Neuropsychological and psychopathological variables modulating cognitive insight in people with schizophrenia

Cognitive insight is the capacity of patients with schizophrenia to evaluate their psychotic experiences and respond to the corrective feedback. The relationship with their neuropsychological functions and the modulation exercised by mood and anxiety are still not clear. To make advances and deepen our knowledge would have an important impact on our understanding of the cognitive mechanisms and intervention programmes. Two samples were chosen, one clinical with persons suffering from schizophrenia (n = 43) and another with healthy individuals (n = 50). The Cognitive Insight Scale (BCIS), a neuropsychological battery and questionnaire concerning depression and anxiety, was applied to them. The results suggest an influence of anxiety and the deficits in cognitive flexibility on the development of the mechanisms of Self-Reflection in persons with schizophrenia, with a different pattern to that found in healthy individuals. The results are discussed with respect to the intervention programmes. El insight cognitivo es la capacidad de los pacientes con esquizofrenia de evaluar sus experiencias psicóticas y responder a la retroalimentación correctiva. Su relación con el funcionamiento neuropsicológico y la modulación que ejercen el estado de ánimo y la ansiedad están aún poco claras. Avanzar y profundizar en su conocimiento tendría un impacto importante sobre la comprensión de los mecanismos cognitivos y los programas de intervención. Se seleccionaron dos muestras, muestra clínica, con personas con esquizofrenia (n = 43), muestra personas sanas (n = 50), a las que se aplicó la Escala de insight cognitivo (EICB), una batería neuropsicológica y cuestionarios de depresión y ansiedad. Los resultados sugieren una influencia de la ansiedad y de los déficits de flexibilidad cognitiva en el desarrollo de los mecanismos de la Auto-Reflexión en personas con esquizofrenia, con un patrón diferente al encontrado en personas sanas. Se discuten los resultados con respecto a los programas de intervención.

Cognitive performance and specific aspects of language processing are associated with Oldowan-like chert flaking and retouch

Experimental data suggesting a co-evolutionary relationship between Palaeolithic stone toolmaking, and cognition and language remain limited to indirect findings of neurophysiological studies. Furthermore, retouch and quartz flaking remain uninvestigated. We recruited thirteen subjects and taught them to produce quartz choppers and chert sidescrapers in either a verbal or gestural condition. Two raters rated on a 5-point scale the subjects’ performances on specific steps of the two stone toolmaking tasks. Subjects also performed on a neuropsychological battery encompassing visuospatial, executive functioning, and linguistic tasks. Given the small sample size, the results should be regarded as exploratory and preliminary. There was only limited evidence that verbal compared to gestural teaching facilitated acquisition. Quartz chopper manufacture was not associated with cognitive performance. Conversely, chert flaking and retouch were moderately and strongly associated with visuospatial working memory and executive functioning. Specific aspects of chert flaking were also associated with verbal fluency performance, showing, among others, moderate and strong positive associations with the productivity and rate of production of syntactically transitive verbs on action fluency. Controversially assuming similar results would have been obtained by testing extinct hominins, our results possibly suggest Oldowan hominins relied on modern-like visuospatial working memory and executive functioning during chert knapping. Furthermore, some prerequisites for aspects of action language and syntactic transitivity in modern humans might have been to some degree present in Oldowan hominin populations. We conclude by proposing that the quality of performance on Oldowan knapping may not reflect the full level of cognitive capacities of Oldowan populations.

Utility of Machine Learning Approach with Neuropsychological Tests in Predicting Functional Impairment of Alzheimer’s Disease

Background: In assessing the levels of clinical impairment in dementia, a summary index of neuropsychological batteries has been widely used in describing the overall functional status. Objective: It remains unexamined how complex patterns of the test performances can be utilized to have specific predictive meaning when the machine learning approach is applied. Methods: In this study, the neuropsychological battery (CERAD-K) and assessment of functioning level (Clinical Dementia Rating scale and Instrumental Activities of Daily Living) were administered to 2,642 older adults with no impairment (n = 285), mild cognitive impairment (n = 1,057), and Alzheimer’s disease (n = 1,300). Predictive accuracy on functional impairment level with the linear models of the single total score or multiple subtest scores (Model 1, 2) and support vector regression with low or high complexity (Model 3, 4) were compared across different sample sizes. Results: The linear models (Model 1, 2) showed superior performance with relatively smaller sample size, while nonlinear models with low and high complexity (Model 3, 4) showed an improved accuracy with a larger dataset. Unlike linear models, the nonlinear models showed a gradual increase in the predictive accuracy with a larger sample size (n > 500), especially when the model training is allowed to exploit complex patterns of the dataset. Conclusion: Our finding suggests that nonlinear models can predict levels of functional impairment with a sufficient dataset. The summary index of the neuropsychological battery can be augmented for specific purposes, especially in estimating the functional status of dementia.

Mental Imagery Skills in Alcohol-Dependent Subjects and Their Associations With Cognitive Performance: An Exploratory Study During Residential Rehabilitation

People in alcohol-detoxification experience deficits in motor and non-motor functions including cognitive performance. Imagery, the cognitive process of generating visual, auditory or kinesthetic experiences in the mind without the presence of external stimuli, has been little studied in Alcohol Use Disorders (AUD). This pilot study aims to observe the cognitive abilities useful for the inspection, maintenance, generation and manipulation of images in these patients during residential rehabilitation and investigate the relationships with their cognitive performance. Thirty-six subjects who completed the 28-day rehabilitation program for alcohol addiction, completed the Mental Imagery Test (MIT) and Neuropsychological Battery (ENB-2). The global score at MIT did not show pathological scores. The 11.1% of AUD patients showed an impaired global score in the cognitive performance and the 5.7% with scoring at limits of norm. Significant correlations were found between Mental Imagery abilities and ENB-2 subscale and stepwise regression analysis showed the close association between the ability of imagery (Mental Imagery Test) and the overall cognitive performance (ENB-2) in alcohol dependent patients and this relationship is stronger than other cognitive tasks.

How immersive virtual reality methods may meet the criteria of the National Academy of Neuropsychology and American Academy of Clinical Neuropsychology: A software review of the Virtual Reality Everyday Assessment Lab (VR-EAL)

Clinical tools involving immersive virtual reality (VR) may bring several advantages to cognitive neuroscience and neuropsychology. However, there are some technical and methodological pitfalls. The American Academy of Clinical Neuropsychology (AACN) and the National Academy of Neuropsychology (NAN) raised 8 key issues pertaining to Computerized Neuropsychological Assessment Devices. These issues pertain to: (1) the safety and effectivity; (2) the identity of the end-user; (3) the technical hardware and software features; (4) privacy and data security; (5) the psychometric properties; (6) examinee issues; (7) the use of reporting services; and (8) the reliability of the responses and results. The VR Everyday Assessment Lab (VR-EAL) is the first immersive VR neuropsychological battery with enhanced ecological validity for the assessment of everyday cognitive functions by offering a pleasant testing experience without inducing cybersickness. The VR-EAL meets the criteria of the NAN and AACN, addresses the methodological pitfalls, and brings advantages for neuropsychological testing. However, there are still shortcomings of the VR-EAL, which should be addressed. Future iterations should strive to improve the embodiment illusion in VR-EAL and the creation of an open access VR software library should be attempted. The discussed studies demonstrate the utility of VR methods in cognitive neuroscience and neuropsychology.

Validation of a Brief Computerized Cognitive Assessment in Multiple Sclerosis (BCCAMS) and comparison with reference batteries

Background: The Brief Computerized Cognitive Assessment in Multiple Sclerosis (BCCAMS) is a short neuropsychological battery for persons with multiple sclerosis (PwMS). Objectives: The main objective of the study is to validate the BCCAMS. Methods: PwMS and healthy subjects (HS) were evaluated using the BCCAMS which include two computerized tests, the Computerized Speed Cognitive Test and the Computerized Episodic Visual Memory Test (CEVMT), a newly developed visuospatial memory test, and the French learning test. The Minimal Assessment of Cognitive Function in MS (MACFIMS), including the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tests, was also administered. Regression-based norms of the BCCAMS were calculated in 276 HS. BCCAMS was compared with BICAMS and MACFIMS for detection of cognitive impairment (CI). Results: Out of 120 PwMS, CI was detected using the BCCAMS, BICAMS (one impaired test), and MACFIMS (two impaired tests) in 59.1%, 50%, and 37.9%, respectively. The BCCAMS produced the same predictive value as that of the BICAMS battery for detecting CI in the MACFIMS. Conclusion: This study validated the BCCAMS as a validated computerized short assessment for information processing speed and learning in MS.

Saccadic Eye Movements in Elderly Depressed Patients With Suicidal Behaviors: An Exploratory Eye-Tracking Study

Suicidal behaviors (SBs) are often associated with impaired performance on neuropsychological executive functioning (EF) measures that encourage the development of more specific and reliable tools. Recent evidence could suggest that saccadic movement using eye tracking can provide reliable information on EF in depressive elderly. The aim of this study was to describe oculomotor performances in elderly depressed patients with SB. To achieve this aim, we compared saccadic eye movement (SEM) performances in elderly depressed patients (N = 24) with SB and with no SB in prosaccade (PS) and antisaccade (AS) tasks under the gap, step, and overlap conditions. All participants also underwent a complete neuropsychological battery. Performances were impaired in patients with SB who exhibited less corrected AS errors and longer time to correct them than patients with no SB. Moreover, both groups had a similar performance for PS latencies and correct AS. These preliminary results suggested higher cognitive inflexibility in suicidal patients compared to non-suicidal. This inflexibility may explain the difficulty of the depressed elderly in generating solutions to the resurgence of suicidal ideation (SI) to respond adequately to stressful environments. The assessment of eye movement parameters in depressed elderly patients may be a first step in identifying high-risk patients for suicide.

Insight into intraindividual variability across neuropsychological tests and its association with cognitive dysfunction in patients with lupus

ObjectiveDispersion, or variability in an individual’s performance across multiple tasks at a single assessment visit, has been associated with cognitive dysfunction (CD) in many neurodegenerative and neurodevelopmental disorders. We aimed to compute a dispersion score using neuropsychological battery (NB) tests and determine its association with CD in patients with SLE.MethodsCD was defined as a z-score of ≤−1.5 on ≥2 domains of the NB. To compute a type of dispersion score known as the intraindividual SD (ISD), the SD of age-adjusted and sex-adjusted z-scores was calculated for each visit in each patient. To estimate the association between ISD and cognitive status (CD and non-CD), we used multilevel logistic regression, adjusting for clinically important covariates.ResultsA total of 301 adult patients with SLE completed the NB at baseline, 187 of whom were reassessed at 6 months and 189 at 12 months. CD was observed in 35.2% of patients at baseline, 27.8% at 6 months and 28.0% at 12 months. Prior to covariate adjustment, the mean ISD for non-CD was 1.10±0.31 compared with 1.50±0.70 for CD. After adjusting for ethnicity, education, employment, socioeconomic status and anxiety/depression, there was a statistically significant association between ISD and CD (OR for one-unit increase in ISD: 13.56, 95% CI 4.80 to 38.31; OR for 1/10th-unit increase in ISD: 1.30, 95% CI 1.17 to 1.44). Findings were valid across multiple sensitivity analyses.ConclusionThis is the first study to show that patients with SLE who were classified as having CD by the NB had more variability across the NB tests (ie, higher ISD score) compared with those who were not classified as having CD.

Cognitive function in elderly patients with Chronic Kidney disease

Background Many elderly patients with Chronic Kidney disease (CKD) develop cognitive impairment and dementia. Cognitive impairment impacts CKD patients negatively by functional dependence and recurrent hospitalization. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery was originally developed to identify early Alzheimer’s disease, but it has become a widely used instrument to assess different levels & domains of cognitive and executive functions. Aim the aim of the study was to assess cognitive function in elderly patients with CKD. Patients and Methods one hundred CKD patients were recruited from outpatient clinics of Ain Shams University hospital. CERAD neuropsychological battery was used to measure cognitive functions in different domains (language functions, verbal learning, visuospatial functions, delayed recall, memory consolidation, recognition memory, and executive functions). Results CKD patients had low mean verbal fluency and mean MMSE while language functions score hadn’t been affected. There was a significant positive correlation (p < 0.001) between the mean eGFR and the CERAD total score. Conclusion This study contributes to the belief that an association exists between renal impairment and cognition, CERAD total score in CKD patients was inversely correlated to eGFR. Age and educational level significantly affect cognitive performance.