Subvocal articulatory rehearsal during verbal working memory in multiple sclerosis.

This study was designed to examine verbal working memory (VWM) components among multiple sclerosis (MS) patients and determine the influence of information processing speed. Of two frequently studied VWM sub-components, subvocal rehearsal was expected to be more affected by MS than short-term memory buffering. Furthermore, worse subvocal rehearsal was predicted to be specifically related to slower cognitive processing. Fifteen MS patients were administered a neuropsychological battery assessing VWM, processing speed, mood, fatigue, and disability. Participants performed a 2-Back VWM task with modified nested conditions designed to increase subvocal rehearsal (via inter-stimulus interval) and short-term memory buffering demands (via phonological similarity). Performance during these 2-Back conditions did not significantly differ and both exhibited strong positive correlations with disability. However, only scores on the subvocal rehearsal 2-Back were significantly related to performance on the remaining test battery, including processing speed and depressive symptoms. Findings suggest that performance during increased subvocal rehearsal demands is specifically influenced by cognitive processing speed and depressive symptoms.

Relative contributions of the cerebellar vermis and prefrontal lobe volumes on cognitive function across the adult lifespan.

Recent research has revealed significant relationships between the vermian regions of the cerebellum and cognitive functions typically associated with prefrontal lobe function. These relationships are believed to be supported by anatomical connections between the distant brain regions. Recent evidence also suggests that age-related reductions in the posterior vermis are associated with age-related decline in frontal lobe cognitive functions, but these studies did not consider concomitant age-related atrophy of the prefrontal lobes. In the present study we addressed this issue by examining cognitive and structural MRI data obtained from 251 adults ranging in age from 18 to 79. Cognition was examined with a computerized cognitive battery and volumes of the cerebellar vermian regions and the prefrontal lobes were determined using quantitative morphometry. Results of the study revealed that both prefrontal and vermian volumes were smaller in older adults compared to younger adults, and both volumes correlated with cognitive performances in the older individuals. However, after controlling for prefrontal volume, the relationships between cognitive function and vermian volumes were eliminated, whereas prefrontal lobe volume remained significantly related to cognitive function after controlling for vermian volumes. These results suggest that while a reduction in cerebellar vermian volume does not significantly relate to normal age-related cognitive decline, prefrontal volume is significantly related to cognitive aging. Our results are consistent with the frontal aging hypothesis.

Rates of decline distinguish Alzheimer's disease and mild cognitive impairment relative to normal aging: integrating cognition and brain function.

AIMS: Increasing age is the strongest risk factor for Alzheimer's disease (AD). Yet, departure from normal age-related decline for established markers of AD including memory, cognitive decline and brain function deficits, has not been quantified. METHODS: We examined the cross-sectional estimates of the "rate of decline" in cognitive performance and psychophysiological measures of brain function over age in AD, preclinical (subjective memory complaint-SMC, Mild Cognitive Impairment-MCI) and healthy groups. Correlations between memory performance and indices of brain function were also conducted. RESULTS: The rate of cognitive decline increased between groups: AD showed advanced decline, and SMC/MCI groups represented intermediate stages of decline relative to normal aging expectations. In AD, advanced EEG alterations (excessive slow-wave/reduced fast-wave EEG, decreased working memory P450 component) were observed over age, which were coupled with memory decline. By contrast, MCI group showed less severe cognitive changes but specific decreases in the working memory N300 component and slow-wave (delta) EEG, associated with decline in memory. DISCUSSION AND INTEGRATIVE SIGNIFICANCE: While the cognitive data suggests a continuum of deterioration associated with increasing symptom severity across groups, integration with brain function measures points to possible distinct compensatory strategies in MCI and AD groups. An integrative approach offers the potential for objective markers of the critical turning point, with age as a potential factor, from mild memory problems to disease.

Cognitive predictors of functional decline in vascular dementia.

BACKGROUND: This study examined changes in cognitive-functional relationships in vascular dementia (VaD) over the course of one year. METHODS: Twenty-four patients with probable VaD were administered the Dementia Rating Scale (DRS). Caregivers completed an informant-based measure of instrumental (IADL) and basic activities of daily living (BADL). Follow-up assessment was conducted one-year post-baseline. RESULTS: Logistic regression revealed that changes in the DRS Initiation/Perseveration and DRS Memory subscales were significantly associated with declines in IADLs and BADLs, respectively. CONCLUSIONS: Among patients with VaD, longitudinal changes in IADLs and BADLs are most strongly associated with changes in executive functioning and memory abilities, respectively. Findings suggest that different cognitive functions subserve complex instrumental and rote, habituated basic functional activities, and neuropsychological screening measures are useful in the prediction of such functional changes.

History of cluster headache.

Possibly because of the manifestation of severe debilitating pain, cluster headache has been identified in early publications, described in exquisite detail by authors dating as far back as 1641. These early descriptions focused on the symptoms of the episodes rather than the periodicity of their occurrence. Similar to most medical conditions described without anatomic or clearly defined pathophysiologic basis, cluster headache often was named for its clinical manifestations, or less helpfully, by the names of the authors of its descriptive publications. It was only in 1952 that the condition was named for its peculiar tendency to occur in clusters over a period of weeks rather than being a chronic, recurrent, episodic condition similar to migraine. Despite having such an interesting mix of autonomic and physical features, this observation seems to be most instrumental in divulging the true pathogenesis of this disease and correctly localizing its origin anatomically in the hypothalamus.

Progressive morphometric and cognitive changes in vascular dementia.

Evidence for progressive cognitive decline in vascular dementia (VaD) is mixed, with some studies showing little or no decline over time. One possible explanation for these inconsistent findings is the heterogeneity of pathology encompassed by the VaD diagnosis. It is possible that subtypes of VaD (i.e. those resulting from different lesion distributions) show different patterns of cognitive decline. In the present study, a heterogeneous VaD group demonstrated cognitive decline from baseline to 12-month follow-up. Although this decline was coincident to morphometric changes (i.e. increased subcortical hyperintensities (SH), decreased whole brain volume (WBV)), no relationship emerged between cognitive decline and morphometric changes. Preliminary examination of VaD subtypes revealed patients with subcortical infarct or SH-only exhibited greater decline than VaD patients with cortical lesions. Further research is needed to determine whether this observed decline is attributable to differential lesion distribution or statistical artifact.

Cognitive-behavioral group treatment for disabling headache.

OBJECTIVES: Severe, disabling headache is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. First-line prophylactic agents combined with triptans do not adequately benefit many disabled headache sufferers. We sought to investigate whether a cognitive-behavioral treatment targeting the psychological and behavioral factors that contribute to disabling headache may provide additional benefit and whether using a group format may provide a more intensive clinic-based treatment without increasing the cost of service delivery. DESIGN: We developed and piloted a cognitive-behavioral group treatment for chronic, disabling headache. We evaluated its effectiveness in decreasing headache, reducing symptomatic medication use, and improving quality of life. SETTING: A behavioral headache management program of an academic medical center. PATIENTS: Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment. INTERVENTIONS: Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation. OUTCOME MEASURES: The impacts of treatment on headache (frequency, intensity, and duration), medication use, and quality of life were assessed. RESULTS: Separate multivariate analyses of variance revealed significant improvements in headache, symptomatic medication use, and quality of life. Overall, 50% of participants experienced at least a 50% reduction in headache frequency from pre- to posttreatment. CONCLUSIONS: The findings provide preliminary evidence that delivering a clinic-based, group-format cognitive-behavioral treatment to moderately to severely disabled headache sufferers can decrease headache activity, reduce symptomatic medication use, and improve quality of life.

Neuroimaging correlates of dementia rating scale performance at baseline and 12-month follow-up among patients with vascular dementia.

The authors previously reported that subcortical hyperintensity (SH) and whole-brain volume (WBV) each covary with different subscale scores of the Mattis Dementia Rating Scale (MDRS) among vascular dementia (VaD) patients. The present longitudinal analysis examined these relationships for change. The authors found that SH volume increased and WBV decreased significantly over 12 months. At baseline, SH volume accounted for significant variance in MDRS total score and every subscale score, except Memory. WBV was unrelated to any MDRS measure. After 12 months, SH volume was related only to the Construction subscale score, whereas WBV accounted for the majority of variance in Attention and Memory subscale performance. These findings indicate that although SH volume increases with disease progression, the relative impact of SH volume on cognitive status decreases among patients with advanced VaD.

Long-term citicoline (cytidine diphosphate choline) use in patients with vascular dementia: neuroimaging and neuropsychological outcomes.

BACKGROUND: Cytidine diphosphate choline (citicoline) has been previously shown to have efficacy in reducing the functional impairments associated with acute stroke. Citicoline is thought to have neuroprotective benefits and has been used for the treatment of chronic cerebrovascular disorders, though its effectiveness has not been fully tested. This randomized, double-blind clinical trial was conducted to determine whether daily citicoline treatment improves neurocognitive and neuroimaging outcome over 12 months among patients diagnosed with vascular dementia (VaD). METHODS: 30 patients diagnosed with VaD, based upon NINDS-AIREN and DSM-IV criteria, were randomized and treated with either 500 mg of citicoline or placebo twice per day. Patients were assessed at baseline, and at 6, and 12 months on a battery of neurocognitive tests. Neuroimaging measures of total brain volume and subcortical/periventricular hyperintensity (SH) volume on magnetic resonance imaging (MRI) were collected at baseline and the 12-month follow-up. RESULTS: The citicoline and placebo treatment groups did not differ in their neuropsychological performance at baseline and the 12-month follow-up. Significant declines in neuropsychological performance were noted, as well as significantly increased SH and reduced total brain volumes on MRI for both groups at the 12-month follow-up. CONCLUSIONS: The efficacy of long-term citicoline treatment for cognitive impairment and neuropathological decline in those patients already meeting criteria for VaD does not appear to be substantiated by the current study.

Sensitivity of the dementia rating scale in vascular dementia: comparison between two sets of criteria to define cognitive impairment.

BACKGROUND: The Dementia Rating Scale (DRS) is a common measure of cognitive function, but its sensitivity to identify deficits across cognitive domains in vascular dementia (VaD) remains unclear. METHODS: We compared the sensitivity and specificity of two recommended cutoff scores of the DRS. Thirty-eight patients diagnosed with VaD participated in the current study. RESULTS: The original recommendations resulted in poor sensitivity for the DRS total score and attention, construction, and memory subscales. The more recent recommendations greatly improved the sensitivity of the subscales and the total DRS score, but resulted in decreased specificity. Correlations between the specific DRS subscales and criterion measures of cognitive function revealed good convergent and divergent validity for most subscales. CONCLUSIONS: The DRS is a valid measure of cognitive dysfunction in VaD, but clinicians should consider using the more recent recommendations developed for AD to determine impaired performances in VaD.

The relationship of subcortical MRI hyperintensities and brain volume to cognitive function in vascular dementia.

The relationship between MRI findings (i.e., subcortical hyperintensities; SH, whole brain volume) and the cognitive dysfunction of vascular dementia (VaD) was examined. Participants included 24 persons that met NINDS-AIREN criteria for VaD (MMSE = 19.9 +/- 4.2) and underwent comprehensive neuropsychological assessment and MRI brain imaging. The volume of subcortical hyperintensities (SH) was strongly associated with executive-psychomotor performance, but not with performance across other cognitive domains or global cognitive functional level. Conversely, WBV was strongly associated with global cognitive functioning and performance across most cognitive domains (memory, language, visual integration), but not with executive-psychomotor functioning. The failure of SH to account for either the global dementia evident in these VaD patients or impairments across most cognitive domains suggests that deep subcortical white matter disease may only indirectly contribute to the global cognitive dysfunction of VaD. That WBV emerged as a stronger correlate of dementia raises further questions regarding the cerebral mechanisms that contribute to the development of VaD.

Behavioral problems as predictors of functional abilities of vascular dementia patients.

The relationship of behavioral disturbance and dementia severity to activities of daily living (ADLs) in vascular dementia (VaD) was examined in baseline data for 29 VaD patients. A series of stepwise regression analyses was conducted to examine the extent to which dementia severity, apathy, disinhibition, and executive dysfunction predict ADLs (total, basic, and instrumental). For total ADLs, apathy accounted for 36% of the variance and dementia severity accounted for an additional 15%. For basic ADLs, apathy accounted for 27% of the variance. Dementia severity, executive dysfunction, and disinhibition were not significantly associated with basic ADLs. For instrumental ADLs, dementia severity accounted for 37% of the variance and apathy accounted for an additional 14%. These findings highlight the importance of apathy as an independent factor associated with functional independence beyond general cognitive abilities.

The serial position effect in mild and moderately severe vascular dementia.

The present study examined the serial position effect in 2 subgroups of individuals with vascular dementia (VaD). Nineteen individuals with mild VaD and 17 individuals with moderate VaD were administered the California Verbal Learning Test. Both groups were impaired on a general memory measure, and the moderately impaired group demonstrated significantly poorer recall than the mildly impaired group on the first learning trial and on total learning across trials. In addition, individuals with mild dementia demonstrated an intact primacy and recency effect, whereas individuals with moderate dementia demonstrated neither primacy nor recency effects. The latter findings are consistent with studies examining the serial position effect in other dementia populations, and suggests that the absence of primacy and recency effects in more advanced dementia may occur regardless of dementia type.

The global deterioration scale: relationships to neuropsychological performance and activities of daily living in patients with vascular dementia.

In the present study, we examined the relationships between ratings on the Global Deterioration Scale (GDS) and activities of daily living and cognitive function in 39 individuals with vascular dementia (VaD). The results of the study revealed significant correlations between GDS rating and performance on cognitive tests, including memory and overall cognitive ability. In addition, the GDS was significantly related to ratings of instrumental activities of daily living. Comparisons between patients with VaD with GDS scores between 4 and 6 (n = 21) and patients with scores between 2 and 3 (n = 18) revealed greater cognitive and functional deficits in the group with higher GDS scores. Further, the GDS score accurately classified 87% of the patients with VaD. These findings provide support for the validity of the GDS in general staging of dementia severity of VaD.

Cognitive and motor impairments predict functional declines in patients with vascular dementia.

BACKGROUND: Vascular dementia (VaD) is associated with impairments in cognitive, motor, and functional domains. Patients with VaD display diverse cognitive and motor deficits, however, and relationships between these impairments and independent living abilities remain unclear. OBJECTIVES: The purpose of the present study was to investigate the contributions made by attentional/executive and motor functions in the prediction of basic and instrumental activities of daily living in 32 patients with VaD. We hypothesized that: (a) motor abilities would emerge as a significant predictor of basic activities of daily living, whereas attentional/executive abilities would not, and (b) both motor and attentional/executive abilities would emerge as significant predictors of instrumental activities of daily living. RESULTS: Stepwise regression analyses revealed that motor performance, but not attentional/executive abilities, accounted for a significant proportion of the variance in basic activities of daily living, and that both motor and attentional/executive abilities contributed significantly to the prediction of instrumental activities of daily living. CONCLUSIONS: These results suggest that attentional/executive and motor impairments may underlie specific aspects of functional disability among patients with VaD.

Cognitive and functional status in two subtypes of vascular dementia.

In the present study we examined cognitive function, radiographic features, and functional ability in individuals with vascular dementia (VaD). Subjects were subdivided into individuals with only white matter involvement (WM) and individuals with evidence of a cortical infarction in addition to white matter ischemic change (C+WM). Results revealed that both groups of subjects were impaired across cognitive functions. Cognitive performance was more severely impaired among the C+WM group, but the general pattern of deficits did not differ between the two groups. Hachinski scores were significantly higher and instrumental activities of daily living were more severely affected in the C+WM group compared to the WM group. No significant differences were evident between the two groups on overall dementia severity or the extent of white matter involvement. These findings indicate that cognitive function in VaD may be globally impaired, and that cortical infarction in addition to white matter ischemia results in greater impairment, but the differences are largely quantitative rather than qualitative.

Electroconvulsive Therapy in Parkinson's Disease: A Report on Five Cases.

Five patients with Parkinson's disease (PD) and depression underwent electroconvulsive therapy (ECT). One patient had a myocardial infarction several hours after the last planned session and died. Of the remaining four patients, all achieved marked improvement in mood and three had markedly improved motor function as well. Improvement in motor function lasted as long as 8 weeks. ECT is helpful in treating both depression and parkinsonism but maintenance ECT is required for continued motor improvement.