Neuropsychological outcome following frontal lobectomy for pharmacoresistant epilepsy in adults

Objective:This retrospective cohort study characterized cognitive and motor outcomes in a large sample of adults who underwent frontal lobe resections for treatment of pharmacoresistant epilepsy.Methods:Ninety patients who underwent unilateral frontal lobe resection for epilepsy (42 language-dominant hemisphere/48 nondominant hemisphere) between 1989 and 2014 completed comprehensive preoperative and postoperative neuropsychological evaluations that included measures of verbal and nonverbal intellectual functioning, attention/working memory, processing speed, language, executive functioning, verbal and visual memory, and motor functioning. Objective methods were used to assess meaningful change across a wide range of abilities and to identify factors associated with neuropsychological decline following frontal lobectomy. Detailed postoperative neuroimaging analysis was conducted to characterize region, extent, and volume of resection.Results:Forty-eight percent of patients did not demonstrate meaningful postoperative declines in cognition and an additional 42% demonstrated decline in 1 or 2 cognitive domains. When cognitive decline was observed, it usually occurred on measures of intelligence, visuomotor processing speed, or executive functioning. Side and site of resection were unrelated to cognitive outcome, but played a role in decline of contralateral manual dexterity following supplementary motor area resection. Higher preoperative ability, older age at surgery, absence of a malformation of cortical development on MRI, and poor seizure outcome were related to cognitive decline on some measures, but had poor sensitivity in identifying at-risk patients.Conclusions:The vast majority of patients who undergo frontal lobectomy for treatment of pharmacoresistant epilepsy demonstrate good cognitive and motor outcomes.

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Epilepsy Surgery in the Frontal Lobe: Terra Incognita or New Frontier?

Epilepsy Currents ◽

10.1111/j.1535-7511.2007.00186.x ◽

2007 ◽

Vol 7 (4) ◽

pp. 98-99 ◽

Cited By ~ 3

Author(s):

John W. Miller

Keyword(s):

Frontal Lobe ◽

Epilepsy Surgery ◽

Prognostic Indicators ◽

P Value ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome ◽

Seizure Freedom ◽

Ratio Test ◽

Longitudinal Outcome ◽

Frontal Lobectomy

Surgical Outcome and Prognostic Factors of Frontal Lobe Epilepsy Surgery. Jeha LE, Najm I, Bingaman W, Dinner D, Widdess-Walsh P, Luders H. Brain 2007;130(Pt 2):574–584. Epub 2007 Jan 5. Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 (mean follow-up 4.1 ± 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50–62] at 1 post-operative year, 45.1% (95% CI = 39–51) at 3 years, and 30.1% (95% CI = 21–39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [risk ratio (RR) = 2.22, 95% CI = 1.40–3.47], any extrafrontal MRI abnormality (RR = 1.75, 95% CI = 1.12–2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15–2.87), occurrence of acute post-operative seizures (RR = 2.17, 95% CI = 1.50–3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66–4.05) (log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to <15% in those with unfavourable outcome predictors. These data underscore the importance of appropriate selection of potential surgical candidates.

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The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults

Gerontology ◽

10.1159/000514871 ◽

2021 ◽

pp. 1-13

Author(s):

Katherine E. Dorociak ◽

Nora Mattek ◽

Jonathan Lee ◽

Mira I Leese ◽

Nicole Bouranis ◽

...

Keyword(s):

Older Adults ◽

Reaction Time ◽

Executive Functioning ◽

Outcome Measures ◽

Processing Speed ◽

Visual Memory ◽

Time Of Day ◽

Community Dwelling ◽

Web Based ◽

Cognitively Intact

Introduction: Brief, Web-based, and self-administered cognitive assessments hold promise for early detection of cognitive decline in individuals at risk for dementia. The current study describes the design, implementation, and convergent validity of a fWeb-based cognitive assessment tool, the Survey for Memory, Attention, and Reaction Time (SMART), for older adults. Methods: A community-dwelling sample of older adults (n = 69) was included, classified as cognitively intact (n = 44) or diagnosed with mild cognitive impairment (MCI, n = 25). Participants completed the SMART at home using their computer, tablet, or other Internet-connected device. The SMART consists of 4 face-valid cognitive tasks available in the public domain assessing visual memory, attention/processing speed, and executive functioning. Participants also completed a battery of standardized neuropsychological tests, a cognitive screener, and a daily function questionnaire. Primary SMART outcome measures consisted of subtest completion time (CT); secondary meta-metrics included outcomes indirectly assessed or calculated within the SMART (e.g., click count, total CT, time to complete practice items, and time of day the test was completed). Results: Regarding validity, total SMART CT, which includes time to complete test items, practice items, and directions, had the strongest relationship with global cognition (β = −0.47, p < 0.01). Test item CT was significantly greater for the MCI group (F = 5.20, p = 0.026). Of the SMART tasks, the executive functioning subtests had the strongest relationship with cognitive status as compared to the attention/processing speed and visual memory subtests. The primary outcome measures demonstrated fair to excellent test-retest reliability (intraclass correlation coefficient = 0.50–0.76). Conclusions: This study provides preliminary evidence for the use of the SMART protocol as a feasible, reliable, and valid assessment method to monitor cognitive performance in cognitively intact and MCI older adults.

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Brenda Milner: Pioneer of the Study of the Human Frontal Lobes

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.786167 ◽

2022 ◽

Vol 15 ◽

Author(s):

Bryan Kolb

Keyword(s):

Frontal Lobe ◽

Intractable Epilepsy ◽

Human Memory ◽

Frontal Lobes ◽

Montreal Neurological Institute ◽

Frontal Lobe Function ◽

Wide Range ◽

And Function ◽

And Behavior ◽

Frontal Lobectomy

Although the behavioral effects of damage to the frontal lobes date back to at least the late 19th century even midway through the 20th century very little was known about human frontal lobe function and there was a general consensus that the frontal lobe did not play a key role in cognition. This all changed when Brenda Milner published a chapter in a 1964 volume entitled: The Frontal Granular Cortex and Behavior. Milner’s chapter, “Some effects of frontal lobectomy in man,” was the first systematic study of the effect of frontal lobe excisions on cognition in human patients. Milner had access to a unique population of frontal excision patients at the Montreal Neurological Institute that were being treated by Wilder Penfield and his associates for a wide range of neurological disorders, including intractable epilepsy. Milner and her colleagues engaged in a more than 50-year study that has had a formidable impact on our understanding of frontal lobe function. Paralleling studies of frontal lobe function in non-humans they influence on understanding the evolution and function of the prefrontal cortex of mammals. Thus, although Brenda Milner is best known for her studies of human memory, she has had an equally important contribution to our understanding of the frontal lobes.

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Seizure outcome of lesional vs nonlesional frontal lobectomy for intractable epilepsy

Electroencephalography and Clinical Neurophysiology ◽

10.1016/s0013-4694(97)88615-8 ◽

1997 ◽

Vol 103 (1) ◽

pp. 136 ◽

Cited By ~ 5

Author(s):

R Mosewich

Keyword(s):

Intractable Epilepsy ◽

Seizure Outcome ◽

Frontal Lobectomy

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Executive Functioning and Processing Speed in Elementary Students

PsycEXTRA Dataset ◽

10.1037/e710632011-001 ◽

2011 ◽

Author(s):

Sarah E. Paret ◽

Lindsay Mcguirk ◽

Jeffrey A. Miller ◽

Jessica Blasik ◽

Molly Scott ◽

...

Keyword(s):

Executive Functioning ◽

Elementary Students ◽

Processing Speed

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Which Neuropsychological Tests? Predicting Cognitive Decline and Dementia in Parkinson’s Disease in the ICICLE-PD Cohort

Journal of Parkinson s Disease ◽

10.3233/jpd-212581 ◽

2021 ◽

pp. 1-12

Author(s):

Rachael A. Lawson ◽

Caroline H. Williams-Gray ◽

Marta Camacho ◽

Gordon W. Duncan ◽

Tien K. Khoo ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Verbal Fluency ◽

Neuropsychological Tests ◽

Visual Memory ◽

Attention And Memory ◽

Memory And Attention ◽

Global Cognition

Background: Cognitive impairment is common in Parkinson’s disease (PD), with 80% cumulatively developing dementia (PDD). Objective: We sought to identify tests that are sensitive to change over time above normal ageing so as to refine the neuropsychological tests predictive of PDD. Methods: Participants with newly diagnosed PD (n = 211) and age-matched controls (n = 99) completed a range of clinical and neuropsychological tests as part of the ICICLE-PD study at 18-month intervals over 72 months. Impairments on tests were determined using control means (<1-2SD) and median scores. Mild cognitive impairment (PD-MCI) was classified using 1-2SD below normative values. Linear mixed effects modelling assessed cognitive decline, while Cox regression identified baseline predictors of PDD. Results: At 72 months, 46 (cumulative probability 33.9%) participants had developed PDD; these participants declined at a faster rate in tests of global cognition, verbal fluency, memory and attention (p < 0.05) compared to those who remained dementia-free. Impaired baseline global cognition, visual memory and attention using median cut-offs were the best predictors of early PDD (area under the curve [AUC] = 0.88, p < 0.001) compared to control-generated cut-offs (AUC = 0.76–0.84, p < 0.001) and PD-MCI (AUC] = 0.64–0.81, p < 0.001). Impaired global cognition and semantic fluency were the most useful brief tests employable in a clinical setting (AUC = 0.79, p < 0.001). Conclusion: Verbal fluency, attention and memory were sensitive to change in early PDD and may be suitable tests to measure therapeutic response in future interventions. Impaired global cognition, attention and visual memory were the most accurate predictors for developing a PDD. Future studies could consider adopting these tests for patient clinical trial stratification.

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Cannabidiol Ameliorates Cognitive Function via Regulation of IL-33 and TREM2 Upregulation in a Murine Model of Alzheimer’s Disease

Journal of Alzheimer s Disease ◽

10.3233/jad-210026 ◽

2021 ◽

pp. 1-5

Author(s):

Hesam Khodadadi ◽

Évila Lopes Salles ◽

Abbas Jarrahi ◽

Vincenzo Costigliola ◽

MB Khan ◽

...

Keyword(s):

Cognitive Function ◽

Cognitive Decline ◽

Murine Model ◽

Early Onset ◽

Behavioral Tests ◽

Translational Model ◽

Therapeutic Modalities ◽

Model Of Alzheimer’S Disease ◽

5Xfad Mice ◽

Motor Outcomes

There is a dire need for due innovative therapeutic modalities to improve outcomes of AD patients. In this study, we tested whether cannabidiol (CBD) improves outcomes in a translational model of familial AD and to investigate if CBD regulates interleukin (IL)-33 and triggering receptor expressed on myeloid cells 2 (TREM2), which are associated with improved cognitive function. CBD was administered to 5xFAD mice, which recapitulate early onset, familial AD. Behavioral tests and immunoassays were used to evaluate cognitive and motor outcomes. Our findings suggest that CBD treatment enhanced IL-33 and TREM2 expression, ameliorated the symptoms of AD, and retarded cognitive decline.

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Longitudinal associations between late-life depression dimensions and cognitive functioning: a cross-domain latent growth curve analysis

Psychological Medicine ◽

10.1017/s003329171600297x ◽

2016 ◽

Vol 47 (4) ◽

pp. 690-702 ◽

Cited By ~ 20

Author(s):

A. Brailean ◽

M. J. Aartsen ◽

G. Muniz-Terrera ◽

M. Prince ◽

A. M. Prina ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Processing Speed ◽

Memory Function ◽

Somatic Symptoms ◽

Late Life ◽

Late Life Depression ◽

Latent Growth ◽

Depressed Affect ◽

Over Time

BackgroundCognitive impairment and depression often co-occur in older adults, but it is not clear whether depression is a risk factor for cognitive decline, a psychological reaction to cognitive decline, or whether changes in depressive symptoms correlate with changes in cognitive performance over time. The co-morbid manifestation of depression and cognitive impairment may reflect either a causal effect or a common cause, depending on the specific symptoms experienced and the cognitive functions affected.MethodThe study sample comprised 1506 community-dwelling older adults aged ⩾65 years from the Longitudinal Aging Study Amsterdam (LASA). We conducted cross-domain latent growth curve analyses to examine longitudinal associations between late-life depression dimensions (i.e. depressed affect, positive affect, and somatic symptoms) and specific domains of cognitive functioning (i.e. processing speed, inductive reasoning, immediate recall, and delayed recall).ResultsPoorer delayed recall performance at baseline predicted a steeper increase in depressed affect over time. Steeper decline in processing speed correlated with a steeper increase in somatic symptoms of depression over time.ConclusionsOur findings suggest a prospective association between memory function and depressed affect, whereby older adults may experience an increase in depressed affect in reaction to poor memory function. Somatic symptoms of depression increased concurrently with declining processing speed, which may reflect common neurodegenerative processes. Our findings do not support the hypothesis that depression symptoms may be a risk factor for cognitive decline in the general population. These findings have potential implications for the treatment of late-life depression and for the prognosis of cognitive outcomes.

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