.05). The scores of MMSE were lower in the patients with prior vascular risk factors than without risk factors (P＜0.05). ConclusionLacunar infarction usually leads to cognitive impairment. Cognitive function is associated with multiple infarcts, lesions affecting the frontal lobe, thalamus and basal ganglia and those with prior vascular risk factors.

Comparison of Working Memory Among the Subtypes of Child and Adolescent Attention-Deficit/Hyperactivity Disorder

OBJECTIVES: This study investigated the differences of working memory among the subtypes of ADHD. METHODS: Eighty-one children and adolescents with ADHD and thirty normal controls were recruited. Children with any cognitive disorders and low intelligence were excluded. In order to evaluate the verbal and visuospatial working memory, Digit span and Finger windows tasks were measured, respectively. Performances on these measures between children with ADHD and controls were compared. Further, performances among the groups of ADHD predominantly inattentive(ADHD-IA)(n=40), predominantly hyperactive-impulsive(ADHD-HI)(n=10), and combined type(ADHD-C)(n=31), were compared. RESULTS: Scores of Finger windows forward task were lower in the ADHD group as compared to the control group, whereas, the Digit span forward showed no difference. Both scores of Digit span backward and Finger windows backward task were lower in the ADHD group than the controls. Children with ADHD-IA performed poorer than children with ADHD-C on the Finger windows backward task. CONCLUSION: The results of this study showed that children with ADHD have deficits in spatial short-term memory and verbal and visuospatial working memory when compared to normal children. The deficits were evident in children with ADHD-IA subtype and in particular, performance on the visuospatial working memory task in this group was poorer than the ADHD-C group.

Desempenhos nas duas tarefas do subteste dígitos do WISC-III e do WAIS-III / Performances in the forward and backward digit span in the WISC-III and WAIS-III

O subteste Dígitos está incluído no WISC-III e no WAIS-III, constituindo uma medida de atenção e memória de trabalho. Considerando que o desempenho em cada parte desse subteste implica em funções cognitivas diferentes, a determinação dos padrões de desempenho e das discrepâncias pode ser útil na investigação clínica. O artigo apresenta os resultados das amostras de normatização brasileiras dos testes WISC-III e WAIS-III nas ordens direta e inversa dos dígitos, analisando-se as discrepâncias entre cada uma delas. Os sujeitos recordaram mais dígitos na ordem direta do que na inversa. No WISC-III, a mediana da quantidade máxima de dígitos que as crianças memorizaram foi de cinco na ordem direta e três na ordem inversa. No WAIS-III, a mediana alcançada pela amostra foi de cinco dígitos na ordem direta e de quatro na inversa. O número de dígitos retido foi menor que o reportado para as amostras de normatização americanas.

Digit Span subtest is comprised in the WISC-III and WAIS-III and it constitutes an attention and working memory measure. Assuming that performance in each part of this subtest implies in different cognitive functions, the determination of performance patterns and of discrepancies can be useful in clinical evaluation. The present article shows the results of the samples of Brazilian standardization of the tests WISC-III and WAIS-III in the forward and backward orders of the digits, analyzing the discrepancies between each of them. Subjects remembered a larger number of digits in the forward than in the backward. In WISC-III, the median of the maximum amount of digits retained by children was five digits in the forward and three in the backward. In WAIS-III, the median was five digits in the forward and four digits in the backward. The number of digits retained was lower than the reported for the American standardization samples.

Neurocognitive Deficits during the Acute and Remitted Stages of Schizophrenia / 신경정신의학

OBJECTIVES: The purpose of this study is to examine whether the neurocognitive deficits of schizophrenia may be associated with certain features of symptomatology or a stable vulnerability of disease itself. METHOD: The 42 schizophrenic patients and 35 matched normal controls with sex, age, and education level were examined for their sustained attention, sensory register, executive function, concentration and attention, and verbal memory and learning in the acute and remitted stages of schizophrenia using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test, respectively. RESULTS: The schizophrenic patients showed significant deficits in the sustained attention, sensory register, executive function, and verbal memory and learning compared with the normal controls in both acute and remitted stages of schizophrenia. Regarding the concentration and attention, the schizophrenic patients showed significant deficits in the backward digit span compared with the normal controls during acute stages, but there was no difference between two groups in the forward and backward digit span during remitted stages. No difference was evident in the sustained attention, sensory register, executive function, and verbal memory and learning between acute and remitted stages of schizophrenia. But the forward and backward digit span of schizophrenic patients showed significant improvement in the remitted stages compared with acute stages. CONCLUSIONS: The sustained attention and sensory register deficits in the visual information processing associated with schizophrenia, detected by high-processing-load version of the Degraded Stimulus Continuous Performance Test and Span Apprehension Task, are highly possible to be stable vulnerability indicators. Executive functioning deficit in the schizophrenic patients detected by Wisconsin Card Sorting Test is not likely to be dependent on symptoms, so it is difficult to conclude that it is a stable vulnerability indicators of schizophrenia. In the digit span task, the forward digit span is more likely to be a episodic indicator but the backward digit span is likely to be a mediating vulnerability indicator. And the forward and backward digit span tasks seem to be tap different cognitive abilities that are differentially associated with the diathesis for schizophrenia. Some forms of the verbal memory and learning deficits associated with schizophrenia appear to be a stable vulnerability indicators.