Subjective Cognitive Dysfunction in Patients with Dizziness and Vertigo

<b><i>Introduction:</i></b> Patients with vestibular disorders sometimes report cognitive difficulties, but there is no consensus about the type or degree of cognitive complaint. We therefore investigated subjective cognitive dysfunction in a well-defined sample of neuro-otology patients and used demographic factors and scores from a measure of depression, anxiety, and stress to control for potential confounding factors. <b><i>Methods:</i></b> We asked 126 neuro-otology clinic outpatients whether they experienced difficulties with thinking, memory, or concentration as a result of dizziness or vertigo. They and 42 nonvertiginous control subjects also completed the Neuropsychological Vertigo Inventory (NVI, which measures cognitive, emotional, vision, and motor complaints), the Everyday Memory Questionnaire (EMQ), and Depression, Anxiety, and Stress Scales (DASS). <b><i>Results:</i></b> In the initial interview questions, 60% of patients reported experiencing cognitive difficulties. Cognitive questionnaire scores were positively correlated with the overall DASS score and to a lesser extent with age and gender. Therefore, we compared patients and controls on the NVI and EMQ, using these mood and demographic variables as covariates. Linear regression analyses revealed that patients scored significantly worse on the total NVI, NVI cognitive composite, and 3 individual NVI cognition subscales (Attention, Space Perception, and Time Perception), but not the EMQ. Patients also scored significantly worse on the NVI Emotion and Motor subscales. <b><i>Conclusions:</i></b> Patients with dizziness and vertigo reported high levels of cognitive dysfunction, affecting attention, perceptions of space and time. Although perceptions of cognitive dysfunction were correlated with emotional distress, they were significantly elevated in patients over and above the impact of depression, anxiety, or stress.

Everyday Memory in People with Down Syndrome

Although memory functions in people with Down Syndrome (DS) have been studied extensively, how well people with DS remember things about everyday life is not well understood. In the current study, 31 adolescents/young adults with DS and 26 with intellectual disabilities (ID) of mixed etiology (not DS) participated. They completed an everyday memory questionnaire about personal facts and recent events (e.g., school name, breakfast). They also completed a standard laboratory task of verbal long-term memory (LTM) where they recalled a list of unrelated words over trials. Results did not indicate impaired everyday memory, but impaired verbal LTM, in people with DS relative to people with mixed ID. Furthermore, the laboratory verbal LTM task predicted everyday memory for both groups after taking into account mental age equivalent. Our research showed both an independence and a connection between everyday memory and the standard laboratory memory task and has important research and clinical implications.

0159 Reduced REM Sleep Percent in Frequent Cannabis Versus Non-Cannabis Users

Introduction THC (the main psychoactive component of cannabis) has been shown to suppress REM sleep and decrease sleep latency, although this is not consistently replicated. Increased dream vividness is reported to occur in abstinent cannabis users, although dream quality in active users is unstudied. The current study aimed to assess the effects of cannabis use compared to non-use on objective sleep measures, dream reports, and self-reported anxiety, memory, and sleep quality. To collect objective sleep data we piloted the use of a portable PSG headband that allows EEG and EOG recording at home. Methods 12 regular cannabis users (&gt; 3 days per week) & 9 non-users (aged 19 - 27; 43% female) participated; participants used no other drugs or alcohol on study nights. The most common form of cannabis use was smoking in joints with tobacco (range = 1 - 15 per day). Participants wore the PSG headband (the Hypnodyne ZMax) over 2 nights at home (2nd night used for analysis), and were instructed to awaken 4 times across the night to fill out brief dream reports. Objective sleep measures included TST, Sleep latency, REM latency, and REM percent. Self-report measures included the Pittsburgh Sleep Quality Index, Everyday Memory Questionnaire, and State-Trait Anxiety Index. Dream measures included recall frequency, word length, and three attributes rated on a 1–7 Likert scale - sensory vividness, emotional intensity, and bizarreness. Results There were no group differences on self-report measures. Cannabis users showed longer REM latency (t=2.23, p=.04) and lower REM% (U=22, p=.02); there were no other objective group differences. Cannabis users reported higher bizarreness in their dreams (t=2.07, p=.05); there were no other dream differences. Conclusion The study presents a novel approach to assess sleep at home and cannabis use. Significant differences emerged between users and non-users on REM latency, REM%, and dream bizarreness. Support N/A

Group cognitive rehabilitation to reduce the psychological impact of multiple sclerosis on quality of life: the CRAMMS RCT

Background People with multiple sclerosis have problems with memory and attention. The effectiveness of cognitive rehabilitation has not been established. Objectives The objectives were to assess the clinical effectiveness and cost-effectiveness of a cognitive rehabilitation programme for people with multiple sclerosis. Design This was a multicentre, randomised controlled trial in which participants were randomised in a ratio of 6 : 5 to receive cognitive rehabilitation plus usual care or usual care alone. Participants were assessed at 6 and 12 months after randomisation. Setting The trial was set in hospital neurology clinics and community services. Participants Participants were people with multiple sclerosis who had cognitive problems, were aged 18–69 years, could travel to attend group sessions and gave informed consent. Intervention The intervention was a group cognitive rehabilitation programme delivered weekly by an assistant psychologist to between four and six participants for 10 weeks. Main outcome measures The primary outcome was the Multiple Sclerosis Impact Scale – Psychological subscale at 12 months. Secondary outcomes included results from the Everyday Memory Questionnaire, the 30-Item General Health Questionnaire, the EuroQol-5 Dimensions, five-level version and a service use questionnaire from participants, and the Everyday Memory Questionnaire – relative version and the Modified Carer Strain Index from a relative or friend of the participant. Results Of the 449 participants randomised, 245 were allocated to cognitive rehabilitation (intervention group) and 204 were allocated to usual care (control group). Of these, 214 in the intervention group and 173 in the control group were included in the primary analysis. There was no clinically important difference in the Multiple Sclerosis Impact Scale – Psychological subscale score between the two groups at the 12-month follow-up (adjusted difference in means –0.6, 95% confidence interval –1.5 to 0.3; p = 0.20). There were no important differences between the groups in relation to cognitive abilities, fatigue, employment, or carer strain at follow-up. However, there were differences, although small, between the groups in the Multiple Sclerosis Impact Scale – Psychological subscale score at 6 months (adjusted difference in means –0.9, 95% confidence interval –1.7 to –0.1; p = 0.03) and in everyday memory on the Everyday Memory Questionnaire as reported by participants at 6 (adjusted difference in means –5.3, 95% confidence interval –8.7 to –1.9) and 12 months (adjusted difference in means –4.4, 95% confidence interval –7.8 to –0.9) and by relatives at 6 (adjusted difference in means –5.4, 95% confidence interval –9.1 to –1.7) and 12 months (adjusted difference in means –5.5, 95% confidence interval –9.6 to –1.5) in favour of the cognitive rehabilitation group. There were also differences in mood on the 30-Item General Health Questionnaire at 6 (adjusted difference in means –3.4, 95% confidence interval –5.9 to –0.8) and 12 months (adjusted difference in means –3.4, 95% confidence interval –6.2 to –0.6) in favour of the cognitive rehabilitation group. A qualitative analysis indicated perceived benefits of the intervention. There was no evidence of a difference in costs (adjusted difference in means –£574.93, 95% confidence interval –£1878.93 to £729.07) or quality-adjusted life-year gain (adjusted difference in means 0.00, 95% confidence interval –0.02 to 0.02). No safety concerns were raised and no deaths were reported. Limitations The trial included a sample of participants who had relatively severe cognitive problems in daily life. The trial was not powered to perform subgroup analyses. Participants could not be blinded to treatment allocation. Conclusions This cognitive rehabilitation programme had no long-term benefits on quality of life for people with multiple sclerosis. Future work Future research should evaluate the selection of those who may benefit from cognitive rehabilitation. Trial registration Current Controlled Trials ISRCTN09697576. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 4. See the National Institute for Health Research Journals Library website for further project information.

A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

BackgroundPeople with traumatic brain injuries (TBIs) commonly report memory impairments. These are persistent, debilitating and reduce quality of life, but patients do not routinely receive memory rehabilitation after discharge from hospital.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of a group memory rehabilitation programme for people with TBI.DesignMulticentre, pragmatic, cluster randomised controlled trial. Qualitative and health economic evaluations were also undertaken.SettingCommunity settings in nine sites in England.ParticipantsParticipants were aged 18–69 years, had undergone a TBI > 3 months prior to recruitment, reported memory problems, were able to travel to a site to attend group sessions, could communicate in English and gave informed consent.Randomisation and blindingClusters of four to six participants were randomised to the memory rehabilitation arm or the usual-care arm on a 1 : 1 ratio. Randomisation was based on a computer-generated pseudo-random code using random permuted blocks of randomly varying size, stratified by study site. Participants and therapists were aware of the treatment allocation whereas outcome assessors were blinded.InterventionsIn the memory rehabilitation arm 10 weekly sessions of a manualised memory rehabilitation programme were provided in addition to usual care. Participants were taught restitution strategies to retrain impaired memory functions and compensation strategies to enable them to cope with memory problems. The usual-care arm received usual care only.Main outcome measuresOutcomes were assessed at 6 and 12 months after randomisation. Primary outcome: patient-completed Everyday Memory Questionnaire – patient version (EMQ-p) at 6 months’ follow-up. Secondary outcomes: Rivermead Behavioural Memory Test – third edition (RBMT-3), General Health Questionnaire 30-item version, European Brain Injury Questionnaire, Everyday Memory Questionnaire – relative version and individual goal attainment. Costs (based on a UK NHS and Personal Social Services perspective) were collected using a service use questionnaire, with the EuroQol-5 Dimensions, five-level version, used to derive quality-adjusted life-years (QALYs). A Markov model was developed to explore cost-effectiveness at 5 and 10 years, with a 3.5% discount applied.ResultsWe randomised 328 participants (memory rehabilitation,n = 171; usual care,n = 157), with 129 in the memory rehabilitation arm and 122 in the usual-care arm included in the primary analysis. We found no clinically important difference on the EMQ-p between the two arms at 6 months’ follow-up (adjusted difference in mean scores –2.1, 95% confidence interval –6.7 to 2.5;p = 0.37). For secondary outcomes, differences favouring the memory rehabilitation arm were observed at 6 months’ follow-up for the RBMT-3 and goal attainment, but remained only for goal attainment at 12 months’ follow-up. There were no differences between arms in mood or quality of life. The qualitative results suggested positive experiences of participating in the trial and of attending the groups. Participants reported that memory rehabilitation was not routinely accessible in usual care. The primary health economics outcome at 12 months found memory rehabilitation to be £26.89 cheaper than usual care but less effective, with an incremental QALY loss of 0.007. Differences in costs and effects were not statistically significant and non-parametric bootstrapping demonstrated considerable uncertainty in these findings. No safety concerns were raised and no deaths were reported.LimitationsAs a pragmatic trial, we had broad inclusion criteria and, therefore, there was considerable heterogeneity within the sample. The study was not powered to perform further subgroup analyses. Participants and therapists could not be blinded to treatment allocation.ConclusionsThe group memory rehabilitation delivered in this trial is very unlikely to lead to clinical benefits or to be a cost-effective treatment for people with TBI in the community. Future studies should examine the selection of participants who may benefit most from memory rehabilitation.Trial registrationCurrent Controlled Trials ISRCTN65792154.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 16. See the NIHR Journals Library website for further project information.

Memoria cotidiana: Dimensiones y pautas de declive en adultos sanos. / Everyday memory: Dimensions and patterns of decline in healthy adults.

RESUMENEl objetivo de este trabajo fue validar y conocer las propiedades psicométricas del Cuestionario de Memoria Cotidiana (CMC) inspirado en el Everyday Memory Questionnaire (EMQ) de Baddeley (1997). Se comprobó su fiabilidad y la validez de constructo y se determinaron sus dimensiones a través de su análisis factorial. En un primer momento participaron 129 adultos sin patología cognitiva, de edades comprendidas entre los 48 y los 91 años de edad. En un segundo momento, con una muestra de 510 adultos sanos de edades comprendidas entre los 48 y los 90 años, se quiso saber si existe afectación diferenciada de las distintas dimensiones de memoria cotidiana establecidas. Los resultados permiten concluir que dicha medida pluridimensional posee propiedades psicométricas adecuadas, alfa de Cronbach de .91, y se evidencia que existen sistemas o áreas componentes de la memoria cotidiana diferencialmente resistentes al deterioro. Los fallos cognitivos autoinformados indican que las áreas que más deterioro sufren con el paso de los años son el recuerdo del sitio de las cosas y la memoria de fuente, siendo la más resistente la memoria autobiográfica en ambos sexos.ABSTRACTThe main of this work was to validate and to know the psychometric properties of the Cuestionario de Memoria Cotidiana (CMC) inspired in Baddeley's Everyday Memory Questionnaire (EMQ) (1997). We checked their reliability and construct validity and their dimensions were determined through their factorial analysis. We make, at first, with a sample of 129 adults not suffering from any cognitive pathology and aged between 48 and 91 years. And at a later stage, a sample of 510 healthy adults with ages ranging from 48 and 90 years was used to discover if there were any differentiation of effects in the various dimensions of everyday memory that were established. Results shown that this multi-dimensional measurement has acceptable psychometric properties, with a Cronbach’s alpha of 0.91, and also provided evidence that there are systems or areas making up every-day memory that are differentially resistant to deterioration. Self-reported cognitive failures indicated that the areas suffering most downgrading with the passage of time are recall of the location of objects and source memory, with autobiographic memory being more resistant in both sexes.