Correlation Between Amygdala Nuclei Volumes and Memory in Cognitively Normal Adults Carrying the ApoE ε3/ε3 Allele

The amygdala is known to be related to cognitive function. In this study, we used an automated approach to segment the amygdala into nine nuclei and evaluated amygdala and nuclei volumetric changes across the adult lifespan in subjects carrying the apolipoprotein E (ApoE) ε3/ε3 allele, and we related those changes to memory function alteration. We found that except the left medial nucleus (Me), whose volume decreased in the old group compared with the middle-early group, all other nuclei volumes presented a significant decline in the old group compared with the young group. Left accessory basal nucleus (AB) and left cortico-amygdaloid transition area (CAT) volumes were also diminished in the middle-late group. In addition, immediate memory recall is impaired by the process of aging, whereas delayed recall and delayed recognition memory functions were not significantly changed. We found significant positive correlations between immediate recall scores and volumes of the bilateral basal nucleus (Ba), AB, anterior amygdaloid area (AAA), CAT, whole amygdala, left lateral nucleus (La), left paralaminar nucleus (PL), and right cortical nucleus (Co). The results suggest that immediate recall memory decline might be associated with volumetric reduction of the amygdala and its nuclei, and the left AB and left CAT might be considered as potential imaging biomarkers of memory decline in aging.

Is Retrieval Practice Always Superior to Restudy?

A classic study by Roediger and Karpicke (2006a) investigated the relative benefits of restudy versus retrieval practice, or “test”, on memory retention. Repeated studying was superior to repeated testing when memory was tested immediately (all study > multiple study/single test > single study/multiple tests). Strikingly, the pattern reversed when memory was tested after a days-long delay, with best performance in a single study/multiple tests condition. As each study period was minutes-long and contained repeated reading of a to-be-remembered text passage, we were interested whether the striking benefit for repeated testing at the expense of any restudy replicates when study opportunities are brief, akin to a single mention of a fact in a lecture. Participants encountered academically relevant facts a total of three times, each time either studied (S) or self-tested (T). Final test followed immediately or after a delay (Experiment 1: two days, Experiment 2: seven days). Partially replicating prior work, immediate memory benefited from repeated study (SSS > SST > STT), but the pattern did not reverse after a delay. Instead, memory was superior for facts the were restudied in addition to self-tested (SST > STT = SSS). We further investigated whether restudy after a test (STS) provides additional benefits compared to restudy before test (SST), but found comparably high delayed recall in both conditions. The results show that under some circumstances, balancing repetition and testing can allow for more information to be learned and retained long-term.

Relationship of Cannabis Use With Immediate, Delayed, and Working Memory: The Health and Retirement Study

Past research has examined relationship between cannabis use and cognition among adolescents and young adults, but less is known about older adults despite rapidly increasing recreational and therapeutic cannabis use by this demographic. These relationships were explored cross-sectionally using data from the 2018 wave of the Health and Retirement Study (HRS). Dependent variables included immediate and delayed memory (10-item word list) and working memory (serial sevens; range 0-5). Cannabis use was categorized as non-user (n=886), past-user (n=334), current moderate (<52 uses/year; n=36), and current heavy (52+ uses/year; n=92). Mean age was 67.59 years (range: 50-98, SD=10.76). The sample was predominantly female (59%), and Caucasian (67%). Uncontrolled analyses found that cannabis use group was associated with immediate memory (F=6.14, p<.001), delayed memory (F=3.75, p=.01), and working memory (F=6.91, p<.001). Analyses controlled for gender, education, age, and race found that cannabis use group was no longer associated with delayed memory (F=1.74, p=.16) or working memory (F=1.66, p=.17); however, cannabis use was associated with immediate memory (F=3.75, p=.01) in controlled analyses. Current heavy users’ (M=4.94, SE=.16) immediate memory worse than that of both non-users (M=5.48, SE=.06) and past users (M=5.49, SE=.09; p<.05 for both). Gender, education, age, and race significantly associated with immediate, delayed, and working memory, respectively (p<.05 for all). In conclusion, relative deficits in immediate memory, but not delayed memory or working memory, were associated with current heavy cannabis use among older adults. In combination with other findings, these results may inform development of safe-use guidelines for older adults.

Acute Inositol-Stabilized Arginine Silicate Improves Cognitive Outcomes in Healthy Adults

Inositol-stabilized arginine silicate (ASI) is an ergogenic aid that upregulates nitric oxide. Acute ASI supplementation improves working memory and processing speed in young adults but there is a lack of data examining other cognitive tasks. Therefore, the purpose of this study was to examine acute ASI effects on young healthy adults by assessing multiple cognitive domains. Nineteen young adults (20.9 ± 3.2 years) completed this randomized, double-blind, crossover study consuming ASI (1.5 g ASI + 12 g dextrose) and placebo (12 g dextrose). The participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and two digital cognitive assessments before consuming the supplement and then completed the same battery of tests 60 min post-supplementation. Repeated measures ANOVA demonstrated that ASI consumption significantly improved total RBANS and immediate memory scores compared to the placebo (p < 0.05). However, no significant differences were displayed between trials for other cognitive domains (p > 0.05). Acute ASI ingestion increased overall RBANS scores and immediate memory scores in young adults. More research is needed to examine the acute effects of ASI on other domains of cognition, in older populations, and its long-term effects on cognition.

Magnetic Seizure Therapy Compared to Electroconvulsive Therapy for Schizophrenia: A Randomized Controlled Trial

Background: Magnetic seizure therapy (MST) is a potential alternative to electroconvulsive therapy (ECT). However, reports on the use of MST for patients with schizophrenia, particularly in developing countries, which is a main indication for ECT, are limited.Methods: From February 2017 to July 2018, 79 inpatients who met the DSM-5 criteria for schizophrenia were randomized to receive 10 sessions of MST (43 inpatients) or ECT (36 inpatients) over the course of 4 weeks. At baseline and 4-week follow-up, the Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess symptom severity and cognitive functions, respectively.Results: Seventy-one patients who completed at least half of the treatment protocol were included in the per-protocol analysis. MST generated a non-significant larger antipsychotic effect in terms of a reduction in PANSS total score [g = 0.17, 95% confidence interval (CI) = −0.30, 0.63] and response rate [relative risk (RR) = 1.41, 95% CI = 0.83–2.39]. Twenty-four participants failed to complete the cognitive assessment as a result of severe psychotic symptoms. MST showed significant less cognitive impairment over ECT in terms of immediate memory (g = 1.26, 95% CI = 0.63–1.89), language function (g =1.14, 95% CI = 0.52–1.76), delayed memory (g = 0.75, 95% CI = 0.16–1.35), and global cognitive function (g = 1.07, 95% CI = 0.45–1.68). The intention-to-treat analysis generated similar results except for the differences in delayed memory became statistically insignificant. Better baseline cognitive performance predicted MST and ECT response.Conclusions: Compared to bitemporal ECT with brief pulses and age-dose method, MST had similar antipsychotic efficacy with fewer cognitive impairments, indicating that MST is a promising alternative to ECT as an add-on treatment for schizophrenia.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02746965.

Association between Cognitive Impairment and Olfactory Deficits in Systemic Lupus Erythematosus Without Major Neuropsychiatric Syndromes

Objective Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed despite its high morbidity and mortality. The aim of the study was to investigate the utility of a brief neuropsychological battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), to evaluate cognitive deficits in patients with SLE and to examine the relationship between cognitive and olfactory function. Methods Fifty-five SLE patients and 50 age- and sex-matched healthy control subjects were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a cognitive screening battery that evaluated five index of cognition including immediate memory (IMME), visuospatial/constructional (Vis/Con), language (LANG), attention (ATT), delayed memory (DEME). Olfactory functions were evaluated using olfactory function assessment by computerized testing including the three stages of smell: threshold (THR), identification (ID) and memory (ME) of the different odors. The disease activity and cumulative damage were assessed by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology(ACR) Damage Index (SDI). Results Patients with SLE exhibited significant lower total RBANS score, IMME, Vis/Con, ATT and DEME index scores than normal controls (P < 0.01 for all and P = 0.027 for attention). Performances on RBANS immediate memory, language, attention and total scores were correlated with education level of SLE patients. Reduced RBANS index and total scores were associated with several organ involvement and autoantibodies. SLE patients with higher SLEDAI-2K scores or with accumulated damage (SDI≥1) showed decreased RBANS scores than patients with lower SLEDAI-2K scores or without accumulated damage. All the olfactory scores (THR, ID and ME) in patients with SLE were significantly decreased than the control group (all P = 0.001). Patients had higher proportion of anosmia (8.57% vs 0%) and hyposmia (28.58% vs 5.72%) than controls (χ2 = 10.533, P = 0.015). Multivariable regression analysis revealed that olfactory threshold, identification and memory had a positive effect on RBANS index score. Olfactory memory and total score were significantly correlated with the RBANS delayed memory (r = 0.393, P = 0.021) and total scores (r = 0.429, P = 0.011).Conclusion The results of this study indicate that significantly correlated cognitive and olfactory functions are impaired in SLE patients. The RBANS is a potentially useful instrument for evaluating neuropsychological status in SLE. Physicians are encouraged to perform routine screening in patients with SLE to detect subtle cognitive dysfunction and strategize early treatment options.

P.214 Improved Cognition After Endoscopic Third Ventriculostomy In Adult Obstructive Hydrocephalus Using Repeatable Battery For The Assessment Of Neuropsychological Status

Background: In addition to symptoms of raised ICP, adults with obstructive hydrocephalus often present with cognitive dysfunction. We previously reported the improvement of global cognition at 3 and 12 months following primary adult ETV using the Montreal Cognitive Assessment (MoCA). This abstract presents multidomain cognitive testing using the RBANS. Methods: Obstructive hydrocephalus was identified based on tri-ventriculomegaly on MRI findings with a site of obstruction. Cognitive function was measured using the RBANS and MoCA at two timepoints: pre-ETV and post-ETV. Within patient analysis was conducted using the Wilcoxon Signed Rank Test. Results: Nine adults underwent ETV, 7 primary and 2 secondary (ETV after shunt malfunction), and completed follow-up assessment. Mean age was 33 years old and 7 (78%) were female. Etiology: 3 (33%) congenital and 6 (67%) acquired. Mean follow-up time was 4.5 months. The RBANS total scaled score, attention, and delayed memory index scores were significantly improved post-ETV (p < 0.05). Immediate memory, language, and visuospatial index scores were not significantly different. Secondary analysis shows that picture naming and figure recall subtests were significantly improved. MoCA total scores were not significantly different. Conclusions: ETV in adults with obstructive hydrocephalus results in improvements in global cognition, attention, and delayed memory on RBANS testing.

Executive Functioning in Adults with Down Syndrome: Machine-Learning-Based Prediction of Inhibitory Capacity

The study of executive function decline in adults with Down syndrome (DS) is important, because it supports independent functioning in real-world settings. Inhibitory control is posited to be essential for self-regulation and adaptation to daily life activities. However, cognitive domains that most predict the capacity for inhibition in adults with DS have not been identified. The aim of this study was to identify cognitive domains that predict the capacity for inhibition, using novel data-driven techniques in a sample of adults with DS (n = 188; 49.47% men; 33.6 ± 8.8 years old), with low and moderate levels of intellectual disability. Neuropsychological tests, including assessment of memory, attention, language, executive functions, and praxis, were submitted to Random Forest, support vector machine, and logistic regression algorithms for the purpose of predicting inhibition capacity, assessed with the Cats-and-Dogs test. Convergent results from the three algorithms show that the best predictors for inhibition capacity were constructive praxis, verbal memory, immediate memory, planning, and written verbal comprehension. These results suggest the minimum set of neuropsychological assessments and potential intervention targets for individuals with DS and ID, which may optimize potential for independent living.

Clinical study of central cholinergic pathway damage in two mild cognitive impairment patients

Objectives To explore the role of the central cholinergic system in amnestic mild cognitive impairment (aMCI) and mild vascular cognitive impairment (vMCI). Methods Twenty-five aMCI patients and 25 vMCI patients were enrolled in this study, and 25 healthy people were chosen as a control group. All participants performed a set of cognitive function scales and were subjected to a brain MRI. We analyzed differences in neuropsychological damage between groups, as well as the degree of brain atrophy and changes in the microstructure of central cholinergic pathways (CCP) in relation to effects on neuropsychological scores. Results (1) Regarding neuropsychological characteristics of the three groups, scores on the MoCA scale, immediate memory, delayed recall, cued recall, long time prolonged recognition, and CDR-SB of the control group were significantly better than those of the aMCI and vMCI groups. Scores on immediate memory, delayed memory, cued recall, long time delayed recognition, and Forward of Digital Span Test (FDST) in the aMCI group were lower than those in the vMCI group. Compared with the aMCI group, the vMCI group was significantly delayed in Trail Making Test (TMA)-A, TMT-B, and TMT B-A. There were no significant differences in HAMA, HAMD, MMSE, MoCA, the Boston Naming Test (BNT), language fluency or visual scale of posterior atrophy (Koedam score) between the vMCI and aMCI groups. (2) As for microstructure changes in the central cholinergic pathway, vMCI group had a decreased FA value in the cingulum (Cing) of the medial pathway, but an increased MD value in the external capsule (Excap) of the lateral pathway when compared to other two groups. Furthermore, the CingMD value of the vMCI group was higher than that of the control group, but the difference was not obvious when compared to the aMCI group. (3) Last, we researched microstructural changes to CCP, degree of brain atrophy, and neuropsychological scores by using partial correlation analysis for all participants. CingFA was negatively correlated with TMT-B, B-A, and FDST. CingMD was negatively correlated with FDST. ExcapFA was positively correlated with MMSE and Backward of BDST, while ExcapMD was negatively correlated with MMSE and MoCA. Claustrum (Claus)FA was positively related to MoCA and FDST, but was negatively related to TMT-A. ClausMD was negatively correlated with MoCA and language fluency. Koedam score was positively correlated with CDR-SB, ExcapMD, and ClausMD, but negatively correlated with MMSE score and inverse BDST. Conclusion The central cholinergic system is involved in the cognitive impairment of both aMCI and vMCI, and their mechanisms may be distinct. aMCI patients may present with primary CCP impairment while vMCI patients probably exhibit impairment secondary to vasogenic damage to the cholinergic system projection network. The lateral cholinergic pathway was more severely impaired than the medial pathway in vMCI patients, in addition to being associated with decreased executive and general cognitive functions. The damage to CCP was related to the degree of brain atrophy, and both may be involved in the development and progression of cognitive dysfunction.

Effects of High-Frequency rTMS on Negative Symptoms and Cognitive Function in Hospitalized Patients With Chronic Schizophrenia: A Double-Blind, Sham-Controlled Pilot Trial

This study aimed to evaluate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral pre-frontal cortex (DLPFC) in ameliorating negative symptoms and cognitive impairments in patients with chronic schizophrenia. Fifty-two patients with chronic schizophrenia were randomly assigned to two groups: active rTMS group and sham rTMS group, with existing antipsychotic drugs combined 20 sessions of 10 Hz active/sham rTMS over DLPFC (20 min/session, 5 times/week). The PANSS, RBANS, and SCWT were used to evaluate the clinical symptoms and cognitive functions of the patients. Our results indicated significant improvements in clinical symptoms (PANSS total and subscale scores) and cognitive functions (RBANS total and subscale scores, card 1 and card 3 of the SCWT test) (All p &lt;0.05) after 4-week intervention both in active and sham rTMS group. Moreover, the active rTMS group showed more effective on ameliorating negative symptoms (p = 0.002), immediate memory (p = 0.016) and delayed memory (p = 0.047) compared to the sham group. Interestingly, PANSS negative symptom scores was negatively correlated with RBANS language scores in the real stimulation group (p = 0.046). The study found that the high frequency rTMS stimulation over left DLPFC as a supplement to antipsychotics may have potential benefits in improving clinical symptoms and cognitive functions in patients with chronic schizophrenia.