Relationships between Cognitive Functioning and Powered Mobility Device Use: A Scoping Review

Background. Powered mobility devices (PMD) promote independence, social participation, and quality of life for individuals with mobility limitations. However, some individuals would benefit from PMD, but may be precluded access. This is particularly true for those with cognitive impairments who may be perceived as unsafe and unable to use a PMD. This study explored the relationships between cognitive functioning and PMD use. The objectives were to identify cognitive functions necessary to use a PMD and describe available PMD training approaches. Methods. A scoping review was undertaken. Results. Seventeen studies were included. Four examined the predictive or correlational relationships between cognitive functioning and PMD use outcomes with intellectual functions, visual and visuospatial perception, attention, abstraction, judgement, organization and planning, problem solving, and memory identified as having a relation with PMD use outcome in at least one study. Thirteen others studied the influence of PMD provision or training on users’ PMD capacity and cognitive outcomes and reported significative improvements of PMD capacities after PMD training. Six studies found improved cognitive scores after PMD training. Conclusions. Cognitive functioning is required to use a PMD. Individuals with heterogeneous cognitive impairment can improve their PMD capacities. Results contribute to advancing knowledge for PMD provision.

Investigating the function of CLU in Alzheimer's Disease in in vitro and in vivo models

<p>Alzheimer’s disease (AD) is a neurodegenerative disease that is responsible for 50-80% of dementia cases and is characterised by lack of visuospatial perception, impairment of language and memory. One of the main physiological attributions towards this disease is the accumulation of large insoluble deposits of amyloid beta, a toxic peptide, which results in the generation of amyloid plaques found in between neurons in the brain. Currently no therapeutic treatments are available. Clusterin (CLU) is an apolipoprotein that when defective is the second highest genetic risk factor for AD. It has been strongly debated whether CLU counteracts or promotes AD pathology. With the roles of CLU including but not limited to acting as a chaperone for cholesterol transport and aiding autophagy functionality in cancer models, this thesis investigates these two specific functionalities by overexpressing CLU in an in vitro SH-SY5Y and in an in vivo AD model of Drosophila melanogaster (fruit fly). Conclusions from this study reveal that within D. melanogaster, CLU reduced Aβ42 levels and increased cholesterol effect through the blood brain barrier. Additionally, in human cells, CLU ameliorated the defective flux in autophagy. This thesis sheds light into how CLU plays a protective role within an Alzheimer’s disease mammalian system.</p>

Investigating the function of CLU in Alzheimer's Disease in in vitro and in vivo models

<p>Alzheimer’s disease (AD) is a neurodegenerative disease that is responsible for 50-80% of dementia cases and is characterised by lack of visuospatial perception, impairment of language and memory. One of the main physiological attributions towards this disease is the accumulation of large insoluble deposits of amyloid beta, a toxic peptide, which results in the generation of amyloid plaques found in between neurons in the brain. Currently no therapeutic treatments are available. Clusterin (CLU) is an apolipoprotein that when defective is the second highest genetic risk factor for AD. It has been strongly debated whether CLU counteracts or promotes AD pathology. With the roles of CLU including but not limited to acting as a chaperone for cholesterol transport and aiding autophagy functionality in cancer models, this thesis investigates these two specific functionalities by overexpressing CLU in an in vitro SH-SY5Y and in an in vivo AD model of Drosophila melanogaster (fruit fly). Conclusions from this study reveal that within D. melanogaster, CLU reduced Aβ42 levels and increased cholesterol effect through the blood brain barrier. Additionally, in human cells, CLU ameliorated the defective flux in autophagy. This thesis sheds light into how CLU plays a protective role within an Alzheimer’s disease mammalian system.</p>

VISUOSPATIALSKILLS AND ANTISEIZURE MEDICATIONSIN CHI

Aim: The aim of this study was to investigate visuospatial abilities in children and adolescents with different types of epilepsy treated with antiseizure monotherapy. Methods: A neuropsychological assessment was performed at baseline and after one year. 207 subjects diagnosed with epilepsy and pharmacologically treated with monotherapy including levetiracetam, ethosuximide, valproic acid, carbamazepine or oxcarbazepine and 45 controls were recruited and were compared by gender and age. To evaluate visuospatial perception and memory we used Rey-Osterrieth Complex Figure. All subjects performed the test at baseline and after 12 month of drug therapy. For the statistical analyzes we regarded: age at onset of epilepsy, epilepsy type, seizure frequency, side and lobe of seizure onset, ASM dose, epilepsy duration, non-verbal intelligence, age, sex, executive functions. EEG, seizure frequency, and drug dose were also recorded. Results: Subjects with epilepsy executed only in the Immediate Recall test significantly worse than controls at baseline. There are no differences between clinical groups. We observed a correlation between Instant Recall scores and executive functions, age of seizure onset and epilepsy duration. There was a significantly worsened re-evaluation in the mean score to Immediate Recall in the valproic acid, ethosuximide and carbamazepine groups while no change was noticed in the levetiracetam and oxcarbazepine group. Conclusion: A visuospatial memory deficit may be present in children with epilepsy compared to control, and this deficit may be related to some aspects of epilepsy and to executive functions; visuospatial memory should be monitored in pediatric subjects which can be influenced by some drugs used for the treatment of seizures.

The impact of visuospatial perception on distance judgment and depth perception in an Augmented Reality environment in patients after stroke: an exploratory study

Background Augmented Reality (AR)-based interventions are applied in neurorehabilitation with increasing frequency. Depth perception is required for the intended interaction within AR environments. Until now, however, it is unclear whether patients after stroke with impaired visuospatial perception (VSP) are able to perceive depth in the AR environment. Methods Different aspects of VSP (stereovision and spatial localization/visuoconstruction) were assessed in 20 patients after stroke (mean age: 64 ± 14 years) and 20 healthy subjects (HS, mean age: 28 ± 8 years) using clinical tests. The group of HS was recruited to assess the validity of the developed AR tasks in testing stereovision. To measure perception of holographic objects, three distance judgment tasks and one three-dimensionality task were designed. The effect of impaired stereovision on performance in each AR task was analyzed. AR task performance was modeled by aspects of VSP using separate regression analyses for HS and for patients. Results In HS, stereovision had a significant effect on the performance in all AR distance judgment tasks (p = 0.021, p = 0.002, p = 0.046) and in the three-dimensionality task (p = 0.003). Individual quality of stereovision significantly predicted the accuracy in each distance judgment task and was highly related to the ability to perceive holograms as three-dimensional (p = 0.001). In stroke-survivors, impaired stereovision had a specific deterioration effect on only one distance judgment task (p = 0.042), whereas the three-dimensionality task was unaffected (p = 0.317). Regression analyses confirmed a lacking impact of patients’ quality of stereovision on AR task performance, while spatial localization/visuoconstruction significantly prognosticated the accuracy in distance estimation of geometric objects in two AR tasks. Conclusion Impairments in VSP reduce the ability to estimate distance and to perceive three-dimensionality in an AR environment. While stereovision is key for task performance in HS, spatial localization/visuoconstruction is predominant in patients. Since impairments in VSP are present after stroke, these findings might be crucial when AR is applied for neurorehabilitative treatment. In order to maximize the therapy outcome, the design of AR games should be adapted to patients’ impaired VSP. Trial registration: The trial was not registered, as it was an observational study.

The impact of visuospatial perception on distance judgment and depth perception in an Augmented Reality environment in patients after stroke: an exploratory study

Background Augmented Reality (AR)-based interventions are applied in neurorehabilitation with increasing frequency. Depth perception is required for the intended interaction within AR environments. Until now, however, it is unclear whether patients after stroke with impaired visuospatial perception (VSP) are able to perceive depth in the AR environment.Methods Different aspects of VSP (stereovision and spatial localization / visuoconstruction) were assessed in 20 patients after stroke (mean age: 64 ± 14 years) and 20 healthy subjects (HS, mean age: 28 ± 8 years) using clinical tests. The group of HS was recruited to assess the validity of the developed AR tasks in testing stereovision. To measure perception of holographic objects, three distance judgment tasks and one three-dimensionality task were designed. The effect of impaired stereovision on performance in each AR task was analyzed. AR task performance was modeled by aspects of VSP using separate regression analyses for HS and for patients.Results In HS, stereovision had a significant effect on the performance in all AR distance judgment tasks (p = .021, p = .002, p = .046) and in the three-dimensionality task (p = .003). Individual quality of stereovision significantly predicted the accuracy in each distance judgment task and was highly related to the ability to perceive holograms as three-dimensional (p = .001). In stroke-survivors, impaired stereovision had a specific deterioration effect on only one distance judgment task (p = .042), whereas the three-dimensionality task was unaffected (p = .317). Regression analyses confirmed a lacking impact of patients’ quality of stereovision on AR task performance, while spatial localization / visuoconstruction significantly prognosticated the accuracy in distance estimation of geometric objects in two AR tasks.Conclusion Impairments in VSP reduce the ability to estimate distance and to perceive three-dimensionality in an AR environment. While stereovision is key for task performance in HS, spatial localization / visuoconstruction is predominant in patients. Since impairments in VSP are present after stroke, these findings might be crucial when AR is applied for neurorehabilitative treatment. In order to maximize the therapy outcome, the design of AR games should be adapted to patients’ impaired VSP.Trial registration The trial was not registered, as it was an observational study.

Perampanel and Visuospatial Skills in Children With Epilepsy

Introduction: Perampanel (PER) is a non-competitive AMPA glutamate receptor antagonist approved for focal and generalized seizures as add-on therapy. PER does not seem to negatively affect the cognitive profile in children and adolescents, but its influence on visuospatial abilities is still to be assessed. The aim of our study was to assess visuospatial skills through a standardized neuropsychological evaluation in adolescents taking PER for 12 months.Methods: Our sample included 46 adolescents aged 12–18 years with focal and generalized drug-resistant epilepsy already in therapy with one or two antiseizure medications. Changes in visuospatial perception and memory were assessed by the Rey–Osterrieth Complex Figure Test at baseline (before taking PER) and after 12 months of pharmacological treatment. Executive functions and non-verbal intelligence were also assessed at baseline.Results: After 12 months of PER therapy, the mean scores on the Rey–Osterrieth Complex Figure Test remained almost unchanged for both visuospatial perception and visuospatial memory skills. At baseline, visuospatial memory was related to executive function, and visuospatial perception was related to executive function and non-verbal intelligence.Conclusions: Adjunctive treatment with PER did not negatively affect visuospatial skills. No adverse event effects have been reported after 12 months of follow-up, and this suggests a good tolerability in the middle-to-long term.

Changes in Cognition and Hemodynamics 1 Year after Carotid Endarterectomy for Asymptomatic Stenosis

Objectives The impact of a change in hemodynamics on cognitive skills in patients with asymptomatic carotid stenosis (ACS) after carotid endarterectomy (CEA) remains unclear. The aim of this study was to evaluate the results of CEA for ACS at 1 year by assessing the changes in anterior, middle, and posterior cerebral artery blood flow in tandem with changes in cognitive efficiency. Methods Flow volume in cerebral arteries using quantitative magnetic resonance angiography was measured in a group of 14 males and 5 females before and at 1 year after CEA for ACS. Cognitive efficiency was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The values of flow volume were processed using simple ratio (SR) and were used for covariance analyses with changes in cognitive skills after CEA. Results A significant improvement in cognitive efficiency indexes of immediate memory and visuospatial perception at 1 year after CEA for ACS was observed. Simultaneously, a significant deterioration of speech index was noted. During the analysis of association between flow and cognition, the highest correlation could be seen between the middle cerebral artery (MCA) flow and the visuospatial perception. A change in posterior cerebral artery (PCA) flow was associated with an increase in immediate memory index and anterior cerebral artery (ACA) flow change with the speech index. Conclusion Convergence of data supporting the association between revascularization and cognitive improvement were added in a small, single-center cohort of ACS patients undergoing CEA. No significant differences in cognition were seen between preoperative findings and at 1 year after CEA. Visuospatial perception improvement was linked to flow change in MCA, immediate memory improvement to flow change in PCA, and speech index change to flow change in ACA. Methodical limitations of this small study preclude formulating larger generalizations. Hemodynamic factors in CEA should be assessed in a larger-scale study.

Effects of a Coordinative Ability Training Program on Adolescents’ Cognitive Functioning

The purpose of this randomized controlled study was to investigate the effects of a 12-week coordinative ability training program on adolescents’ cognitive functioning, using evaluation tests of visuospatial perception, attention, and working memory. We randomly assigned 60 public school students (14–15 years) to either an experimental coordinative abilities training (∼40 min twice/week) group (n = 30) or a control group (n = 30) who received general psycho-physical wellness training (∼40 min., twice a week). At baseline and after training we used two standardized motor tests and a single cognitive measure (Corsi’s Block-tapping test) to assess students’ visuospatial perception, attention, and working memory. We found a significant Time x Group interaction for the Throwing and Catching Test and Corsi’s Block-Tapping test, reflecting a meaningful experimental group improvement (p &lt; 0.001), and there were no significant pre-post changes found in the control group. Thus, a 12-week program of coordinative abilities was able to improve not only coordination skills but aspects of cognitive functioning relevant to academic achievement.