The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology.

Research into cognitive functions across psychological disorders suggests that cognitive deficiencies may be present across multiple disorders, potentially pointing to a transdiagnostic phenomenon. More recently, a single dimension model of psychopathology, the p factor, has been proposed, in which cognitive deficits are thought to be an intrinsic construct, assumed to be transdiagnostic. However, no systematic investigation to date tested this hypothesis. The aim of the present study was to systematically review meta-analyses to assess the hypothesis that the C factor (cognitive dysfunction) is transdiagnostic in psychopathology and review potential moderators that may account for such a phenomenon. We conducted a systematic review of meta-analyses examining cognitive function across all disorders for which data were available. Included meta-analyses (n = 82), comprising 97 clinical samples, yielded 1,055 effect sizes. Twelve major disorders/categories (e.g., bipolar disorder, substance use disorders) were included, comprising 29 distinct clinical entities (e.g., euthymic bipolar disorder; alcohol use disorder). Results show that all disorders reviewed are associated with underperformance across cognitive domains, supporting the hypothesis that the C factor (or cognitive dysfunction) is a transdiagnostic factor related to p. To examine moderators that may explain or contribute to c, we first consider important interpretative limitations of neuropsychological data in psychopathology. More crucially, we review oft-neglected motivational and emotional transdiagnostic constructs of p, as prominent contributing constructs to the C factor. These constructs are offered as a roadmap for future research examining these constructs related to p, that contribute, and may account for cognitive dysfunctions in psychopathology.

Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays.

BACKGROUND: Patient non-attendance is an expensive and persistent problem worldwide with rates between 5-39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic. METHODS: Records were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008-2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic. RESULTS: In the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004). DISCUSSION: Our data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients' ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments. CONCLUSION: Our results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide.

G but not g: In search of the evolutionary continuity of intelligence.

Conceptualizing intelligence in its biological context, as the expression of manifold adaptations, compels a rethinking of measuring this characteristic in humans, relying also on animal studies of analogous skills. Mental manipulation, as an extension of object manipulation, provides a continuous, biologically based concept for studying G as it pertains to individual differences in humans and other species.

Empirically derived algorithm for performance validity assessment embedded in a widely used neuropsychological battery: Validation among TBI patients in litigation.

INTRODUCTION: Validity of neuropsychological assessment depends, inter alia, on the cooperation of the examinee, requiring separate assessment. Stand-alone tests devised for detecting negative response bias (NRB) are exposed to potential threats to their validity. In this study, an algorithm was developed for assessing NRB within a standardized, computerized neuropsychological battery (NeuroTrax), making it difficult to detect and circumvent. METHOD: Data were collected from the archived medical records of 75 outpatients with mild to moderate head injury, all in litigation. Participants were classified as low or high likelihood for NRB, using a known test for effort assessment (Test of Memory Malingering). RESULTS: Variables judged to be prone for exaggeration and showing large differences between the groups were entered into a logistic regression analysis. The resulting formula exhibited high specificity (98.0%) and sensitivity (87.5%), classifying correctly 94% of the cases. CONCLUSION: It is suggested that the algorithm developed empirically using scores on the NeuroTrax computerized battery can be a useful tool for assessing effort. This algorithm should resist threats to its validity and can be automatically computed while assessing a range of cognitive skills.

Neuropsychological investigations in obsessive-compulsive disorder: A systematic review of methodological challenges.

The inconsistent nature of the neuropsychology literature pertaining to obsessive-compulsive disorder (OCD) has long been recognized. However, individual studies, systematic reviews, and recent meta-analytic reviews were unsuccessful in establishing a consensus regarding a disorder-specific neuropsychological profile. In an attempt to identify methodological factors that may contribute to the inconsistency that is characteristic of this body of research, a systematic review of methodological factors in studies comparing OCD patients and non-psychiatric controls on neuropsychological tests was conducted. This review covered 115 studies that included nearly 3500 patients. Results revealed a range of methodological weaknesses. Some of these weaknesses have been previously noted in the broader neuropsychological literature, while some are more specific to psychiatric disorders, and to OCD. These methodological shortcomings have the potential to hinder the identification of a specific neuropsychological profile associated with OCD as well as to obscure the association between neurocognitive dysfunctions and contemporary neurobiological models. Rectifying these weaknesses may facilitate replicability, and promote our ability to extract cogent, meaningful, and more unified inferences regarding the neuropsychology of OCD. To that end, we present a set of methodological recommendations to facilitate future neuropsychology research in psychiatric disorders in general, and in OCD in particular.

Response inhibition in a subclinical obsessive-compulsive sample.

BACKGROUND AND OBJECTIVES: Inconsistent findings across studies challenge the viability of response inhibition (RI) as an endophenotype of obsessive-compulsive disorder (OCD). Contemporary conceptualization of endophenotypes in psychiatric disorders suggests that these markers vary continuously in the general population, highlighting the importance of analogue sample research. Although neuropsychological functions have been studied in subclinical obsessive-compulsive (OC) samples, no study to date had examined RI in the context of the go/no-go paradigm. METHODS: A subclinical OC sample (HOC; n = 27) and a low OC symptoms control sample (LOC; n = 25), as determined by the Obsessive-Compulsive Inventory-Revised, completed a go/no-go task and clinical questionnaires. RESULTS: The groups did not differ on age, gender, or state anxiety. Controlling for depressive severity, the HOC group made significantly more commission errors and exhibited larger response time variability on the go/no-go task. However, standardized scores produced using population norms revealed that the HOC group performed within normative range. LIMITATIONS: This study used a non-clinical sample and no structured clinical screening was performed. CONCLUSIONS: Compared to LOC participants, a psychometrically-defined subclinical OC sample exhibited deficient RI and sustained attention. However, when raw scores were converted to age and education adjusted standardized scores according to the test's population norms, the HOC group task performance was in the normative range. These results, are in line with findings in OCD samples, suggesting that moderate degree of RI deficiencies is associated with the presence of OC symptomatology regardless of clinical status. However, the conceptualization of RI underperformance as an OCD disorder-specific impairment, remains controversial.

Costeff syndrome: clinical features and natural history.

Costeff syndrome (CS) is a rare autosomal-recessive neurological disorder, which is known almost exclusively in patients of Iraqi Jewish descent, manifesting in childhood with optic atrophy, ataxia, chorea and spastic paraparesis. Our aim was to study the clinical spectrum of CS and natural history using a cross-sectional study design. Consecutive patients with CS were recruited to the study. Patients were diagnosed based on clinical features, along with elevated urinary levels of methylglutaconic and methylglutaric acid, and by identification of the disease-causing mutation in the OPA3 gene in most. All patients were examined by a neurologist and signs and symptoms were rated. 28 patients with CS (16 males, 21 families, age at last observation 28.6 ± 16.1 years, range 0.5-68 years) were included. First signs of neurological deficit appeared in infancy or early childhood, with delayed motor milestones, choreiform movements, ataxia and visual disturbances. Ataxia and chorea were the dominant motor features in childhood, but varied in severity among patients and did not seem to worsen with age. Pyramidal dysfunction appeared later and progressed with age (r = 0.71, p < 0.001) leading to spastic paraparesis and marked gait impairment. The course of neurological deterioration was slow and the majority of patients could still walk beyond the fifth decade. While visual acuity seemed to deteriorate, it did not correlate with age. CS is a rare neurogenetic disorder that causes serious disability and worsens with age. Spasticity significantly increases over the years and is the most crucial determinant of neurological dysfunction.

Correlates of physical activity with intrusive thoughts, worry and impulsivity in adults with attention deficit/hyperactivity disorder: a cross-sectional pilot study.

BACKGROUND: Physical exercise is known to produce numerous psychological beneficial effects in healthy and clinical populations. Nevertheless, little is known about the relationship between exercise and ADhD symptoms, let alone among adults with ADhD. this study examines the association between exercise and three ADhD symptoms: (1) behavioral impulsivity; (2) intrusive unwanted thoughts and (3) worry. the latter two are cognitive facets of anxiety, a prominent symptom of ADhD. METHODS: Physical activity was measured using a selfreport questionnaire. thirty participants with a diagnosis of ADhD were divided into two groups: Participants engaging in frequent aerobic activity ("high activity" group), and participants engaging in non-frequent physical activity ("low activity" group). RESULTS: Adults with ADhD engaging in frequent aerobic physical activity report significantly less behavioral impulsivity and experience significantly less worrisome and intrusive thoughts. CONCLUSIONS: Our results reflect an association between physical activity and reduced symptoms of impulsivity and intrusive and worrisome thoughts in an adult ADhD sample. the results of this pilot study may encourage further investigations emphasizing the causal link between physical activity and ADhD symptoms. Suggested underlying neurobiological mechanisms, clinical implications and limitations are discussed.

Cerebral language reorganization in the chronic stage of recovery: a longitudinal fMRI study.

The goal of the present study was to investigate whether spontaneous functional recovery following insult to the language-dominant hemisphere continues in the so-called "chronic stage," and if so, to examine its neuro-functional correlates. We used a longitudinal functional magnetic resonance imaging (fMRI) block design, where each young patient served as his/her own control. Specifically, we examined whether language functions differed significantly in two monitoring sessions conducted years apart, both in the chronic stage, where almost no functional changes are expected. We focused on a unique cohort of young brain damaged patients with aphasiogenic lesions occurring after normal language acquisition, in order to maximize the potential of plasticity for language reorganization following brain damage. The most striking finding was that the linguistic recovery of our patients was significant not just relative to their linguistic scores on initial testing (T1), but also in absolute terms, relative to the respective age-matched normal population. Such improvement, therefore, cannot be simply attributed to the natural process of development. Overall, we found that right hemisphere (RH) activation was associated with better recovery in the chronic stage. Our longitudinal findings may challenge the view of recovery as ending within the first year following onset, suggesting that the RH may provide the substrate for ongoing plasticity in the damaged brain.

Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition.

BACKGROUND: Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk. METHODOLOGY/MAIN RESULTS: We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74-.98, p = .021), the attention index (RR: .84; CI: .75-.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01-1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02). CONCLUSIONS/SIGNIFICANCE: These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk.

Comparative neuropsychology of adult obsessive-compulsive disorder and attention deficit/hyperactivity disorder: implications for a novel executive overload model of OCD.

Research implicates frontostriatal pathophysiology in both attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Nevertheless, ADHD is characterized with frontostriatal hypoactivity and OCD with hyperactivity. Furthermore, both disorders seem to lie on opposite ends of a clinical impulsive-compulsive continuum. While never having directly been compared, and despite these differences, OCD and ADHD appear to share similar neuropsychological impairments especially in executive functions. This study aimed at comparing adults with OCD and adults with ADHD on neuropsychological measures and behavioural impulsivity and OC measures. Thirty OCD, 30 ADHD, and 30 matched healthy control (HC) participants were administered a comprehensive neuropsychological battery and completed several questionnaires. The groups were compared on all neuropsychological and clinical measures and correlations between neuropsychological and clinical symptoms were computed. The ADHD and OCD groups performed more poorly than HC on all neuropsychological domains and most domain subtests. The ADHD group reported significantly higher impulsivity than the OCD group. OCD patients did not differ from HC on behavioural impulsivity. A unique dissociation was found between impulsivity and response inhibition where both clinical groups showed similar response inhibition deficit, but differed significantly on impulsivity. Moreover, a negative association between OC symptoms and response inhibition and a bias in self-perception of impulsivity was found only in the OCD group. We propose an executive overload model of OCD that views neuropsychological impairments in OCD as an epiphenomenon, according to which continuous attempts to control automatic processes are associated with obsessive thoughts overflow that causes an overload on the executive system.

Neuropsychological impairments and their association with obsessive-compulsive symptom severity in obsessive-compulsive disorder.

Neurobiological research in obsessive-compulsive disorder (OCD) consistently demonstrates an association between abnormal brain activity and symptom severity. Conversely, research addressing the corresponding neuropsychological impairments in OCD and their association with symptom severity has produced inconsistent results. This study reexamines neuropsychological performance and its association with symptom severity in 30 participants with OCD while controlling for confounding variables. We used a computerized neuropsychological battery that was expected to provide more objective and accurate information and minimize examinee-examiner interactions, which may affect performance by reducing anxiety. The OCD group revealed dysfunctions on all neuropsychological domains compared with controls. OCD severity correlated significantly with the composite performance, executive functions, and verbal domain indexes. These results did not change after controlling for depression severity. We suggest that controlling for potential confounding variables and using a computerized battery may have contributed to the association found between obsessive symptoms and neuropsychological impairments. Theoretical implications are discussed.

Does normal fetal brain ultrasound predict normal neurodevelopmental outcome in congenital cytomegalovirus infection?

OBJECTIVE: We evaluated the neuropsychological outcome of children with proven congenital cytomegalovirus (CMV) infection and normal consecutive fetal neurosonographic examinations. METHODS: We retrospectively reviewed laboratory and imaging findings of children with congenital CMV infection. The study group consisted of children with a positive polymerase chain reaction (PCR) in amniotic fluid and virus isolation in urine in the first week of life, and normal fetal ultrasonographic (US) examination findings, including a normal multiplanar neurosonographic evaluation. Patients with abnormal magnetic resonance (MR) findings were not excluded. The study and control groups were evaluated for cognitive, language, and motor development at one follow-up examination conducted at 11-81 months of age. RESULTS: Children with congenital CMV infection and normal fetal brain findings in the US examination did not differ from the control group in terms of cognitive, language, motor, emotional-behavioral, and executive functioning. There were no differences between congenitally infected children who had a normal fetal brain MR examination and children whose fetal brain MR examination raised suspicion of a possible brain insult. CONCLUSIONS: Normal neurosonographic examinations during pregnancy appear to predict a normal early neuropsychological outcome in fetuses with congenital CMV infection. Outcome did not correlate with suspected abnormal white matter on fetal MR imaging.

Cerebral reorganization as a function of linguistic recovery in children: An fMRI study.

Characterizing and mapping the relationship between neuronal reorganization and functional recovery are essential to the understanding of cerebral plasticity and the dynamic processes which occur following brain damage. The neuronal mechanisms underlying linguistic recovery following left hemisphere (LH) lesions are still unknown. Using functional magnetic resonance imaging (fMRI), we investigated whether the extent of brain lateralization of linguistic functioning in specific regions of interest (ROIs) is correlated with the level of linguistic performance following recovery from acquired childhood aphasia. The study focused on a rare group of children in whom lesions occurred after normal language acquisition, but prior to complete maturation of the brain. During fMRI scanning, rhyming, comprehension and verb generation activation tasks were monitored. The imaging data were evaluated with reference to linguistic performance measured behaviorally during imaging, as well as outside the scanner. Compared with normal controls, we found greater right hemisphere (RH) lateralization in patients. However, correlations with linguistic performance showed that increased proficiency in linguistic tasks was associated with greater lateralization to the LH. These results were replicated in a longitudinal case study of a patient scanned twice, 3 years apart. Additional improvement in linguistic performance of the patient was accompanied by increasing lateralization to the LH in the anterior language region. This, however, was the result of a decreased involvement of the RH. These findings suggest that recovery is a dynamic, ongoing process, which may last for years after onset. The role of each hemisphere in the recovery process may continuously change within the chronic stage.

Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling.

BACKGROUND: Executive function (EF) deficits may increase fall risk, even among older adults with no overt cognitive impairment. Indeed, the effects of dual tasking (DT) on gait, a challenge to executive control, are more exaggerated in persons with a history of falls. Prospective evidence is, however, lacking. METHODS: We prospectively evaluated whether EF predicts falls over a 2-year period among 262 community-living, healthy, and well-functioning older adults, focusing on the 201 who reported no falls during the previous year. At baseline, participants completed a computerized cognitive battery that generated an index of EF and other cognitive domains. Gait was assessed using performance-based tests and by quantifying walking during single- and dual-task conditions. RESULTS: The 262 participants (mean age: 76.3 ± 4.3 years, 60.3% women) had intact cognitive function on testing, a low comorbidity index, and good mobility. The EF index predicted future falls. Among those who reported no previous falls, participants in the worst EF quartile were three times more likely to fall during the 2 years of follow-up, and they were more likely to transition from nonfaller to faller sooner. DT gait variability also predicted future falls and multiple falls, whereas other measures of cognitive function, gait, and mobility did not. CONCLUSIONS: Among healthy older adults, individuals with poorer EF are more prone to falls. Higher-level cognitive functions such as those regulated by the frontal lobes are apparently needed for safe everyday navigation that demands multitasking. Optimal screening, early detection, and treatment of falls should, apparently, also target this cognitive domain.

[Microcephaly diagnosed during pregnancy].

Microcephaly is defined postnatally as small head circumference (below the norm by more than two standard deviations (SD)). Incidence at birth: 1:6250-8500. The prenatal diagnosis of microcephaly, particularly in cases of primary microcephaly, is usually difficult before the 3rd trimester. Congenital microcephaly may present as an isolated finding, in this case it is known as primary microcephaly or microcephaly vera and may also be associated with a wide range of central nervous system (CNS) and non-CNS pathologies. The association between microcephaly and intellectual capabilities has frequently been searched but there is no definite correlation with prenatal diagnosis of microcephaly. Postnatally, the risk for developmental disabilities for microcephaly is 11% when head circumference is -2SD, 50-75% in -3SD and 100% when head circumference is smaller than -4SD. The lack of knowledge regarding the prognosis when microcephaly is found during pregnancy makes counselling difficult. In this review, the authors describe and define microcephaly and the association with intellectual disabilities, emphasizing the importance of prenatal diagnosis.

[The importance of prenatal neuroimaging in prediction of developmental outcome of fetuses infected with cytomegalovirus].

Cytomegalovirus (CMV) infection is the most common viral cause of congenital infection and one of the most common contributors to neurodevelopmental disabilities in children. The physiological condition of the infants at birth is a good predictor of long-term cognitive functioning, while children who manifest clinical symptoms at birth (symptomatic) are more likely to develop future cognitive impairments. Brain imaging studies from prenatal diagnosed children are scant, focusing mainly on fetuses with brain signs of CMV infection. While several studies demonstrate a poor outcome for children with neurosonographic findings during pregnancy, a systematic investigation regarding long-term neurodevelopmental outcome of fetuses infected with CMV, but without fetal ultrasonographic brain findings, has not been reported.

[Developmental outcome of fetal macrocephaly and associated syndromes].

Macrocephaly is defined as an enlargement of the head circumference above the 98th percentile or greater than two standard deviations above the mean normalized for age and gender. The diagnosis of enlarged head circumference can be made by ultrasound, during pregnancy. This condition may be caused by enlargement of any of the head's compartments. When resulting from excessive brain tissue, the condition is defined as megalencephaly. Macrocephaly can be associated with many genetic disorders. Emphasis is placed on its outcome. Although the literature concerning macrocephaly and its neurodevelopmental features is vast, there is no general consensus concerning its outcome. Several studies claim macrocephaly is usually a benign, familial condition without any clinical significance, while others claim an association between macrocephaly and learning and attention difficulties, visuo-motor problems and expressive and receptive deficits. Based on these reports, concerning macrocephaly identified in utero, doctors find it difficult to assess prognosis and provide clear guidelines for parents.

Unwanted intrusive and worrisome thoughts in adults with Attention Deficit\Hyperactivity Disorder.

Attention Deficit/Hyperactivity Disorder (ADHD) is associated with deficient motor and cognitive inhibitory mechanisms. The aim of this article is to examine two symptoms associated with cognitive disinhibition, namely: intrusive unwanted thoughts, worrisome thoughts and their suppression. Thirty-seven college students diagnosed with ADHD and 23 healthy college students were compared on the Distressing Thoughts Questionnaire and on the Anxious Thoughts Inventory. Results show that in comparison to the control group, participants with ADHD experienced significantly higher ratings on all intrusive thoughts scales, and three worrisome thoughts scales. Our results suggest that worrisome intrusive thoughts are an important phenotypical expression of adults with ADHD. A neurobiological explanation for this phenomenon is suggested, and clinical implications are discussed.

Adjustment of cognitive scores with a co-normed estimate of premorbid intelligence: implementation using mindstreams computerized testing.

Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of +/-1 SD and 6 normalized units for scores of +/-2 SD. The present approach shows promise as a practical solution for assessment of high- and low-intelligence individuals.