Cognitive Decline in Korean Patients with Neurocognitive Disorder due to Traumatic Brain Injury: A Control for Premorbid Intelligence

OBJECTIVE: Previous studies of cognitive decline in patients with neurocognitive disorder due to traumatic brain injury (NCD-TBI) have often failed to control for baseline factors such as premorbid intelligence. The purpose of the current study was to estimate and compare cognitive function among three groups (controls, complicated mild/moderate TBI, and severe TBI) after controlling for premorbid intelligence.METHODS: Severity of TBI was classified as complicated mild/moderate or severe based on duration of loss of consciousness and brain neuroimaging results. Premorbid intelligence quotients (IQs) were estimated with the Oklahoma Premorbid Intelligence Estimate. There were no differences in premorbid intelligence between the groups, which were also matched for age and education. Current cognitive function was evaluated with the Wechsler Adult Intelligence Scale-Fourth Edition.RESULTS: Comparison of current cognitive function among the three groups indicated significant group differences for all indexes and subtest scores. Processing speed showed the highest effect size. However, only working memory differed significantly between the two NCD-TBI groups.CONCLUSION: The present findings suggest that mental memory manipulation processes seem to be more sensitive to TBI severity than are perceptual-motor processes. Specifically, both auditory rehearsal/discrimination and mental alertness/manipulation will be most strongly influenced by TBI severity.

Results of cardiac electrical stability of Mongolian population of by the method of dispersion visual image electrocardiography / Монголын Анагаах Ухаан

Introduction@#Cardiovascular diseases remains the leading cause of morbidity and mortality in most developed and developing countries. The 34.3% of mortality are due to cardiovascular diseases are in Mongolia. The lifetime risk of cardiovascular disease can be predicted by cardiac electrical instability and arrhythmia findings in ECG. The lack of nationwide data and large multicenter studies in our country do not allow us to estimate the true extend of the problem and we want doing the analysis of the cardiac electrical stability and myocardial index.@*Goal@#Evaluate prevalence of cardiac electrical stability and myocardial index of Mongolian people@*Material end Methods@#The subjects were recruited from The “Brilliant Hospise” Hospital of Ulaanbaatar, between April 2017 to May 2018. A total of 1000 consecutive patients, aged between 20-70 years were selected. Research was conducted by descriptive research design, anamnesis, anthropometry measurement, laboratory research and was analyzed dispersion visual image ECG. Statistics data was analyzed by SPSS 27 software. @*Results@#1000 surveyed aged 20-70 questionnaires, anthropometry measurements, fasting venous blood cholesterol and glucose determined and ECG dispersion visual image sensitive to power quality integrated change and electrical instability of very low frequency change, stimulate the formation and electrical transmission loss, heart disease 23,7% of 610 people surveyed in a relatively healthy and electrical stability of the heart muscle are unchanged, tachycadia, power generation and transmission losses, thickening of the heart muscle, axial deviation, other heart disease due had myocardial electrical instability and changed HRV.@*Conclusion@#In this study, we demonstrated that prevalence of myocardial electrical instability and myocardial index of relatively healthy people Mongolia. 23,7% of all healthy people changed myocardial electrical instability and HRV. This method that sensitivity of dispersion functions in differentiating norm, premorbid stage and pathologies in many cases in higher than sensitivity of the usual ECG analysis.

Estimación de la Función Cognitiva Premórbida con el Test de Acentuación de Palabras / Estimation of Premorbid Cognitive Function with the Word Accentuation Test

Resumen Objetivo: La valoración premórbida de la función cognitiva es esencial para la interpretación de la presencia y severidad del deterioro cognitivo. El método más confiable para evaluar esto en países hispanohablantes es el Word Accentuation Test (WAT) / Test de Acentuación de Palabras (TAP), ya que predice los resultados de pruebas de inteligencia mediante una regresión linear. Resultados: En una muestra ecuatoriana, el TAP tiene buena consistencia interna y confiabilidad test-retest. La correlación del TAP con los puntajes del WAIS-IV es alta (r=.827), permitiendo el desarrollo de una ecuación de regresión para estimar las puntuaciones de CI. Además, se encontró que una muestra de pacientes con demencia funcionaba normalmente en el TAP en comparación con el grupo de control. Esto sugiere que el rendimiento del TAP se mantiene en la presencia de una enfermedad neurológica con un deterioro cognitivo y puede usarse para valorar inteligencia premórbida. Conclusiones: El TAP tiene buenas propiedades psicométricas y puede ser utilizado para estimar puntuaciones de pruebas de inteligencia en participantes sanos. También puede valorar puntajes de inteligencia premórbida en pacientes con enfermedades neurológicas o psiquiátricas, permitiendo una interpretación clara de la gravedad del deterioro. Esta evaluación podría utilizarse en contextos clínicos y de investigación.

Abstract Objectives: Premorbid estimation of cognitive function is essential for the interpretation of the presence and severity of actual cognitive impairment. The most reliable method in Spanish speaking countries is with the Word Accentuation Test (WAT) / Test de Acentuación de Palabras (TAP). This is used to predict intelligence test scores by linear regression. Results: In an Ecuadorian sample the TAP was found to have good internal consistency and test-retest reliability. The correlation of the TAP with WAIS-IV full IQ scores was high (r= .827), allowing the development of a regression equation to estimate IQ scores from TAP performance. Furthermore, a sample of dementia patients was found to perform normally on the WAT compared to a matched control group. This suggests that WAT performance holds in the presence of neurological illness with associated cognitive impairment. Conclusions: The WAT has good psychometric properties and can be used to rapidly estimate actual intelligence test scores in healthy participants. It can also estimate premorbid intelligence scores in patients with neurological or psychiatric illnesses, allowing a clearer interpretation of the severity of impairment. This simple assessment could be used in various research and clinical contexts.

Vocabulary Knowledge is Not a Predictor of General Cognitive Functioning in Elderly People with Very Low Educational Attainment

BACKGROUND AND PURPOSE: Vocabulary knowledge is used as a representative index of general intelligence, and is regarded as a marker for cognitive reserve in elderly people. However, vocabulary knowledge mainly depends on formal education, hence, it may not fully represent cognitive functioning in elderly people with poor educational backgrounds. Herein, we investigated whether vocabulary knowledge is a measure of general cognitive ability among normal elderly people with few years of formal education. METHODS: The association between vocabulary knowledge and general cognitive functioning was compared between 35 elderly females with very low educational attainment and 68 elderly females with higher education. RESULTS: The vocabulary knowledge was a significant predictor of general cognitive functioning in elderly individuals with more than primary education, even after controlling the effects of age and years of education. However, it was not a significant predictor of general cognitive functioning in elderly individuals with very low educational attainment. CONCLUSIONS: Vocabulary assessment was effective in estimating general cognitive functioning in elderly individuals who received ≥6 years of education. Our findings suggested that vocabulary knowledge may not be an effective proxy of premorbid intelligence or cognitive reserve in people who have not completed elementary schooling.

Performance of a sample of patients with Mild Cognitive Impairment (MCI), Alzheimer's Disease (AD) and healthy elderly on a lexical decision test (LDT) as a measure of pre-morbid intelligence / Desempenho de uma amostra de pacientes com Comprometimento Cognitivo Leve (CCL), doença de Alzheimer (DA) e idosos saudáveis em Teste de Decisão Lexical (TDL) como medida de QI pré-mórbido

Objective:The objective of this study was to describe the performance of healthy elderly patients with aging-related pathologies (MCI) and patients with AD on a lexical decision test.Methods:The study included 38 healthy elderly subjects, 61 MCI and 26 AD patients from the Neurology Department of the Hospital das Clinicas, Behavioral and Cognitive Neurology Group. The neuropsychological instruments included the episodic memory test (RAVLT), subtests from the WAIS-III (Matrix Reasoning and Vocabulary) to determine estimated IQ, the Boston naming test (BNT) and Lexical Decision Test (LDT).Results:All groups differed on the MMSE, as expected according to their pathologies, memory tests, naming and estimated IQ. For the vocabulary and the LDT - measures of crystalized intelligence no differences were found.Conclusion:The LDT demonstrated that lexical decision can be used as a measure of pre-morbid IQ among the individuals assessed in a Brazilian sample.

Objetivo:O objetivo deste artigo é descrever o desempenho de idosos saudáveis, idosos com patologias relacionadas ao envelhecimento (CCL) e de idosos com DA, em teste de decisão lexical.Métodos:Participaram 38 idosos saudáveis, 61 CCL e 26 DA, atendidos no Setor de Neurologia do Hospital das Clínicas (GNCC) e do Centro de Referência em Distúrbios Cognitivos (CEREDIC). Os instrumentos neuropsicológicos incluíram teste de memória episódica (RAVLT), Subtestes do WAIS-III (Vocabulário e Raciocínio Matricial) para estabelecer QI estimado, teste de nomeação (BNT) e o Teste de Decisão Lexical (TDL).Resultados:Todos os grupos diferiram quanto ao MEEM, de acordo com o esperado para as patologias, para os testes de memória, para a nomeação e o QI estimado. No caso do vocabulário e do TDL - medidas de inteligência cristalizada não apresentaram diferença.Conclusão:O TDL permitiu que se mostrasse que a decisão lexical pode ser uma medida de QI pré-mórbido nos indivíduos avaliados em uma amostra da população brasileira.

Metodologias de estimação da Inteligência Pré-Mórbida na identificação do declínio cognitivo / Premorbid intelligence measures in identifying cognitive decline / Metodologías de estimación de inteligencia premórbida en la identificación de deterioro cognitivo

A avaliação do declínio cognitivo implica a mensuração de uma discrepância entre o nível de funcionamento anterior a uma lesão ou situação de declínio (pré-mórbido) e o estado atual do indivíduo. No entanto, dados relativos ao funcionamento pré-mórbido (ou Inteligência Pré-Mórbida: IPM) raramente se encontram disponíveis, sendo necessário recorrer a métodos indiretos de estimação. O presente estudo apresenta uma abordagem histórica do desenvolvimento das várias metodologias de estimação da IPM, sistematizando e analisando a validade desses métodos, desde as primeiras abordagens qualitativas, às recentes estratégias mais quantitativas. Concluise que a metodologia mais válida, fiável e promissora para a estimação da IPM combina, em fórmulas de regressão, a informação relativa à capacidade atual do sujeito e dados referentes a variáveis demográficas. O constante desenvolvimento de metodologias de estimação da IPM progressivamente mais fiáveis evidencia a importância desta variável na avaliação e investigação psicológica...

Cognitive decline assessment implies measuring discrepancies between the subject's previous (premorbid) and the current levels of functioning. However, this information is rarely available and clinicians have to infer it by using indirect methods. This article provides an historical overview of the different methods that have been developed for premorbid intelligence estimation, from the first qualitative methods to the most recent quantitative approaches. The discussion sustains that the most valid methods for premorbid intelligence estimation are those that combine current level of the subject's performance and demographic variables in regression formulas. The constant development of premorbid estimation methods with increasing validity is suggestive of the importance that this measure has for psychological assessment...

La evaluación del deterioro cognitivo supone la medición y definición de la presencia de una discrepancia entre el nivel del funcionamiento anterior a una lesión o situación de deterioro (premórbido) y el estado actual del indivíduo. Sin embargo, los datos referidos relativos al funcionamiento premórbido (o inteligencia premórbida: IPM) raramente se encuentran disponibles, siendo necesario recurrir a métodos indirectos de estimación. El presente estudio presenta un método de acercamiento histórico del desarrollo de diferentes metodologías de estimación de la IPM, sistematizando y analizando brevemente la validez de estos métodos desde los primeros acercamientos cualitativos a recientes estrategias más cuantitativas. Se concluye sobre la metodología más válida, fiable y prometedora para la estimación del IPM que combina, en fórmulas de regresión, la información relativa a la capacidad actual del sujeto y datos referentes a las variables demográficas. El constante desarrollo de metodologías de estimación de la IPM, cada vez más fiables, demuestra la importancia que esta variable ocupa en la evaluación e investigación científica...

Premorbid intelligence of patients with cerebral infarction:estimation and utilization / 中华行为医学与脑科学杂志

Objective To explore the methods for estimating premorbid intelligence of patients with cerebral infarction.Methods Ten regression equations were employed to estimate intelligence quotients (IQs) of 74 patients and 74 demographically matched,healthy adults.Those valid estimated IQs were transformed into standard scores and adopted to evaluate the difference with don' t hold' subtests.Results In the healthy group,there were trivial difference between the estimated IQs and obtained IQs with mean discrepancy less than one and the correlation coefficients between them ranged from 0.755 to 0.956.However in the patients group,the estimated IQs were significantly higher than obtained IQs with mean discrepancy of 3.20-10.67.Mean estimated IQs of the patient group were lower than those of healthy group to varing degrees with mean discrepancy of 0.83-8.28,in which the mean IQs estimated just with demographic variables showed small between group effect size of 0.26,and so did IQs estimated with combination of demographic variables and performance on the Information or Figural Matrix (effect size:0.24 and 0.38 respectively).The latter two kinds of estimated IQs were adopted and transformed into standard scores to estimate premorbid intelligence.The two kinds of estimated normal scores of intelligence were higher than normal scores of the Digit Symbol (0.70 and 0.63 respectively) and the Block Design(0.67 and 0.61 respectively)in the patients group.As regarding the healthy group,the counterparts of discrepancies between estimates of intelligence and obtained scores were 0.21,0.21,0.12 and 0.12 respectively,which were significantly smaller than those in the patients group.Conclusion IQ estimated with combination of demographic variables and performance on the Information or Figural Matrix are suggested to estimate premorbid intelligence of patients with cerebral infarction.

Relationship between Premorbid Personality and Behavioral and Psychological Symptoms in Dementia in Korean Patients with Alzheimer's Disease

OBJECTIVE: We performed a cross-sectional study to examine the relationship between premorbid personality and behavioral and psychological symptoms in dementia (BPSD) in Korean patients with Alzheimer's disease (AD). METHODS: We assessed 103 patients diagnosed with AD for the presence of BPSD over the disease course by using the caregiver-rated Korean version of the Neuropsychiatric Inventory (K-NPI) and for the premorbid personality by using a retrospective version of the NEO-Five Factor Inventory questionnaire completed by informants. RESULTS: Premorbid neuroticism was significantly correlated with delusion, agitation, anxiety, disinhibition, total K-NPI score (p<0.05), and sleep disturbances (p<0.01). Lower premorbid conscientiousness was significantly correlated with symptoms of hallucinations and sleep disturbances in AD patients (p<0.05). However, premorbid neuroticism and low premorbid conscientiousness did not act as independent predictors for "psychosis, hyperactivity," or "moods, apathy, frontal" factors of BPSD. CONCLUSION: Premorbid personality was associated with the K-NPI score, but was not observed to be potential predictors of BPSD.

Rasgos de personalidad en pacientes con esquizofrenia / Personality traits in patients with schizophrenia

In recent years, research on the comorbidity of personality disorders and other clinical conditions has increased. Nevertheless, it is quite surprising that very little research has been done in terms of personality and its disorders in patients with schizophrenia. Most of the studies related to the binomial construct of personality disorders and schizophrenia are limited to the study of premorbid personality, which emphasizes the importance of the interaction between trait-personality disorder-schizophrenia symptoms. The study of personality in patients with schizophrenia suggests several issues that must be considered, including the trait-state interactions and the role of personality in the course of schizophrenia. The conceptual definition of trait emerges from the dimensional classification of models of personality. In this way, knowing that some personality features are present in all individuals, we can assume that their deviation in a quantitative level results in abnormal personality features that constitute personality disorders or even can be expressed as a specific expression of some schizophrenia symptoms. Although there is growing evidence in the knowledge of schizophrenia, there are very few models that include the scientific neurobio-logical evidence of the disease and personality features. An inclusive model may promote our understanding of the relationship between schizophrenia symptoms and the personality features of the patient who suffers the disease. So far, we are still far from reaching scientific consensus to be unanimously shared by all researchers with respect to both issues. Nevertheless, the importance of personality in schizophrenia is undeniable, so future longitudinal that assess personality characteristics since illness onset should be warranted. These studies may be extremely useful to determine personality stability during the course of the illness and may help to determine the prognosis and treatment implications of personality in schizophrenia.

En los últimos años han proliferado las investigaciones y publicaciones sobre la comorbilidad de los trastornos de personalidad con otras entidades clínicas. En este marco sorprende la escasez de estudios que se centren en la personalidad y sus trastornos en los pacientes con esquizofrenia. Las investigaciones llevadas a cabo en el binomio trastorno de personalidad-esquizofrenia se han limitado al estudio de la personalidad premórbida, las cuales se orientan hacia la importancia de la interacción rasgo-trastorno de personalidad-síntomas en la esquizofrenia. El estudio de la personalidad en la esquizofrenia sugiere varias cuestiones que deben ser consideradas, incluyendo las interacciones rasgo-estado y la función de la personalidad en la esquizofrenia. El concepto de rasgo surge en los modelos dimensionales de clasificación de la personalidad. Si consideramos que los rasgos de la personalidad están presentes en todos los individuos, cabría decir que una desviación en el nivel cuantitativo de los mismos caracteriza los rasgos anormales que constituirán los trastornos de personalidad o en una expresión específica de los síntomas de la esquizofrenia. A pesar de los avances crecientes en el conocimiento de la esquizofrenia, existen pocos modelos que integren los avances neurobiológicos con la personalidad, lo cual permitiría un mayor entendimiento de la relación entre los síntomas de la esquizofrenia y la personalidad del individuo que la padece. Hasta el momento, aún nos encontramos lejos de poder alcanzar acuerdos científicos que sean compartidos unánimemente por todos los investigadores con respecto a ambas cuestiones. Sin embargo, la importancia de la personalidad en la esquizofrenia es innegable, lo que hace necesario la realización de estudios longitudinales que evalúen de forma específica las características de la personalidad desde el inicio de la esquizofrenia para poder determinar su estabilidad o variabilidad de acuerdo al curso del padecimiento y sus implicaciones pronósticas y de tratamiento.

The Effect of Premorbid Demographic Factors on the Recovery of Neurocognitive Function in Traumatic Brain Injury Patients

OBJECTIVE: Premorbid demographic backgrounds of injured individuals are likely to reflect more accurately the status of patients with traumatic brian injury (TBI) than clinical factors. However, the concrete study about the relationship between the demographic factors and neurocognitive function in TBI patients has not been reported. The object of this study was to evaluate the effect of premorbid demographic factors on the recovery of neurocognitive function following TBI. METHODS: From July 1998 to February 2007, 293 patients (male: 228, female: 65) with a history of head injury, who had recovered from the acute phase, were selected from our hospital to include in this study. We analyzed the effect of premorbid demographic factors including age, sex, educational level and occupation on the recovery of neurocognitive function in each TBI subgroup as defined by Glasgow Coma Scale (GCS) score. Intelligence and memory are components of neurocognitive function, and the Korean Wechsler Intelligence Scale (K-WAIS) and the Korean memory assessment scale (K-MAS) were used in this study. The results were considered significant at p<0.05. RESULTS: The higher level of education was a good prognostic factor for intelligence regardless of GCS score and younger age group showed a better result for memory with an exception of severe TBI group. In the severe TBI group, the meaningful effect of demographic factors was not noted by the cause of influence of severe brain injury. CONCLUSION: The demographic factors used in this study may be helpful for predicting the precise prognosis and developing an appropriate rehabilitation program for TBI patients.

Factors related to Disturbing Behaviors, Premorbid Personality and Depression in the Pre-demented Elderly and the Mild Demented Elderly

PURPOSE: The purpose of this study was to identify premorbid personality, depression and disturbing behaviors to provide information for developing nursing interventions for the pre-demented and mild demented elderly living as residents of their community. METHOD: The survey was conducted through direct interviews using a structured questionnaire in J city. Among the subjects contacted, 89 made appropriate replies to the survey. RESULT: The subjects' disturbing behaviors were significantly related to premorbid personality and depression. The predictors to disturbing behaviors of the pre-demented elderly were sex, extroversion, neuroticism and conscientiousness. The predictors to disturbing behaviors of the mild demented elderly were agreeableness, depression, sex, conscientiousness, and extroversion. CONCLUSION: In conclusion, disturbing behaviors of pre-demented elderly and mild demented elderly are affected not only by their premorbid personality but also by their depression. Therefore, it is necessary to encourage and respond to them with understanding their disturbing, behaviors in relation to their premorbid personality. In addition. it is important to maintain positive emotion in order to reduce their disturbing behaviors.

Clinical Correlates of Duration of Untreated Psychosis in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Number of previous studies reported poor treatment outcome of longer duration of untreated psychosis (DUP). The purpose of this study was to determine whether DUP was associated with clinical and cognitive variables in patients with schizophrenia in Korea. METHODS: The data were collected from forty-five patients with DSM-IV schizophrenia who were hospitalizaed. Demographic data, psychiatric family history, insight, duration of first hospitalization, age of onset, DUP, cognitive function, and premorbid functioning were assessed. RESULTS: The mean DUP was 23.7 months. Female subjects showed longer DUP (p<0.007) independent of age of onset. No significant correlations were observed between DUP and clinical and cognitive variables except the highest Global Assessment Functioning score in past year (r=-0.35, p=0.02). CONCLUSION: These findings do not support the hypothesis of a psychotoxic effect of prolonged period of untreated psychosis.

Early Development and Premorbid Social Adjustment during Childhood and Adolescence in Schizophrenic Patients / 신경정신의학

OBJECTIVES: Schizophrenia, one of the major mental illnesses, shows abnormal developmental patterns such as delayed developmental milestones, impaired language and motor function, and poor premorbid social adjustment long before the onset of clinical symptoms of illness. In this study, we tried to find out developmental patterns and premorbid adjustment during childhood and adolescence in Schizophrenic patients. METHODS: The subjects were 56 inpatients (26 male patients and 30 female patients) who met the diagnostic criteria for schizophrenia by DSM-IV and 52 healthy control subjects (25 male patients and 26 female patients). Interview with subjects and their families and the review of medical records were done to assess sociodemographic factors, timing of developmental milestones, language and motor function of childhood, and timing of sexual maturational events. Obstetrical Complication Scale of Lewis was used to get information on the subjects' prenatal and perinatal history, and Premorbid Social Adjustment Scale (PSAS) to assess premorbid adjustment. RESULTS: 1) There were no significant differences in the rates of obstetrical complications. The deveolpmental milestones during infancy such as sitting, walking, age of first sentence were significantly delayed in the Schizophrenics than in the controls (p<0.05). 2) Disturbances of speech and language development were significantly more common in the schizophrenics than in the controls (p<0.05), but there were no significant differences in the rates of disturbance in motor development. Mean ages of reading and writing were significantly delayed in schizophrenics than in the controls (p<0.05). No significant differences were found between males and females for either language disturbance or motor disturbance in the Schizophrenics. 3) During adolescence, premorbid adjustment was poorer in Schizophrenic patients (p<0.05). The Schizophrenic patients scored significantly worse than the controls on both sociability and schooling domains (p<0.05). There was a trend for correlation between poor premorbid functioning and early age of onset, but it failed to achieve statistical significance (Spearman's coeff =-0.27, p=.07). 4) Male Schizophrenic subjects showed poorer premorbid functioning on schooling domain than female Schizophrenic subjects (p<0.05). No significant difference was recogni ed in timing of sexual maturational events between Schizophrenics and controls. CONCLUSION: In summary, the Schizophrenics were significantly delayed in infantile developmental milestones, impaired in development of language, delayed mean age of reading and writing, and showed poorer premorbid social adjustment than the controls.