Systemic arterial hypertension and cognition in adults: effects on executive functioning / Hipertensão arterial sistêmica e cognição em adultos: efeitos no funcionamento executivo

ABSTRACT Background: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (WAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37±12.29) and education (10.98±4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.

RESUMO Introdução: As alterações do sistema nervoso central associadas à hipertensão arterial sistêmica (HAS) são progressivas e podem ocasionar efeitos negativos no desempenho cognitivo. O objetivo deste estudo foi investigar a relação entre a HAS e os componentes das funções executivas (FE), controle inibitório (CI), atualização e alternância, comparando um grupo controle (sem HAS) a pacientes com HAS, em dois níveis de gravidade. Métodos: O protocolo incluiu os seguintes testes para avaliar os componentes das FE: T.O.V.A. Test (CI), Dígitos Ordem Indireta da Escala de Inteligência Wechsler para Adultos (Wechsler Adults Intelligence Scale - WAIS-III), Fluência Verbal fonêmica e semântica (atualização) e Teste de Trilhas parte B (alternância). Resultados: Foram incluídos 204 participantes, sendo 56 do Grupo Controle (GC), 87 HAS estágio 1 (HAS 1) e 61 de HAS estágio 2 (HAS 2). Os grupos não foram diferentes em relação à idade (52,37±12,29) e escolaridade (10,98±4,06). Em relação à pressão arterial (PA) controlada, tempo de tratamento da HAS e número de medicações, o grupo HAS 2 apresentou pior controle de PA, mais tempo de tratamento da HAS e uso de maior número de medicações quando comparado ao grupo HAS 1. Os achados revelaram que os pacientes com HAS em estágio mais grave apresentaram pior desempenho nos testes de alternância (Teste de Trilhas parte B) e atualização (Dígitos Ordem Indireta, FV fonêmica e semântica). Conclusão: Esses resultados sugerem que pacientes com a HAS possuem prejuízo significativo em FE, especificamente em alternância e atualização, e que esse prejuízo pode ser diretamente proporcional à gravidade da HAS. Sugere-se que, em estudos futuros, incluam-se exames de neuroimagem com o objetivo de excluir possíveis doenças cerebrovasculares.

Contribuição do funcionamento executivo para o risco de obesidade extrema / Contribution of executive functioning to the risk of morbid obesity

O presente estudo tem como objetivo verificar se o funcionamento executivo pode influenciar o processo de obesidade extrema. Foi utilizada uma amostra composta por 48 participantes, que foram avaliados através dos seguintes instrumentos: Teste do Mapa do Zoo; Stroop Color and Word Test; Figura Complexa de Rey; e Trail Making Test (parte B). Os resultados mostraram que as provas Mapa do Zoo e Figura Complexa de Rey apresentam um efeito estatisticamente significativo sobre o logit da probabilidade de sofrer obesidade extrema, pelo que défices executivos podem se repercutir num comportamento alimentar mal adaptativo. Estes resultados comprovam a necessidade de identificar de forma precoce os défices executivos. Estas alterações podem ter um impacto no aumento da adiposidade e consequentemente poderão conduzir a obesidade. Desta forma, é possível delinear intervenções mais adequadas, com o intuito de educar as decisões alimentares destes indivíduos

This work aims to verify if the executive functioning can influence the development of morbid obesity. It was used a sample of 48 subjects, which were evaluated by the following neuropsychological assessment tools: Zoo Map; Stroop Interference Test; Rey Complex Figure; and Trail Making Test (part B). The results have shown that the Zoo Map and the Rey Complex Figure have a statistically significant effect on the probability of suffering of morbid obesity, so that executive deficits may lead to a maladaptive eating behavior. These results confirm the need to identify early executive deficits. These changes may have an impact on the increase of adiposity and, consequently, on the evolution of an obesogenic process. Thus, it is possible to delineate more appropriate interventions, in order to educate the eating habits of these individuals

Research of gnostic functions in the elderly people suffering from dementia

The study was aimed at investigating the features of gnostic functions in the elderly people suffering from dementia. To implement the objectives of the study and to solve the set tasks, the following methods were used: visual gnosis tests (recognition of images, the selection of three subject pictures, selecting parts of a whole, etc.), the acoustic gnosis tests (score and perception of rhythms, recognition of nonspeech sounds), and tactile gnosis tests (tactile identification, Teuber test, Foerster test). When running the visual gnosis tests, the elderly people with the dementia diseases slowly initiated the tasks, made numerous errors, and sometimes could not cope with the tasks at all. Also, the perception integrity disorders, the presence of fragmentation, lack of accuracy, differentiation, preservation of specific objective images-objects, and the violation in the understanding of the spatial arrangement of things were revealed. When performing the auditory-motor coordination tests, the elderly people suffering from dementia needed more time to listen to, they asked for the repeated sound representation, and there were often errors in the rhythmic structure reproduction. When performing the tactile gnosis tests, the elderly people suffering from dementia had difficulties in identifying the subject by touch, in understanding the right and left-sided spatial relationships, and also made errors in recognizing one of the touches when the experimenter touched their hands. Based on the study results, the recommendations have been developed for the preservation and improvement of the existing gnostic functions' disorders in the elderly people suffering from dementia. The recommendations are complex, and they can also be useful for the medical staff whose professional activity is directly related to the elderly people suffering from dementia, their relatives and the persons closest to them.

Subjective Age and Cognitive Functioning in Old Age

OBJECTIVE: The present study has examined whether subjective age would be associated with cognitive functioning in older adults. METHODS: Data from the third wave of Korean Social Life, Health, and Aging Project were used. This study was conducted with 152 older adults aged 60–89 years (mean=72.26, standard deviation=6.41) who completed measures of subjective age, Mini-Mental State Examination for Dementia Screening, Elderly Verbal Learning Test, Digit Span Test, Korean-Color Word Stroop Test, Trail Making Test, Verbal Fluency Test, Korean Boston Naming Test-Short form. The association of subjective age and cognitive functioning was analyzed using hierarchical regression analysis. Sex, depression, and chronological age were included as control variables. RESULTS: Hierarchical regression analysis revealed that a younger subjective age was associated with better processing speed, immediate memory, and executive function respectively. Even after controlling for chronological age, depression, and sex, the subjective age was associated with cognitive functioning in old age. CONCLUSION: Beyond chronological age, the subjective experience of age was associated with cognitive aging.

Assessment of Cognition in Schizophrenia Using Trail Making Test: A Meta-Analysis

OBJECTIVE: The present meta-analysis aimed to analyze the cognitive performance of schizophrenia patients measured by Trail Making Tests (TMT) and the contribution of socio-demographic factors to cognitive impairments. METHODS: PubMed and PsycARTICLES databases were searched for the studies published between January 1985 and November 2017. Data were drawn from 19 studies encompassing 1095 patients and 324 controls. The effect size and heterogeneity were assessed with Comprehensive Meta-Analysis version 2 using random-effect model. RESULTS: Overall, the results showed that the schizophrenia patients performed significantly (p < 0.001) worse than healthy controls in both TMT-A and B. However, concurrent substance abuse, clinical status (inpatient or outpatient), duration of education and duration of illness were not associated with cognitive impairment among the schizophrenia patients. CONCLUSION: The present meta-analysis confirmed the cognitive processing speed and flexibility of schizophrenia patients were impaired. However, their duration of education, duration of illness and clinical status (inpatient or outpatient) were not the risk factors.

Modified Criteria for Diagnosing “Cognitive Frailty”

The concept of cognitive frailty has recently been proposed by an International Consensus Group as the presence of physical frailty and cognitive impairment [defined using the Clinical Dementia Ratings (CDR)=0.5], without concurrent dementia. However, CDR is difficult to implement and not often available in epidemiologic studies or busy clinical settings, and an alternative to CDR is required. We suggest an alternative definition of cognitive frailty as: 1) physical frailty, 2) more than 1.5 standard deviation below the mean for age-, gender-, and education-adjusted norms on any cognitive function test (e.g., the Montreal Cognitive assessment test, the Alzheimer’s disease assessment scale-cognitive subscale, verbal learning test, Digit Span, Boston Naming Test, Trail Making Test, and Frontal Assessment Battery), and 3) no dependency in instrumental activities of daily living. The redefined criteria for cognitive frailty would be more feasible to implement and thus more applicable in epidemiologic studies and busy clinical settings.

Brazilian norms and effects of age and education on the Hayling and Trail Making Tests / Normas brasileiras e efeitos de idade e escolaridade no Teste Hayling e no Teste de Trilhas

Abstract Objectives To describe normative data for the Hayling Test and the Trail Making Test (TMT) in a sample of Brazilian adults, and to investigate the effects of age and education on test performance. Method A total of 313 (TMT) and 364 (Hayling) individuals with age ranges of 19-39, 40-59, and 60-75 years, and with at least 5 years of formal education, participated in this study. The tests were administered as part of a large battery of a normative project. Individuals were evaluated individually in silent, ventilated rooms at a university clinic. Instrument protocols were scored by trained research assistants and double-checked to ensure data reliability. Results There were major effects of age on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Errors B/15, B/45), and major effects of education on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Time A, Errors B/15, B/45). Interaction effects were found in Time B and B-A for the Hayling Test and in Time A for the TMT. Conclusions Age and education were critical for performance on both verbal and non-verbal executive functions.

Resumo Objetivos Descrever dados normativos do Teste Hayling e do Teste de Trilhas em uma amostra de adultos brasileiros e investigar os efeitos de idade e escolaridade no desempenho das tarefas. Método Participaram deste estudo um total de 313 (TMT) e 364 (Hayling) indivíduos com idades nos intervalos de 19-39, 40-59 e 60-75 anos e com pelo menos 5 anos de escolaridade formal. Os testes foram administrados como parte de uma bateria maior de um projeto de normatização. Os indivíduos foram avaliados individualmente em salas silenciosas e ventiladas em uma clínica universitária. As pontuações dos protocolos foram realizadas por assistentes de pesquisa treinados e foram checadas duplamente para garantir a fidedignidade dos dados. Resultados Foram encontrados efeitos principais de idade no TMT (Tempo B, Erros B e Tempo B-A) e no Teste Hayling (Erros B/15 e B/45), e efeitos principais de educação no TMT (Tempo B, Erros B e Tempo B-A) e no Teste Hayling (Tempo A, Erros B/15 e B/45). Foram encontrados efeitos de interação entre variáveis nos Tempos B e B-A do Teste Hayling e no Tempo A do TMT. Conclusões Idade e escolaridade foram fatores críticos para o desempenho em ambos os testes verbal e não-verbal de avaliação das funções executivas.

Executive Dysfunction in Obsessive-Compulsive Disorder and Anterior Cingulate-Based Resting State Functional Connectivity

OBJECTIVE: Executive dysfunction might be an important determinant for response to pharmacotherapy in obsessive-compulsive disorder (OCD), and could be sustained independently of symptom relief. The anterior cingulate cortex (ACC) has been indicated as a potential neural correlate of executive functioning in OCD. The present study examined the brain-executive function relationships in OCD from the ACC-based resting state functional connectivity networks (rs-FCNs), which reflect information processing mechanisms during task performance. METHODS: For a total of 58 subjects [OCD, n=24; healthy controls (HCs), n=34], four subdomains of executive functioning were measured using the Rey-Osterrieth Complex Figure Test (RCFT), the Stroop Color-Word Test (SCWT), the Wisconsin Card Sorting Test (WCST), and the Trail Making Test part B (TMT-B). To probe for differential patterns of the brain-cognition relationship in OCD compared to HC, the ACC-centered rs-FCN were calculated using five seed regions systemically placed throughout the ACC. RESULTS: Significant differences between the OCD group and the HCs with respect to the WCST perseverative errors, SCWT interference scores, and TMT-B reaction times (p<0.05) were observed. Moreover, significant interactions between diagnosis×dorsal ACC [S3]-based rs-FCN strength in the right dorsolateral prefrontal cortex for RCFT organization summary scores as well as between diagnosis×perigenual ACC [S7]-based rs-FCN strength in the left frontal eye field for SCWT color-word interference scores were unveiled. CONCLUSION: These network-based neural foundations for executive dysfunction in OCD could become a potential target of future treatment, which could improve global domains of functioning broader than symptomatic relief.

Anatomical Correlates of Neuropsychological Deficits Among Patients With the Cerebellar Stroke

OBJECTIVE: To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. METHODS: We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. RESULTS: Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score < 0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. CONCLUSION: The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

Anatomical Correlates of Neuropsychological Deficits Among Patients With the Cerebellar Stroke

OBJECTIVE: To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. METHODS: We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. RESULTS: Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score < 0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. CONCLUSION: The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

Relationship Between Cognitive Function and Dysphagia After Stroke

OBJECTIVE: To investigate the characteristics of cognitive deficits in patients with post-stroke dysphagia, and to analyze the relationships between cognitive dysfunction and severity of dysphagia in supratentorial stroke. METHODS: A total of 55 patients with first-ever supratentorial lesion stroke were enrolled retrospectively, within 3 months of onset. We rated dysphagia from 0 (normal) to 4 (severe) using the dysphagia severity scale (DSS) through clinical examinations and videofluoroscopic swallowing studies (VFSS). The subjects were classified either as non-dysphagic (scale 0) or dysphagic (scale 1 to 4). We compared general characteristics, stroke severity and the functional scores of the two groups. We then performed comprehensive cognitive function tests and investigated the differences in cognitive performance between the two groups, and analyzed the correlation between cognitive test scores, DSS, and parameters of oral and pharyngeal phase. RESULTS: Fugl-Meyer motor assessment, the Berg Balance Scale, and the Korean version of the Modified Barthel Index showed significant differences between the two groups. Cognitive test scores for the dysphagia group were significantly lower than the non-dysphagia group. Significant correlations were shown between dysphagia severity and certain cognitive subtest scores: visual span backward (p=0.039), trail making tests A (p=0.042) and B (p=0.002), and Raven progressive matrices (p=0.002). The presence of dysphagia was also significantly correlated with cognitive subtests, in particular for visual attention and executive attention (odds ratio [OR]=1.009; 95% confidence interval [CI], 1.002–1.016; p=0.017). Parameters of premature loss were also significantly correlated with the same subtests (OR=1.009; 95% CI, 1.002–1.016; p=0.017). CONCLUSION: Our results suggest that cognitive function is associated with the presence and severity of post-stroke dysphagia. Above all, visual attention and executive functions may have meaningful influence on the oral phase of swallowing in stroke patients with supratentorial lesions.

Avaliação da percepção de fala em usuários de próteses auditivas após ajuste fino via mapeamento de fala com estímulo em Português / Speech perception evaluation in hearing aid users after fine tuning with speech mapping in Brazilian Portuguese

RESUMO Objetivo Avaliar a percepção de fala de adultos usuários de próteses auditivas, antes e depois do ajuste fino realizado com base nos resultados obtidos no Mapeamento de Fala com Estímulo em Português (MFP). Métodos Participaram desta pesquisa 20 adultos, com idades entre 18 e 60 anos, com perda auditiva neurossensorial bilateral simétrica de grau moderado a severo, usuários de próteses auditivas digitais, com no mínimo, seis meses de experiência e programadas de acordo com a regra prescritiva National Acoustics Labs, Non-Linear, version 1 (NAL-NL1).Para avaliação da percepção de fala, foi aplicado o Teste Listas de Sentenças em Português (LSP) em dois momentos distintos: T1, antes do ajuste fino realizado com base no MFPe T2, após ajuste fino realizado com base no MFP. O teste Lista de Sentenças em Português (LSP) possibilitou a pesquisa do Limiar de Reconhecimento de Sentenças no Silêncio (LRSS) e do Limiar de Reconhecimento de Sentenças no Ruído (LRSR), bem como a Relação Sinal/Ruído (S/R) necessária para compreensão das sentenças do teste. Resultados Verificou-se melhora significativa dos LRSS e LRSR no momento T2, ou seja, após o ajuste fino para alcance dos alvos prescritos. Em ambas as medidas, houve redução dos valores: o LRSS médio caiu de 39,60 dB para 34,41 dB e a relação sinal/ruído, de 5,82 dB para 3,34 dB. Conclusão Foi possível estabelecer uma relação nítida entre o alcance dos alvos prescritos e a melhora na percepção de fala. Usuários de próteses auditivas apresentaram melhor desempenho em testes verbais após o ajuste das características eletroacústicas de suas próteses auditivas, por meio do procedimento de mapeamento de fala.

ABSTRACT Purpose To evaluate the speech perception of adult hearing aid users pre and post fine tuning based on Speech Mapping in Brazilian Portuguese (SMBP). Methods Twenty adults aged 18 to 60 years old presenting moderate to severe bilateral symmetrical sensorineural hearing loss and wearing digital hearing aids programmed according to the prescriptive formula National Acoustics Labs, Non-Linear, version 1 (NAL- NL1) for at least six months participated in this study. The test Lists of Sentences in Portuguese (LSP) has been used to evaluate speech perception. The test was applied in two different moments: T1 - before hearing aid fine tuning based on the SMBP and T2 - after fine tuning based on SMBP. The LSP test allowed the Sentence Recognition in Silence (SRTS) and in Noise (SRTN) Threshold calculation and the minimal signal to noise ratio (SNR) required to understand the sentences. Results There was significant improvement of SRTS and SRTN in moment T2, or after hearing aid fine-tuning, to reach the prescribed targets. In both tests decreased values could be observed; the average SRTS fell from 39.60 dB to 34.41 dB and the signal to noise ratio (SNR) fell from 5.82 dB to 3.34 dB. Conclusion It was possible to establish a clear link between achieving the prescribed targets and the improvement in speech perception. Hearing aid users performed better on speech perception tests after adjustments of the electroacoustic characteristics of their hearing aids based on the Speech Mapping procedure.

Correlation between Quantitative Electroencephalogram Findings and Neurocognitive Functions in Patients with Obsessive-Compulsive Disorder and Schizophrenia

OBJECTIVES: Obsessive-compulsive disorder (OCD) and schizophrenia have many common clinical and neurocognitive features. However, not all of them share the same underlying mechanism. The aim of this study was to discover evidences that indicate a pathophysiological mechanism specific to OCD by comparing correlations of quantitative electroencephalography (QEEG) patterns and neurocognitive function in patients with OCD and schizophrenia. METHODS: Resting-state QEEG data of total 265 patients were acquired retrospectively and parameters such as absolute power, relative power and peak frequency were analyzed from the data. Stroop test and Trail Making Test results as well as demographic features were reviewed for this study. The correlation of neurocognitive functions and brain electrical activities in each group were assessed and compared by correlation analysis. RESULTS: Compared with the OCD group, the schizophrenia group performed poorly in neurocognitive tests. Mean values of QEEG parameters in patients with OCD and schizophrenia did not show significant differences. Both absolute and relative power of alpha rhythm in central and frontal regions showed significant positive correlation with Stroop test results in OCD patients. CONCLUSIONS: Findings in this study shows distinctive correlations between frontal executive dysfunction and frontal alpha rhythm in the OCD patients, both of which might be a candidate for endophenotype underlying obsessive rumination.

Menopause and Cognitive Function : Hospitalized Female Patients with Depression

OBJECTIVES: Although forgetfulness is a common complaint among menopausal depressed women, there is still a debate about the relationship between memory impairment and menopause. The aim of this study is to examine whether menopause is related to cognitive decline among women with depressive disorders. We hypothesized that postmenopausal depressed women show generally poorer performance than premenopausal depressed women on various cognitive function tests. METHODS: With a retrospective chart review, we identified a total of 87 female patients (45 premenopausal patients and 42 postmenopausal patients) who were hospitalized with depressive disorders from 2000 to 2016. Demographic and clinical variables and cognitive test results were compared between two groups. RESULTS: ducation year is longer in premenopausal group than postmenopausal group whereas clinical characteristics (illness duration, recurrence, and symptom severity) and mean Intelligence Quotient (IQ) were similar between two groups. The postmenopausal group took longer time for Bender-Gestalt Test (BGT) recall, Trail Making Test (TMT)-A, and TMT-B than the premenopausal group. After controlling for age and education, significant difference was remained for BGT recall (p = 0.029). CONCLUSIONS: Postmenopausal state may be related with decline of visuospatial memory function, in particular, among depressed female patients. Other areas of cognitive function including complex attention, verbal memory, auditory memory, and working memory might be interpreted while considering age and education level.

A Comparison of Five Types of Trail Making Test in Korean Elderly

BACKGROUND AND PURPOSE: Previously developed Korean versions of the Trail Making Test (TMT) that replaced the English in part B, has been unsuccessful in Korea. The current study identifies the type of TMT tasks from the among multiple TMT versions, which practically and accurately detects the stage of cognitive decline. METHODS: We applied five TMT versions, which include the original TMT, TMT-Korean letter (TMT-KL), TMT-Korean consonant (TMT-KC), TMT-black and white (TMT-B&W), and TMT-square and circle (TMT-S&C). A total of 168 participants were enrolled: 42 cognitively normal controls (NC), 72 patients with mild cognitive impairment (MCI), and 54 patients with Alzheimer's disease (AD). Two sets of TMT (set "A" including TMT, TMT-KL and TMT-B&W, and set "B" including TMT, TMT-KC, and TMT-S&C) were randomly administered to subjects within the contact of a fixed neuropsychological battery. RESULTS: The completion times of TMT-B and TMT-B&W successfully distinguished NC from MCI and AD. TMT-B&W also showed a high correlation with other neuropsychological tests, and correlated well with the original TMT. The other TMT were frequently not successfully completed, nor could they differentiate the clinical groups. CONCLUSIONS: Among the five TMT tasks, the original TMT and the TMT-B&W appeared to be most sensitive to the degree of cognitive impairment. TMT-B&W showed a pattern consistent with the original TMT; thus, this measure may be optimal in Korean older adults, where familiarity with the English alphabet is questionable.

Genetic Variations in Attention Deficit Hyperactivity Disorder Subtypes and Treatment Resistant Cases

OBJECTIVE: ObjectiveaaWe evaluated the distribution of alpha-2A adrenergic receptor (ADRA2A) and catechol-o-methyltransferase (COMT) single nucleotide polymorphisms (SNPs) among ADHD subtypes and other homogeneous patient populations including treatment-resistant cases and patients with high symptom severity. METHODS: Methodsaa121 ADHD patients aged 6-18 years were included in the study. Diagnosis and subtypes designation were confirmed using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and symptoms were evaluated using the Conners' Parent (CPRS) and Teacher Rating Scales (CTRS). The response to methylphenidate was assessed objectively using the Clinical Global Impression-Severity Scale (CGI-S) and Global Assessment of Functioning Scale (GAS) as well as the Continuous Performance (CPT) and Trail Making tests (TMT-A, B). Patients were genotyped for ADRA2A (rs1800544) and COMT (rs4680) SNPs by PCR/RFLP and compared to a gender-matched control group. RESULTS: Although there was no association of COMT (rs4680) SNP with symptoms or diagnosis, the ADRA2A polymorphism, low socioeconomic status (SES), and comorbid psychiatric diagnosis were all associated with poor response to methylphenidate in logistic regression analysis. CONCLUSION: Clinicians may consider adjuvant strategies when these negative factors are present to increase the success of tailored ADHD treatments in the future.

Gender-specific Associations of the Brain-derived Neurotrophic Factor Val66Met Polymorphism with Neurocognitive and Clinical Features in Schizophrenia

OBJECTIVE: To explore associations of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism with cognitive functioning and psychopathology in patients with schizophrenia. METHODS: We included 133 subjects meeting the DSM-IV criteria for schizophrenia who were in the post-acute stage of the disease. BDNF Val66Met genotypes were identified via polymerase chain reaction. The computerized neurocognitive function battery, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Scale (SOFAS), and the Subjective Well-being under Neuroleptic Treatment (SWN-K) were administered. Gender-stratified sub-analysis was also conducted to identify gender-specific patterns in the findings. RESULTS: In male patients, no significant difference in any measure by BDNF genotype was evident. In female patients, scores on the CDSS and total PANSS and all subscales were significantly higher in valine (Val) carriers. In addition, scores on the SOFAS and SWN-K were significantly lower in Val carriers. In terms of neurocognitive measures, female patients with the Val allele had significantly poorer reaction times and fewer correct responses on the Continuous Performance Test (CPT) and the Trail Making Test (Parts A and B). After adjustment of PANSS total scores and log-transformed CDSS scores, CPT outcomes were significantly poorer in female patients with than in those without the Val allele. CONCLUSION: Gender-specific associations of the Val allele with poor neurocognitive function and more severe psychopathology were evident. Further studies are required to explore the mechanisms of these differences and the potential utility of the BDNF genotype as a predictor of outcome in patients with schizophrenia.

Influencia de la memoria de trabajo y la flexibilidad cognitiva en la ejecución de la tarea balloon analogue risk task / Influence of Working Memory and Cognitive Flexibility in Performance of the Balloon Analogue Risk task

Diversos estudios plantean la importancia que tienen las funciones ejecutivas como la flexibilidad cognitiva, la inhibición y la memoria de trabajo en la toma de decisiones. En este estudio se pretende valorar si la memoria de trabajo y la flexibilidad cognitiva, procesos cognitivos presentes en la toma de decisiones, pueden explicar las alteraciones en el rendimiento de los pacientes con daño cerebral adquirido (DCA) en la Balloon Analogue Risk Task (BART). A 73 pacientes con DCA se les administró la BART, el Trail Making Test (TMTB) y el Wisconsin Card Sorting Test (WCST), para valorar la flexibilidad cognitiva; y el subtest Letras y Números (LN) del WAIS-III para evaluar la memoria de trabajo. Los mismos test fueron administrados a un grupo control de 30 sujetos sin DCA. En el grupo clínico, las variables neuropsicológicas estudiadas incluidas para explicar la variación del BART$ fueron TMTB, p < .001, y WCST, p <.001. Observamos que únicamente la flexibilidad cognitiva valorada con WCST y TMTB pudo explicar las alteraciones en el rendimiento de los pacientes con DCA en la BART. Por tanto, es lógico pensar que si el rendimiento de la BART depende de la flexibilidad cognitiva de estos pacientes, entonces es de esperar que dicha capacidad sea un buen factor predictivo en la toma de decisiones.

A number of studies have raised the importance of certain executive functions such as attention, cognitive flexibility, response inhibition, and working memory in decision-making. The purpose of this study is to prove whether or not working memory and cognitive flexibility, capacities present in decision-making, can explain the changes in the performance of patients with acquired brain damage in Balloon Analogue Risk Task (BART). 73 patients with adult Acquired Brain Injury (ABI) were assessed with the BART, Trail Making Test B (TMTB), Wisconsin Card Sorting Test (WCST) to asses cognitive flexibility; and subtest Letter-Number (LN) of WAIS -III to asses working memory. The same test was administered to a control group of 30 subjects without ABI. In the clinical group, the only variables studied that were included to explain the variation in BART$ were TMTB, p < .001, and WCST, p < .001. We observe that changes in the performance of our patients with ABD in BART could only be explained by cognitive flexibility. Therefore we can conclude that performance in BART depends on the cognitive flexibility of these patients; therefore, it is to be expected that this capacity will be a good predictor of decision-making.

The Influence of Levetiracetam in Cognitive Performance in Healthy Individuals: Neuropsychological, Behavioral and Electrophysiological Approach

OBJECTIVE: The present study sought to analyze the influence of Levetiracetam (LEV) in cognitive performance by identifying the changes produced by LEV in reaction time, in neuropsychological assessment of attention and memory and in absolute theta power in frontal activity. METHODS: Twelve healthy subjects (5 men and 7 women; mean age, 30.08 years, standard deviation, 4.71) were recruited for this study. The neuropsychological tests: Trail Making Test (A and B), Digit Span (direct and indirect numerical orders/working memory); Stroop test (inhibitory control of attention); Tower of London (planning and decision-making) and a quantitative electroencephalography were applied in 2 different days after and before the participants ingested the capsule of placebo or 500 mg LEV. RESULTS: A two-way-ANOVA was implemented to observe the interaction between conditions (placebo or LEV 500 mg) and moments (pre- and post-ingestion of LEV or placebo). The data were analyzed by the SPSS statistical package (p<0.05). For the neuropsychological parameter, the Trail Making Test (A) was the only test that showed significant difference for condition in the task execution time (p=0.026). Regarding the reaction time in the behavioral parameter, an interaction between both factors (p=0.034) was identified through a two-way-ANOVA (condition versus moment). Electrophysiological measures showed a significant interaction for electrodes: F7, F3, and FZ. CONCLUSION: The findings showed that LEV promotes an important cognitive enhancement in the executive functions.

Korean Facial Emotion Recognition Tasks for Schizophrenia Research

OBJECTIVE: Despite the fact that facial emotion recognition (FER) tasks using Western faces should be applied with caution to non-Western participants or patients, there are few psychometrically sound and validated FER tasks featuring Easterners' facial expressions for emotions. Thus, we aimed to develop and establish the psychometric properties of the Korean Facial Emotion Identification Task (K-FEIT) and the Korean Facial Emotion Discrimination Task (K-FEDT) for individuals with schizophrenia. METHODS: The K-FEIT and K-FEDT were administered to 42 Korean individuals with schizophrenia to evaluate their psychometric properties. To test the convergent and divergent validities, the Social Behavior Sequencing Task (SBST) and hinting task were administered as social-cognitive measures, and the Trail Making Test (TMT)-A and -B were administered as neurocognitive measures. RESULTS: Average accuracy on the K-FEIT and K-FEDT were 63% and 74%, respectively, and internal consistencies of the K-FEIT and K-FEDT were 0.82 and 0.95, respectively. The K-FEIT and K-FEDT were significantly correlated with SBST and Hinting Task, but not with TMT-A and B. CONCLUSION: Following replication studies in a larger sample, the K-FEIT and K-FEDT are expected to facilitate future studies targeting facial emotion recognition in schizophrenia in Korea. Limitations and directions for future research are discussed.