The role of neuropsychological examination in the diagnosis and treatment of adult patients with epilepsy

Individuals with epilepsy may experience various difficulties in cognitive and emotional functioning. The neuropsychological examination plays a significant role in the diagnosis and management of patients with epilepsy. It should be conducted by psychologists with appropriate competencies and experience, preferably by specialists who have undergone dedicated training in clinical psychology and gained clinical experience with neurological patients. Conclusions from neuropsychological examination provide information about the influence of epilepsy on cognitive and behavioral functioning of the patient. Neuropsychological assessment enables delineating the neuropsychological profile, including the description of the type and level of cognitive deficits, as well as examining the emotional state and psychosocial functioning of patients. Neuropsychological evaluation plays an important part in qualifying patients with epilepsy for neurosurgical treatment, and helps in the process of monitoring the state of patients in terms of postsurgical outcomes. In this paper, the authors present the aims of neuropsychological assessment in patients with epilepsy. Various factors are listed that can affect the profile of cognitive and emotional functioning of patients during the examination. On the basis of guidelines formulated by experts of the International League Against Epilepsy, the indications for neuropsychological examination are described, and the core cognitive and emotional dimensions that should be evaluated are presented. A list of psychometric tests and clinicalexperimental tasks addressing cognitive functions as well as a selection of tools assessing the emotional state that are available and used in Poland are also provided.

Assessment of influence of attention and delayed reproduction on quality of life in patients with cerebrovascular disease on background of taking various doses of cholecalciferol

The aim of this study was evaluating the effect of the level attention and delayed reproduction on the quality of life in patients with cerebrovascular disease while taking various doses of cholecalciferol. 146 patients were examined, the average age of which was 59.8 ± 12.7 years. All patients were divided into three groups, depending on the dose of cholecalciferol administration. During the study, participants were assessed for the level of 25(OH) D, a neuropsychological examination and a study of the quality of life. Against the background of taking cholecalciferol at a dosage of 4000 IU per day, the level of 25(OH)D in blood serum signifcantly increased by 64.4 [12.5; 124.7] per cent (p < 0.001), and when taking 8000 IU per day – 131.8 [19.5; 298.4] per cent (p < 0.001) and its average value in the group reached an adequate level and amounted to 34.26 ± 11.22 ng/ml. In patients with cerebrovascular disease, the assessment of cognitive functions most often revealed violations in the assessment of delayed reproduction and attention. It was found that attention and delayed reproduction have a signifcantly signifcant relationship with most indicators in quality of life. Against the background of cholecalciferol therapy, a signifcantly signifcant improvement in attention and delayed reproduction was obtained when evaluated on neuropsychological scales, and there was also a signifcantly signifcant improvement in the quality of life when evaluated on the SF-36 questionnaire scale. Our study showed that the administration of cholecalciferol can improve the quality of life in patients with cerebrovascular disease.

The Congruency of Neuropsychological and F18-FDG Brain PET/CT Diagnostics of Alzheimer’s Disease (AD) In Routine Clinical Practice: Insights From a Mixed Neurological Patient Cohort

Background:Clinical diagnostics of Alzheimer’s Disease (AD) require a multimodal approach. Neuropsychological assessments are commonly implemented to obtain information about the degree of cognitive impairment, while cerebrospinal fluid markers and imaging data provide etiological information. In routine clinical practice, neuropsychologists often have to rely on relatively limited anamnestic information, as well as cognitive test results and are required to infer whether patients actually suffer from AD, prior to the availability of exhaustive etiological information. To date, it remains to be explored how congruent the results of such a phenomenological approach may be with results from neuroimaging techniques such as FDG-PET/CT examinations. The latter are known to yield highly accurate diagnostic information. Methods:A mixed sample of N=127 hospitalized neurological patients suspected of displaying a syndrome of dementia underwent routine differential diagnostics including an extensive neuropsychological and an FDG-PET/CT examination. The neuropsychological examination included an interview in which anamnestic information was obtained, as well as the administration of the standardized CERAD cognitive test battery. Two separate decisional approaches were considered: First, routine diagnostic results were obtained, as reflected by the final clinical decision of the examining neuropsychologist (ADClinical vs. non-ADClinical) for the routine clinical report. Secondly, a logistic regression model was implemented, that relied on data from the CERAD test profiles alone. Based on the logistic regression, the CERAD test subscales that best predicted the presence of AD according to the FDG-PET/CT results were identified and a nominal categorization was obtained (ADTest vs. non-ADTest). Results from both decisional approaches were matched against the FDG-PET/CT results (ADPET vs. non-ADPET) in cross-tables and estimates of accuracy, sensitivity and specificity were derived.Results:Based on the FDG-PET/CT examination, N=33/127 (26%) of the patients were diagnosed as ADPET patients. When matched against these results, the clinical decision approach of the neuropsychological examination (ADClinical vs. non-ADClinical) yielded a good accuracy (84.2%), involving moderate sensitivity (75.8%) and excellent specificity (92.6%). The decisional approach that relied on the neuropsychological test data alone (ADTest vs. non-ADTest) involved a lower estimate of accuracy (74.8%), that was attributable to considerably decreased sensitivity (56.3%) while specificity was comparable (93.3%) to the clinical decision model.Conclusions:These results indicate that it is feasible to identify AD in context of a comprehensive routine neuropsychological examination in a mixed sample of neurological patients, relative to an FDG-PET/CT classification. However, decisions based on cognitive test results alone appear limited in this respect. It may be assumed that anamnestic information in combination with the clinical impression obtained by the neuropsychological examiner play a crucial role in the identification of AD patients in routine clinical practice.

Assessment of the formation of writing and reading skills in firstgrade students with mental retardation

The article deals with the problem of the formation of writing and reading skills in first grade students with mental retardation. With the help of a neuropsychological examination, an assessment of the formation of writing and reading skills in this category of children was carried out. The reasons for the difficulties in the formation of writing and reading skills, as well as the types of difficulties in mastering these skills are highlighted.

Relationship of psychoalgological status and results of neurosurgical treatment of patients with discogenic radiculopathy

The OBJECTIVE was to improve the results of surgical treatment of patients with discogenic radiculopathy by preoperative neuropsychological examination of patients with an increased risk of unsatisfactory outcome of the operation.METHODS AND MATERIALS. Neuropsychological status of 77 patients with discogenic radiculopathy in the preoperative period was studied. For this purpose, we assessed the intensity of pain, levels of personal and situational anxiety and the presence and severity of depression. The obtained data were compared with postoperative results of quality of life assessment for the main parameters, which include the level of pain and adaptation to daily activities.RESULTS. Data from neuropsychological tests were revealed, the presence of which in patients with discogenic pain syndrome suggests the risk of an unsatisfactory assessment of the operation performed by the patient. According to the long-term results of neurosurgical treatment, patients were divided into three groups: 1 – with a good result; 2 – patients with a number of preserved complaints, who rated the result of the operation as satisfactory; 3 – unsatisfactory outcome. In patients with unsatisfactory results of surgical treatment of discogenic radiculopathies with pain syndrome, patterns of psychological indices were found that were significantly associated with the outcome of treatment.CONCLUSION. Conducting a neuropsychological examination prior to surgery with the identification of predictors of chronic discogenic pain and patient dissatisfaction with the results of treatment can influence the surgical tactics and optimize the process of further treatment.

Transcranial magnetic stimulation in the correction of consequences of minor traumatic brain injury

Purpose. To evaluate therapeutic options of rhythmic transcranial magnetic stimulation (rTMS) in the treatment of consequences of minor traumatic brain injury.Materials and methods. A neuropsychological examination using standard scales for assessing cognitive functions, as well as the Beck depression inventory, the Spielberger State-Trait Anxiety Inventory, and the MFI-20 multidimensional fatigue inventory was performed on patients with traumatic brain injury (TBI) and complaints of decreased memory, attention, general weakness and fatigue. Patients were split into two groups. Active group (24 patients) received rhythmic TMS besides standard treatment (neurometabolic, nootropic) while control group (23 patients) received only standard therapy. After the treatment course, the reassessment of neuropsychological examination with the following statistic processing was performed.Study results. Comparison of treatment results in the active and control groups showed the highest efficacy of rTMS in the treatment of depression (p=0,016), anxiety (p=0,001) and in fatigue lowering (p=0,017) in patients with consequences of minor TBI.Conclusion. The data obtained from the study point the high efficacy of treatment of consequences of minor TBI by means of rTMS that displays in lowering of fatigue, anxiety, and depression severity when using.

DYNAMICS OF HIGHER MENTAL FUNCTIONS AT YOUNGER ADOLESCENT

Provided are results of a study of the dynamics of higher mental functions in young adolescents obtained in the course of a longitudinal study are presented. For three years, schoolchildren underwent a complete neuropsychological examination, and the obtained data were processed using descriptive statistics and non-parametric criteria of Friedman and Wilcoxon. The revealed dynamics of higher mental functions is multidirectionalin nature: along with the general positive trend, there will be a decrease in some indicators, primarily related to the functions of the right hemisphere, because younger adolescence is accompanied by the onset of puberty.