Comparison of cognitive functioning of elders with late-life depression and patients with and without a history of depressive episodes: a cross-sectional study.

Nowadays there are numerous studies on the occurrence of cognitive dysfunction in late-life depression (LLD). The role of executive dysfunctions in the psychopathology of depression is particularly emphasized and needs further examination. The aim was to assess cognitive functions and their relation to depressive symptoms in elders with LLD, previously depressed, and patients without the history of depressive episodes. The study consisted of 824 older adults who underwent a neuropsychological evaluation (97 currently depressed, 114 previously depressed and 613 patients without the history of depressive episodes). LLD patients performed poorer in ACE-III and AVLT and poorer in TMT-B than those previously depressed and never depressed. The LLD group also performed significantly poorer than the previously depressed on Digit Span Forward. Results of a multiple regression analysis indicated that performance on measures of executive functioning was associated with depression severity in LLD (ß =.227, P =.024). The results of this study suggest that executive functions are the most impaired in the elderly with LLD. Furthermore, there is a relationship between executive dysfunction and the severity of depression in LLD. Executive dysfunction appears to be the core neurocognitive deficit in LLD.

Prospect of using schema therapy in working with sex offenders. / Perspektywa zastosowania terapii schematów w pracy ze sprawcami przestepstw seksualnych.

The search for effective methods of treating sex offenders is essential in order to reduce the risk of their subsequent sexual offences. This article presents Jeffrey Young's concept of Schema Therapy with a discussion on the appropriateness of its use in the treatment of those who engage in problematic sexual behaviour directed against sexual freedom. Such behaviours are prohibited by law and are connected to committing crimes set out in Chapter XXV of the Penal Code (including rape, exploitation of helplessness, abuse of dependence relation, sexual act with a minor under 15 years of age). The article presents the main assumptions of schema therapy. Then, with reference to the main assumptions of this therapeutic approach, a theoretical model of schema therapy in the context of violent sexual behaviour is proposed and discussed. The authors also attempted to analyze the mechanism of formation and perpetuation of deviant criminal behaviors in the context of key constructs of this approach, such as: early maladaptive schemas, schema modes, and coping styles. As Schema Therapy has proven to be effective in treating chronic personality aspects of disorders, often underlying the sexual pathology of the sex offenders, this approach seems to be a promising trend for such a difficult population of people.

Subjective experience, cognitive functioning and trauma level of patients undergoing awake craniotomy due to brain tumor - Preliminary study.

BACKUP AND OBJECTIVE: Awake craniotomy (AC) for brain tumors, when the patient is conscious during the operation, allows to reduce the risk of motor disability and aphasia, however, it may be a source of extreme stress. The aim of our study was to examine the patients' subjective experience of the surgery including the level of psychological trauma and cognitive functioning. METHOD: Eighteen patients operated due to brain tumor were enrolled in this study. The Essener Trauma-Inventory Questionnaire and the Addenbrooke's Cognitive Examination (ACE III) were administrated. The patients' experience with awake craniotomy was evaluated with a qualitative descriptive survey. RESULTS: All patients remembered the intraoperative neuropsychological examination and several sensations like: drilling, cold, head clamp fixation or having eyes covered. In most of the patients the postoperative psychological trauma experience did not reach the clinical level. The ACE III postoperative scores revealed partial cognitive deficits with the lowest scores in memory and word fluency domains. Slight amnestic aphasia was observed postoperatively only in two patients. CONCLUSIONS: Awake craniotomy for resection of brain tumors is well-tolerated by patients and does not cause significant psychological trauma. Nonetheless, anxiety about the procedure warrants further study and individualized neuropsychological care is needed for the emotional preparation of the patient.

Is Addenbrooke's Cognitive Examination III Sensitive Enough to Detect Cognitive Dysfunctions in Patients with Focal Cerebellar Lesions?

OBJECTIVE: The main aim of the study was to evaluate whether the available brief test of mental functions Addenbrooke's cognitive examination III (ACE III) detects cognitive impairment in patients with cerebellar damage. The second goal was to show the ACE III cognitive impairment profile of patients with focal cerebellar lesions. METHOD: The study sample consisted of 31 patients with focal cerebellar lesions, 78 patients with supratentorial brain damage, and 31 subjects after spine surgery or with spine degeneration considered as control group, free of organic brain damage. The ACE III was used. RESULTS: Patients with cerebellar damage obtained significantly lower results in the ACE III total score and in several subscales: attention, fluency, language, and visuospatial domains than healthy controls without brain damage. With the cut-off level of 89 points, the ACE III was characterized by the sensitivity of 71%, specificity of 72%, and accuracy of 72%. The cerebellar cognitive impairment profile was found to be "frontal-like" and similar to that observed in patients with anterior supratentorial brain damage, with decreased ability to retrieve previously learned material and its preserved recognition, impaired word fluency, and executive dysfunction. The results are consistent with cerebellar cognitive affective syndrome. CONCLUSIONS: The ACE III can be used as a sensitive screening tool to detect cognitive impairments in patients with cerebellar damage.

Differences in personality related determinants of empathetic sensibility in female and male students of medicine.

The issues of personality and its relations with the level of empathetic sensibility of medical doctors are broadly discussed in the literature. The aim of this study was an assessment of personality related predictors of empathy indicators in female and male students of medicine with consideration of gender differences. Methods applied were Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R). The study included 153 participants, who were students of the fifth year of medical studies. Students filled in questionnaires during workshops in clinical psychological skills. Participation in the study was voluntary and anonymous. The statistical analysis was performed using Statistica 13 PL and PS IMAGO PRO (SPSS). Linear regression analysis with the interaction component was performed to explore the relationship between personality factors and gender and their interaction with the variable dependent level of empathy. The analysis showed that Extraversion, Openness and Agreeableness are associated with the level of Empathic Concern. Neuroticism, Extraversion, Agreeableness and Conscientiousness are associated with the level of Personal Distress. Extraversion, Openness, Agreeableness and Conscientiousness are associated with the level of Perspective-taking. The regression analysis with the interactive component showed that there is no relationship between gender and the level of empathy, therefore the interactions were insignificant. Empathetic sensibility is related to personality dimensions of the students of medicine. Although there has been no interaction among chief personality dimensions, empathy indicators and gender, detailed analysis of personality dimensions' components has shown differences between men and women.

Changes in cognitive functions and quality of life in patients after transcatheter aortic valve implantation.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for patients with severe aortic stenosis (AS). However, an association between cognitive functions (CF) and health-related quality of life (HRQoL) in TAVI patients is still unclear. AIM: To assess the long-term changes in CF and HRQoL in elderly patients with AS after TAVI. MATERIAL AND METHODS: A total of 259 patients who underwent cardiological and psychological TAVI qualification were enrolled and divided into the normal (n = 174) and impaired cognition group (n = 85). CF and HRQoL characteristics assessed at baseline and 13 months were compared between groups. The analysis of multiple linear regression was performed to identify the association between HRQoL and CF and to assess the influence of TAVI on HRQoL. RESULTS: There was no difference in CF between baseline and follow-up. However, an improvement in attention functions and memory skills in the cognitively impaired group was noted at follow-up. In addition, HRQoL scores increased in both groups. An independent predictor associated with HRQoL was global CF (ß = -213, p = 0.01), which explained 7% of CF variation. Improvements in all five dimensions of HRQoL, from 4.8% in self-care and up to 33.6% in pain/discomfort, were found. At follow-up, 60% of TAVI patients had improved health, 12% had worse health, 4% showed no change and 24% had a "mixed" change. CONCLUSIONS: TAVI is associated with positive changes in the functioning of elderly patients at long-term follow-up.

Executive functions and working memory in motor control: Does the type of MCI matter?

The purpose of this study was to evaluate the association between functional mobility performance and executive functions in older adults with the amnestic (aMCI) and nonamnestic (naMCI) type of mild cognitive impairment (MCI), as well as in a control group. A cross-sectional study was conducted among 800 older adults (147 with MCI) who participated in a longitudinal study consisting in an interdisciplinary geriatric assessment and rehabilitation program in Kraków. Motor performance was measured with the Timed Up and Go test (TUG), while standard neuropsychological tests were used to assess different cognitive domains. Analysis of the entire sample showed that almost all cognitive domains and the presence of MCI are associated with functional mobility. Executive functions, letter fluency, and working memory were associated with TUG in the MCI group. The MCI type was not a significant moderator of the relationship between cognitive and motor performance. In group analyses, various cognitive predictors for TUG in the aMCI group, naMCI, and control group were demonstrated. Our results suggest that executive functions and working memory in aMCI and letter fluency in naMCI are independently associated with functional mobility performance. Executive functions are important for gait control in MCI.

"Cerebellar lesions after low-grade tumor resection can induce memory impairment in children, similar to that observed in patients with frontal lesions".

The aim of the present study was to specify if cerebellar lesions cause memory impairment in children. The study sample consisted of 44 children with low-grade cerebellar astrocytoma, who underwent surgical treatment and 30 healthy controls, matched with regard to age and sex. Memory was tested using the Rey Auditory Verbal Learning Test AVLT, Corsi Block-Tapping Test, Digit Span, Digit Backwards and Information Subtests from the Wechsler Intelligence Scale for Children-Revised WISC-R (PL). Patients with cerebellar lesions demonstrated memory impairments, similar to those typical for patients with frontal lesions, with auditory and visuospatial working memory deficits, a disorganized learning process without mnemonic strategy (executive dysfunctions) and problems with recalling new material from long-term memory storage, while maintaining good recognition of previously learned material, preserved semantic knowledge and short-term auditory-verbal memory (digit span). Obtained results showed that memory deficits would vary according to the side of the cerebellar lesion, with more pronounced impairment of visuospatial memory tasks accompanying the left-sided cerebellar lesions and worse performance of verbal memory task, observed in the group of patients with right-sided cerebellar lesions. Although the presence of hydrocephalus significantly worsens the memory performance of the children studied, patients with cerebellar lesions without hydrocephalus still present significantly lower memory indicators in the profile described, compared to the control group of healthy children. It confirms the hypothesis that cerebellar lesion alone could result in memory dysfunctions in children.

[Clinical and demographic predictors of mild cognitive impairment - cross-sectional study].

OBJECTIVE: Introduction: Cognitive limitations are a serious health and social problem, which concerns elderly people. Effective prevention and treatment of cognitive dysfunction is one of the challenges of modern medicine. There is not enough consistent data in the literature to indicate to indicate the relationship between various clinical and demographic factors with cognitive functioning in different age ranges. The aim: To analyze clinical and demographic predictors of mild cognitive impairment by age group. PATIENTS AND METHODS: Material and methods: The analysis included 817 participants (669 with normal cognitive function and 148 people with MCI). The evaluation of the level of depressive symptoms was measured by the Short Form Geriatric Depression Scale. All participants were screened for cognitive functioning using the Mini-Mental State Examination and Addenbrooke's Cognitive Examination-III. Different cognitive domains were evaluated with different neuropsychological tools: the Rey Auditory Verbal Learning test, Clock Drawing test, Verbal Fluency test, Digit Span Test and Trail Making test. RESULTS: Results: It has been shown that independently associated with MCI ware age (OR = 1.09, 95% CI: 1.05-1.13) and level of education (OR = 0.75, 95% CI: 0.69-0.81). Depending on the age, it turned out that in the younger MCI group, age, education and depression were significant, and the age and level of education were significant in the older MCI group. CONCLUSION: Conclusions: The identification of cognitive dysfunctions is an important element of the diagnostic and therapeutic process.

Global cognitive functioning and physical mobility in older adults with and without mild cognitive impairment: evidence and implications.

INTRODUCTION: Co-occurrence of physical and cognitive dysfunctions contribute to functional decline and a gradual loss of independence. OBJECTIVES: The purpose of this study was to evaluate the association between global cognitive impairment and physical mobility in older adults with and without mild cognitive impairment (MCI). MATERIAL AND METHODS: A total of 800 older adults were recruited (653 with normal cognitive functioning and 147 participants with MCI). Motor performance was measured with the Timed Up and Go test (TUG) and the 6 Minute Walk Test (6MWT). Cognitive functions were evaluated using Mini- Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination (ACE-III). RESULTS: ACE-III scores were associated with the TUG test performance in older adults (with and without MCI), but not with 6MWT results. The overall score in ACE-III and its subscales, i.e. a) memory and fluency in the MCI group and in the total group, and b) fluency in the control group, were associated with TUG after adjusting for age, sex, body mass index, medication use, depressive symptoms, hypertension, coronary artery disease and diabetes. In the case of the 6MWT test results, only the ACE-III fluency subscale scores and not the overall ACE-III score were associated with them. CONCLUSIONS: Global cognitive function, verbal fluency and memory were independently associated with the TUG. ACE-III, being a more extensive testing tool than MMSE, made it possible to show the relationship between global cognition and motor skills.

Slow gait as a motor marker of mild cognitive impairment? the relationships between functional mobility and mild cognitive impairment.

The purpose of this study was to evaluate the association between functional mobility and mild cognitive impairment in older adults. A total of 800 older adults were recruited (653 controls and 147 subjects with MCI [88 subjects with aMCI and 59 subjects with naMCI]). Motor performance was measured with the Timed Up and Go test (TUG). The demographic factors associated with MCI were: age (OR = 1.05; 95% CI: 1.01-1.09) and the level of education (OR = 0.73; 95% CI: 0.68-0.79). An independent clinical factor associated with MCI was the TUG (OR = 1.14; 95% CI: 1.03-1.27). In the aMCI group, the relation between the TUG and cognitive status occurred (OR = 1.15; 95% CI: 1.02-1.31), whereas in the naMCI group this relationship was not observed. There is an association between cognitive dysfunction and impaired motor performance in older adults with MCI.

The role of the cerebellum in the regulation of language functions. / Rola mózdzku w regulacji funkcji jezykowych.

The present paper is a review of studies on the role of the cerebellum in the regulation of language functions. This brain structure until recently associated chiefly with motor skills, visual-motor coordination and balance, proves to be significant also for cognitive functioning. With regard to language functions, studies show that the cerebellum determines verbal fluency (both semantic and formal) expressive and receptive grammar processing, the ability to identify and correct language mistakes, and writing skills. Cerebellar damage is a possible cause of aphasia or the cerebellar mutism syndrome (CMS). Decreased cerebellocortical connectivity as well as anomalies in the structure of the cerebellum are emphasized in numerous developmental dyslexia theories. The cerebellum is characterized by linguistic lateralization. From the neuroanatomical perspective, its right hemisphere and dentate nucleus, having multiple cerebellocortical connections with the cerebral cortical language areas, are particularly important for language functions. Usually, language deficits developed as a result of a cerebellar damage have subclinical intensity and require applying sensitive neuropsychological diagnostic tools designed to assess higher verbal functions.

Executive dysfunction in late-life depression. / Dysfunkcje wykonawcze w depresji wieku podeszlego.

OBJECTIVES: Nowadays there are numerous reports stressing the occurrence of cognitive functions disorders in late-life depression (LLD). More and more frequently the studies stress the role of executive dysfunctions in LLD. The purpose of the study was an evaluation of the components of executive functions in non-demented LLD patients, as well as an evaluation of the relation between the individual components of executive functions and the level of depressiveness. METHODS: The study included 87 persons with depression and 100 persons in the control group. For the purpose of a screening evaluation of cognitive functions the Mini-MentalState Examination (MMSE) was applied. For the evaluation of the level of executive functions efficiency the following were chosen: a) Trail Making Test (TMT), b) Verbal Fluency Tests (VFT) and c) go/no-go task (GNG). RESULTS: A significant difference was found in the levels of efficiency of all the components of executive functions in patients with late-life depression. The patients with depression demonstrated the slowest psychomotor speed and worse results in the tests evaluating cognitive flexibility, semantic fluency and inhibition. Statistically significant relation was observed between the higher result in GDS-SF (Geriatric Depression Scale-Short Form) and the worse performance in the GNG test. CONCLUSIONS: The patients with depression demonstrated a significant impairment of executive functions. A relation was found between the cognitive control disorder and the level of depressiveness. Executive dysfunctions can play an important role in the persistence of depressive symptoms. Identification of patients with depression and executive dysfunctions has significant therapeutic implications.

Cognitive disorders in children's hydrocephalus.

BACKGROUND AND OBJECTIVE: Hydrocephalus is defined as an increase of volume of cerebrospinal fluid in the ventricular system of the brain. It develops as a result of cerebrospinal fluid flow disorder due to dysfunctions of absorption or, less frequently, as a result of the increase of its production. Hydrocephalus may lead to various cognitive dysfunctions in children. MATERIALS AND METHODS: In order to determine cognitive functioning in children with hydrocephalus, the authors reviewed available literature while investigating this subject. RESULTS: The profile of cognitive disorders in children with hydrocephalus may include a wide spectrum of dysfunctions and the process of neuropsychological assessment may be very demanding. The most frequently described cognitive disorders within children's hydrocephalus include attention, executive, memory, visual, spatial or linguistic dysfunctions, as well as behavioral problems.

[The relationship between executive functions, physical and functional capability in people over 60 years old].

Introduction: Nowadays it is believed that cognitive decline may contribute to the formation of gait disturbance and increased risk of falls. Currently the importance of executive functions to maintain proper control of gait is emphasized. The aim of the study was to assess the relationship between the level of executive function, functional and physical capability in patients over 60 years of age. Materials and methods: The study included 300 patients (199 women and 101 men) aged 60-88 years. In order to screening for cognitive function Mini-Mental State Examination (MMSE) was used. The following researchers tools were used to conduct functional assessment: a) Short Physical Performance Battery (SPPB), b) Timed "Up and Go" (TUG) and c) Fast Walking Test. To assess executive fucntion Trail Making Test (TMT) was selected. Results: The relationship between the speed of information processing (part A, TMT), executive functions (Part B, TMT), level of functional and physical capability was observed. The strongest positive correlation was noted between the time of TUG test and TMT part B (r=0.32; p<0.01), and also between Fast Gait Test and TMT part A (r=0.27; p<0.01). It has been proven that the level of executive function is related to the level of functional capability (ß=0.18; p=0.001). It was found that 15% of variation in the level of the TUG test was explained by age, TMT- B, GDS and BMI. Conclusions: There is a relationship between level of executive functions, functional and physical capability in patients over 60 years of age. Cognitive processes play an important role in the control of motor functions therefore it is important to incorporate examination of cognitive functions in the early geriatric diagnosis.

[The Post Stroke Depression Scale (PSDRS) as a tool for evaluation of depressed mood at an early stage after cerebral stroke].

Introduction: Cerebral stroke can lead both to the limitation of motor skills and cognitive dysfunctions as well as mood disorders. One of the most frequent results of cerebral stroke is post-stroke depression (PSD). Numerous researchers have emphasized the significance of an early detection of this disorder. There is discussion concerning both its background and the methods that might be used for its evaluation. One of the scales applied for this purpose is Post Stroke Depression Rating Scale (PSDRS). Material and methods: The aim of this study was to determine the profile of depressive symptoms in patients at an early stage after stroke. The participants of the study were 43 persons who underwent cerebral stroke. The study was carried out in the course of the first week after the vascular incident. The patients were examined with the application of the PSDRS elaborated in order to determine the specific nature of post-stroke depression. Results: The results of the PSDRS applied indicate the occurrence of three factors present in the group under study. The first factor includes the symptoms related to a depressive mood, sense of guilt, apathy and suicidal thoughts; the second one is related to the impairment of emotional control, anhedonia, variation over time and a catastrophic reaction; the third factor concerns vegetative disorders and anxiety. Conclusions: The application of the PSDRS for the evaluation of depressed mood in persons in the acute phase after cerebral stroke enables the distinction of the factors covering various aspects related to post-stroke depression. This scale is a valuable tool for the evaluation of early symptoms of depression in patients in the first week after cerebral stroke.