Cognitive deficits are distressing adverse effects of chemotherapy that have a negative effect on quality of life in breast cancer survivors (BCSs). Cognitive deficits in cancer survivors are a top ...research and clinical practice priority.
The aims of this study were to describe cognitive deficits that occur after chemotherapy, describe deficits in BCSs treated with chemotherapy within a framework of cognitive reserve and neuroplasticity, and discuss cognitive interventions (ie, cognitive training interventions, compensatory strategies with cognitive training interventions, pharmacological interventions, and complementary and integrative medicine interventions).
PubMed search yielded 21 intervention studies of cognitive deficits in BCSs.
Cognitive training interventions and compensatory strategies with cognitive training resulted in improvement of cognitive deficits. Methylphenidate did not result in cognitive improvement. Modafinil showed improvement in attention. Some complementary and integrative medicine interventions are promising.
Cognitive training has been most beneficial. Effectiveness of pharmacologic and complementary and integrative medicine interventions has not yet been established.
While limited evidence is available to guide clinical management of cognitive deficits in BCSs, validating patients' symptom experience and evaluating co-occurring symptom clusters such as fatigue, sleep, and depression, are suggested.
Objective: To identify cognitive predictors of declining financial capacity (FC) in persons with mild cognitive impairment (MCI).
Methods: Participants were 66 cognitively normal older adults and 49 ...persons with MCI who completed neuropsychological testing and a performance measure of financial capacity (Financial Capacity Instrument; FCI) at baseline and two-year follow-up. We calculated two-year change scores for neuropsychological tests and FCI total score. We examined bivariate correlations between demographic/clinical variables and FCI change score, and between neuropsychological and FCI change scores. The five strongest bivariate correlates were entered into a linear regression analysis to identify longitudinal predictors of financial decline within group.
Results: Persons with MCI showed significant decline on the FCI and most cognitive variables, while controls demonstrated relatively stable performance. For persons with MCI, education correlated with FCI change score. The top four cognitive variable-FCI change score correlations were written arithmetic, confrontation naming, immediate visual memory, and visual attention. In the regression model, written arithmetic was the primary predictor and visual memory and visual attention were secondary predictors of two-year FCI change scores.
Conclusion: Semantic arithmetic knowledge, and to a lesser extent visual memory and attention, are key longitudinal cognitive predictors of financial skill decline in individuals with MCI.
Clinical Implications: Clinicians should consider neurocognitive abilities of written arithmetic, visual memory, and processing speed in their assessments of financial capacity in person with MCI.
This research examined differences in the perception of emotion words as a
function of individual differences in subclinical levels of depression and
anxiety. Participants completed measures of ...depression and anxiety and performed
a lexical decision task for words varying in affective valence (but equated for
arousal) that were presented briefly to the right or left visual field.
Participants with a lower level of depression demonstrated hemispheric asymmetry
with a bias toward words presented to the left hemisphere, but participants with
a higher level of depression displayed no hemispheric differences. Participants
with a lower level of depression also demonstrated a bias toward positive words,
a pattern that did not occur for participants with a higher level of depression.
A similar pattern occurred for anxiety. Overall, this study demonstrates how
variability in levels of depression and anxiety can influence the perception of
emotion words, with patterns that are consistent with past research.
INTRODUCTION Deep brain stimulation (DBS) is an effective treatment for motor disturbance in patients with primary dystonia. Candidacy and appropriateness of DBS therapy is determined by an ...interdisciplinary consensus conference after considering numerous demographic, medical, cognitive, and behavioral factors on an individual basis. However, little is known about which of these factors are associated with consensus conference decisions. METHODS Thirty-two patients with primary dystonia completed comprehensive neurological and neuropsychological examinations in consideration for potential DBS surgery. Demographic and medical data (e.g., dystonia disease characteristics, medical comorbidities, medications) were also collected. An interdisciplinary conference committee comprised of representatives from neurology, neuropsychology, nursing, and neurosurgery determined DBS therapy eligibility based on these data. Patients were grouped based on DBS conference decision (eligible: n = 21, ineligible: n = 11) and compared across demographic, medical, cognitive, and behavioral variables. To quantify medical disease factors, we used a modified Revised Cardiac Risk Index. RESULTS Across clinical variables, patients who were deemed ineligible for DBS surgery had a higher modified Revised Cardiac Risk Index. Patients who were classified as ineligible displayed lower global cognitive functioning, working memory, phonemic fluency, memory retrieval, and cognitive flexibility. CONCLUSION Deficits in executive functioning were closely associated with DBS consensus committee decisions. Incidentally, we observed elevated cardiac risk among these individuals, likely reflecting the relationship between vascular health and cognition. Executive functioning may be an important target for intervention to improve surgical candidacy for DBS in patients with primary dystonia.
A number of measures have been developed to assess medical decision-making capacity (MDC) in adults. However, their clinical utility is limited by a lack of available normative data. In the current ...study, we introduce age-independent and age-adjusted normative data for a measure of MDC: the Capacity to Consent to Treatment Instrument. The sample consisted of 308 cognitively normal, community-dwelling adults ranging in age from 19 to 86 years. For age-adjusted norms, individual raw scores were first converted to age-corrected scaled scores based on position within a cumulative frequency distribution and then grouped according to empirically supported age ranges. For age-independent norms, the same method was utilized but without age-corrections being applied or participants being grouped into age ranges. This study has the potential to enhance MDC evaluations by allowing clinicians to compare a patient’s performance on the Capacity to Consent to Treatment Instrument with that of adults regardless of age as well as to same age peers. Tables containing normative corrections are supplementary material available online at http://asm.sagepub.com/supplemental.
Abstract
Objective
Primary dystonia is conventionally seen as a motor disorder, though growing literature indicates cognitive dysfunction among persons with primary dystonia (PWD). Here, we completed ...a meta-analysis comparing cognition on clinical measures between PWD and normal controls.
Method
We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO using a uniform search-strategy to locate original research comparing cognition between PWD and control samples. All analyses were modeled under random-effects. We used Hedge’s g as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2.
Results
The initial search strategy yielded 866 results. Twenty studies were analyzed (PWD n = 739, control n = 865; 254 effect sizes extracted). Meta-analysis showed a significant combined effect size of primary dystonia across all studies (g = −0.55, p < 0.001), with low heterogeneity (Q = 23.60, p = 0.21, I2 = 19.49). Trim-and-fill procedure estimated 6 studies missing due to publication bias (adjusted g = −0.47, Q = 44.58). Within-domain effects of primary dystonia were: Motor/Non-Motor Speed = −0.76, Global Cognition/Orientation = −0.65, Language = −0.62, Executive Functioning = −0.50, Learning/Memory = −0.46, Visuospatial/Construction = −0.44, and Simple/Complex Attention = −0.36. Heterogeneity was generally low within domains. Effects were comparable between Speed tasks with (g = −0.85) and without (g = −0.80) a motor component. Meta-regressions indicated age, education, gender, and disease duration were not related to effect sizes.
Conclusions
PWD consistently demonstrated lower performances on neuropsychological tests compared to controls. Effect sizes were generally moderate in strength, with smallest effects in Simple/Complex Attention, and largest in Motor/Non-Motor Speed. Within the Speed domain, results suggested cognitive slowing beyond effects from motor symptoms. This quantitative summary indicates that PWD experience difficulties in multiple aspects of cognition, as detected by neuropsychological tests.
This study focused on prenatal and perinatal factors related to autism spectrum disorder (ASD). The authors hypothesized that mothers who exposed their infants to intrauterine toxicity or who had ...complications with labor or delivery would be more likely to give birth to individuals with lower IQ scores, higher scores on a measure of ASD, and lower scores on a measure of adaptive functioning. This clinical sample consisted of 33 children who presented for neuropsychological assessment with symptoms of ASD. Results indicated that individuals with a history of intrauterine toxicity had lower IQ scores than individuals who did not have a history of intrauterine toxicity. However, no significant effects were found for intrauterine toxicity and ASD or adaptive functioning. Results indicated that individuals with a history of complications during labor and delivery had lower IQ scores, higher scores on a measure of ASD, and lower scores on a measure of adaptive functioning. Findings may lend support to the oxidative stress theory of ASD.
•The neurocognitive profile in patients with primary dystonia was examined.•Patients with primary dystonia showed worse cognition relative to healthy controls.•Executive function and verbal memory ...deficits were most salient in primary dystonia.•Multi-domain cognitive impairment is a common non-motor feature in primary dystonia.
Primary dystonia has been traditionally viewed as a motor disorder. However, non-motor symptoms are frequently present and significantly quality of life. Neuropsychiatric and cognitive symptoms have been identified, but prior studies have been limited in sample size and lack of control groups. This study examined the neurocognitive profile of a sample of persons with primary dystonia (PWD) as compared to demographically matched healthy control group.
A cognitive test battery was administered to 25 PWD who presented for pre-surgical candidacy evaluation for deep brain stimulation surgery. The test battery domains included global cognitive function, attention, expressive language, visuospatial skills, memory, and executive functioning. Twenty-five age, gender, education-matched healthy control participants were compared to the PWD.
Compared to demographically matched healthy controls, PWD performed worse on measures of global cognitive function, attention, memory, and conceptualization. Based on normative comparison, a large portion of PWD were impaired on tasks of executive functioning and expressive language. Over 80% of the PWD showed impairment on at least one neurocognitive measure and over 60% showed impairment on 3 or more tests.
Neurocognitive deficits were prevalent among our PWD sample. These impairments were present across a broad range of cognitive domains. Given the degree of cognitive impairment found in this study, our results have implications for health care providers with providing interventions to PWD.
Deep brain stimulation (DBS) is an effective treatment for motor disturbance in people with primary dystonia (PWD). Numerous factors are considered by an interdisciplinary consensus conference before ...deciding candidacy for DBS surgery (e.g., demographic, medical, cognitive, and behavioral factors). However, little is known about which of these factors are associated with PWD DBS surgery consensus conference decisions.
Our goal was to examine whether pre-operative demographic, medical, and cognitive/behavioral variables are associated DBS consensus conference decisions in patients with dystonia.
Thirty-two PWD completed comprehensive presurgery workup included neurological and neuropsychological exams, and neuroimaging in consideration for DBS surgery. An interdisciplinary conference committee either recommended or did not recommend DBS surgery based upon these data. Demographic and medical data (e.g., dystonia disease characteristics, medical comorbidities, medications) were also collected. We also examined impact from cardiovascular disease factors, using a Revised Cardiac Risk Index. PWD were grouped based on DBS conference decision (eligible: n = 21, ineligible: n = 11) and compared across demographic, medical, and cognitive/behavioral variables.
Across clinical variables, PWD who were deemed ineligible for DBS surgery had a higher Revised Cardiac Risk Index. PWD who were classified as ineligible displayed lower global cognitive functioning, working memory, phonemic fluency, memory retrieval, and cognitive flexibility.
Consensus decision making regarding DBS surgery eligibility involves a multifactorial process. We found that deficits in executive functioning were associated with the DBS consensus committee decision. We also observed elevated cardiac risk among these individuals, likely reflecting the relation between vascular health and cognition. Implications, and clinical and scientific applications of these findings are discussed.
•Factors associated with DBS candidacy in patients with primary dystonia (PWD), including cognition, is largely unknown.•Thirty-two PWD completed neurological and neuropsychological exams prior to DBS surgery consensus decision.•PWD who were deemed ineligible had greater executive dysfunction and more vascular risk factors.•The ineligible group had lower global cognition, working memory, verbal fluency, memory, and cognitive flexibility.•We observed elevated cardiac risk in these ineligible PWD likely reflecting the link between cognition and vascular health.
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