Particularities of Electrophysiological and Psychoneurological Assessment of Mild Traumatic Brain Injury

Neuropsychological functioning after mTBI is individualized and dynamic, with no currently known predictors and usually having a trajectory of gradual improvement. It is still a challenge to identify specific cognitive profiles associated with mTBI. One of the causes is the transient character of TBI symptoms as they are not appearing immediately after the injury. Another explanation resides in the individual and group variability of cognitive impairements following mTBI, which also affects the standardisation of the neuropsychological tests to use in mTBI assessment batteries (Iverson et al., 2013; Prince & Bruhns, 2017; Tulsky et al., 2017). Presently concussion has no accepted definition or diagnostic criteria. Also, there is no standard (or gold standard) for screening or properly identifying and diagnosing all population with concussion. (Borg et al., 2004). Patients with mTBI could evolve in a bunch of physical, cognitive, and emotional symptoms (Permenter et al., 2021) that are usually known as post-concussion syndrome (PCS). In terms of symptoms, we target neuropsychological evaluation of four key domains (“higher-order attention”, “executive function”, “episodic memory”, and “speed of information processing”) implicated in chronic impairment after mTBI. Alternatively, studies on the EEG frequency domain shed new light on the possibility to have a diagnostic marker based on QEEG patterns identified in the mTBI population and some prognostic factors for the PCS syndrome.(Rapp et al., 2015; Thornton & Carmody, 2009). Given the particularities of neuropsychological functioning after mTBI we emphasize the need of a mixed methodology, using both electrophysiological and psychoneurological tools, to provide the best sensitivity and specificity in assessing cognitive and functional deficits and in predicting further PCS.

Burden of Insomnia and Sleep Disturbances and the Impact of Sleep Treatments in Patients with Probable or Possible Alzheimer’s Disease: A Structured Literature Review

Background: Sleep disturbances are frequent in Alzheimer’s disease (AD). This review summarizes the impact of sleep disturbances on AD patients and their caregivers and the effects of currently available sleep therapies. Methods: Published studies (January 1985–March 2020) assessing the burden associated with insomnia/sleep disturbances in the AD population and insomnia treatment effects were identified by searching PubMed, Embase and Cochrane Library and screened against inclusion criteria. Findings: This review included 58 studies which assessed patient and caregiver burden, institutionalization, and insomnia treatments in AD patients with sleep disturbances. Sleep disturbances were associated with worse cognition, functional ability, and behavioral and neuropsychological functioning, including increased depression and anxiety. Health status and quality of life of both patients and caregivers were reduced in the presence of sleep disturbances, with caregiver burden driven largely by disruptive nocturnal behaviors including nighttime awakenings and wanderings. Sleep disturbances were also associated with institutionalization. Although significant associations between sleep problems and clinical outcomes were apparent, there was generally no control for other influencing factors (e.g. cognitive status). With respect to insomnia treatments, bright light, and behavioral therapies as well as drugs such as trazodone, risperidone and suvorexant showed some promise in AD patients, but studies were primarily small and limited data were available, particularly in regard to insomnia treatment effects on associated clinical burden. Interpretation: Sleep disturbances are a significant problem for AD patients and caregivers. They are associated with behavioral and psychological problems and cognitive decline and impose a burden on caregivers, but remain poorly characterized and under-researched. As the global population is aging and AD is on the rise, data from larger, prospective trials are required to fully understand the clinical correlates of sleep disturbances and the impact of insomnia treatments on AD patients and their caregivers.

Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer

Purpose To examine long-term cognitive effects of chemotherapy and identify predictors among women with breast cancer (WBC). Patients and methods Sixty-nine WBC scheduled to receive chemotherapy, and 64 matched-controls with no cancer, participated. Objective and subjective cognition, total sleep time, nap time, circadian activity rhythms (CAR), sleep quality, fatigue, and depression were measured pre-chemotherapy (Baseline), end of cycle 4 (Cycle-4), and one-year post-chemotherapy (1-Year). Results WBC showed no change in objective cognitive measures from Baseline to Cycle-4 but significantly improved from both time points to 1-Year. Matched-controls showed an increase in test performance at all time points. WBC had significantly higher self-reported cognitive dysfunction at Cycle-4 and 1-Year compared to baseline and compared to matched-controls. Worse neuropsychological functioning was predicted by less robust CARs (i.e., inconsistent 24 h pattern), worse sleep quality, longer naps, and worse cognitive complaints. Worse subjective cognition was predicted by lower sleep quality and higher fatigue and depressed mood. Conclusion Objective testing showed increases in performance scores from pre- and post-chemotherapy to one year later in WBC, but matched-controls showed an increase in test performance from baseline to Cycle-4 and from Cycle-4 to 1-Year, likely due to a practice effect. The fact that WBC showed no practice effects may reflect a form of learning deficit. Compared with the matched-controls, WBC reported significant worsened cognitive function. In WBC, worse objective and subjective cognitive functioning were predicted by worse sleep and sleep-related behaviors (naps and CAR). Interventions that target sleep, circadian rhythms, and fatigue may benefit cognitive function in WBC.

Impaired social cognition and fine dexterity in patients with Cowden syndrome associated with germline PTEN variants

PurposeCowden syndrome (CS) is an autosomal dominant disease related to germline PTEN variants and is characterised by multiple hamartomas, increased risk of cancers and frequent brain alteration. Since the behaviour of patients with CS sometimes appears to be inappropriate, we analysed their neuropsychological functioning.MethodsThis monocentric study was conducted between July 2018 and February 2020. A standardised neuropsychological assessment, including an evaluation of social cognition, executive functions, language and dexterity, as well as a cerebral MRI were systematically proposed to all patients with CS. Moreover, PTEN variants were identified.ResultsFifteen patients from 13 families were included, with six non-sense (40%), three missense (20%), five frameshift (33.3%) and one splice site (6.6%) variant types. Twelve patients (80%) had altered social cognition: 10 patients had an abnormal modified Faux-Pas score and 5 had Ekman’s facial emotions recognition impairment. Nearly all patients (93%) had impaired dexterity. Cerebral MRI showed various cerebellar anomalies in seven patients (46.7%).ConclusionAltered social cognition and impaired fine dexterity are frequently associated with CS. Further studies are needed to confirm these results and to determine whether dexterity impairment is due to the effect of germline PTEN variants in the cerebellum.

Neuropsychological functioning and cognitive reserve in newly HIV diagnosed antiretroviral-naïve South African adults from peri-urban and informal settlements

Despite lower incidences of HIV-associated dementia due to antiretroviral therapy, neuropsychological impairment (NPI) remains a persistent challenge in sub-Saharan Africa. Improving cognitive reserve (CR) can mitigate NPI, but there are few investigations on neuropsychological (NP) performance, and its association with CR in newly diagnosed ART-naïve HIV-positive individuals to inform early treatment strategies. A comprehensive battery of tests were administered to assess various NP domains (International HIV Dementia Scale [for memory, motor speed, psychomotor speed], Digit Span Test [for attention], Action Fluency Test [for language] and Clock Drawing Test [for executive/visuospatial function]), and CR (using Cognitive Reserve Index Questionnaire) among 211 newly diagnosed ART-naïve HIV-positive participants from two clinics that serve peri-urban and informal settlement communities in KwaZulu-Natal, South Africa. Regression models were fitted to assess the association between NP performance and CR controlling for socioeconomic and clinical factors. Test results revealed high levels of impairment across NP domains: language (96.7%), memory and psychomotor speed (82.5%), concentration (17.5%), executive function (15.2%) and visuo-spatial function (3.3%). Low CR and educational attainment were the only factors consistently associated with poor NP performance based on regression. High levels of impairment were found in certain NP domains in a relatively young group of newly diagnosed ART-naïve HIV-positive individuals. Residents of peri-urban and informal settlements face multitude of complex challenges in South Africa. An early multilevel intervention targeting clinical- (e.g. CR) and structural-level challenges (e.g. access to education) is needed for mitigating HIV-associated NPI and promoting long-term healthy living.

Neuropsychological Profile in Pediatric Migraine without Aura: A Pilot Study

Despite the high prevalence of headache in developmental age, current reports about its neuropsychological effects are still lacking. The aim of the present pilot study is to assess the neuropsychological skills among children affected by migraine without aura (MwoA). Fifteen children (7M/8F) (mean age 10.73 ± 2.13) with MwoA, consecutively referred to the Center for Childhood Headache at Università degli Studi della Campania “Luigi Vanvitelli”, underwent the Italian version of the NEPSY-2 after cognitive evaluation. Moreover, to assess the pain level and disability grade during daily activity, the VAS and PedMIDAS scales were used. MwoA children were comparable with the control group of 38 children with respect to age, gender, language, and education level. Written informed consent was obtained from all parents and from children directly, when appropriate. MwoA children differed from controls significantly among the NEPSY-2 subscales, with a relevant relationship between the frequency and intensity of the attacks. In conclusion, the results of the present pilot study may suggest that MwoA could impact significantly neuropsychological functioning in children.

Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over Two Weeks—Comparison, Precursor Symptoms, and the Chronotype

Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6–12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.