The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health related quality of life in newly diagnosed ovarian cancer patients.

Objective: To assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. Methods: From May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. Results: This study included 105 newly diagnosed OC patients, with an average age of 49.73 (±8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. Conclusion: The incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.

Persistent neurocognitive deficits in cognitively impaired survivors of sepsis are explained by reductions in working memory capacity.

Introduction: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Mounting evidence suggests that many cognitively impaired sepsis survivors show long-term neurocognitive deficits in neuropsychological tasks. To date, the underlying mechanisms of these deficits are insufficiently understood. Based on previous evaluations we hypothesized that visual attention and working memory may be affected in a sample of cognitively impaired sepsis survivors. Methods: We utilized psychophysical whole-and partial-report paradigms based on the computational theory of visual attention (TVA) to determine (i) whether sepsis survivors show changes in basic parameters of visual attention and working memory, (ii) whether the affected parameters are related to neuropsychological test results in a standard battery in sepsis survivors and matched healthy control participants, (iii) whether between-group differences in these basic parameters of visual attention could account for underperformance of sepsis survivors in neuropsychological tests when adjusting for potentially relevant clinical variables. Results: We showed that, in sepsis survivors, the maximum number of elements consciously maintained in an instant, i.e. the working memory storage capacity K, is reduced (sepsis survivors: M = 3.0; healthy controls: M = 3.4). Moreover, K explained variance in neurocognitive outcomes -17% in attentional and 16 % in executive functions - in a standard neuropsychological battery. The association remained stable when adjusting for clinical variables. Discussion: Thus, in our sample of cognitively impaired sepsis survivors, a reduction in working memory capacity seems to be a critical determinant of the neurocognitive sequelae. It should be the subject of future work on mechanisms but may also serve as surrogate outcome measure in interventional studies.

Qualitative and Visual Along-Tract Analysis of Diffusion-Based Parameters in Patients with Diffuse Gliomas.

BACKGROUND: Grade 2-3 diffuse gliomas (DGs) show extensive infiltration through white matter (WM) tracts. Along-tract analysis of WM tracts based on diffusion tensor tractography (DTI) can been performed to assess the microstructural integrity of WM tracts. The clinical implication of these DTI-related findings is still under debate, especially in tumor patients. The aim of this study was to analyze and compare diffusion-based parameters along WM tracts and variables specific to WM -tumor interactions in DGs and correlate them with preoperative neuropsychological assessment. METHODS: Fourteen patients with IDH-mutated grade 2-3 DGs were included. Tumor volumes were manually segmented on 3D-FLAIR images after spatial normalisation to MNI space. DTI was acquired using a single-shot echo-planar sequence on a 3T with 48 sampling directions. DTI data were reconstructed within the MNI space using q-space diffeomorphic reconstruction (QSDR) in DSI studio. Five bilateral sets of WM tracts were reconstructed based on the HCP-1065 template. All WM tracts were stretched to the same length of 100 indices, and for each index diffusion-based parameters fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD), mean diffusivity (MD) and quantitative anisotropy (QA) were sampled. Tumor-related parameters (TRP); tumor volume (Tv), maximum tumor presence (MTP) and the number of sequential indices in which a tumor is present (Te) were derived based on the along-tract analysis. Normal data were constructed by calculating the average and standard deviations of contralateral and not-affected WM tracts for each diffusion-based parameter, respectively. Affected WM tracts were individually compared to normal data using a z-test. Preoperative neuropsychological assessment was performed in all subjects and correlated to results from the along-tract analysis using correlation and logistic regression models. RESULTS: Abnormalities in diffusion-based parameters were detected in WM tracts. Topographical and quantitative information were presented within the same graph. AD and MD displayed the highest linear correlation with the TRPs. Abnormal QA showed a linear correlation with Tv per WM tract. Neuropsychological impairment was correlated with all the TRPs and with abnormal FA (p < 0.05) and abnormal QA (p < 0.01). Abnormal QA was the only independent variable able to predict the presence of neuropsychological impairment in the patients based on the linear regression analysis. CONCLUSIONS: Graphical presentation of the along-tract analysis presented in this study shows that it may be a sensitive and robust method to acquire and display topographical and qualitative information regarding WM tracts in close proximity to DGs. Further studies and refinements to the methods presented herein may advance current clinical methods for evaluating displacement and infiltrations and further aid the efforts of pre-planning surgical interventions with the goal to maximise EOR and tailor oncological treatment.

Development of robust normative data for the neuropsychological assessment of Greek older adults.

OBJECTIVE: Normative data for older adults may be tainted by inadvertent inclusion of undiagnosed individuals at the very early stage of a neurodegenerative process. To avoid this pitfall, we developed norms for a cohort of older adults without MCI/dementia at 3-year follow-up. METHODS: A randomly selected sample of 1041 community-dwelling individuals (age ≥ 65) received a full neurological and neuropsychological examination on two occasions [mean interval = 3.1 (SD = 0.9) years]. RESULTS: Of these, 492 participants (Group 1; 65-87 years old) were without dementia on both evaluations (CDR=0 and MMSE ≥ 26); their baseline data were used for norms development. Group 2 (n = 202) met the aforementioned criteria only at baseline, but not at follow-up. Multiple linear regressions included demographic predictors for regression-based normative formulae and raw test scores as dependent variables for each test variable separately. Standardized scaled scores and stratified discrete norms were also calculated. Group 2 performed worse than Group 1 on most tests (p-values < .001-.021). Education was associated with all test scores, age with most, and sex effects were consistent with the literature. CONCLUSIONS: We provide a model for developing sound normative data for widely used neuropsychological tests among older adults, untainted by potential early, undiagnosed cognitive impairment, reporting regression-based, scaled, and discrete norms for use in clinical settings to identify cognitive decline in older adults. Additionally, our co-norming of a variety of tests may enable intra-individual comparisons for diagnostic purposes. The present work addresses the challenge of developing robust normative data for neuropsychological tests in older adults.

How fear of intimacy affects infertile men's neuropsychological functioning through mental toughness.

Objective: There is a significant need in Pakistan to investigate the psychological effects of infertility on the mental health of infertile men. The current study examined how fear of intimacy affects neuropsychological impairment and evaluated its relationship to other variables including quality of life and mental toughness. Method: An analytical cross-sectional study was carried out on infertile male patients in various healthcare settings in Punjab, Pakistan. The participants were recruited using a non-probability (purposive) sampling strategy. The sample size was 120 infertile. SPSS 26 was used to analyze the data. Results: Fear of intimacy was found significant impact on neuropsychological impairment (r = 0.40; ***p < 0.001), as well as fear of intimacy, significantly associated with emotional problems (r = 0.48; **p < 0.01), learning problems (r = 0.33; **p < 0.01), sensory and motor problem (r = 0.55; **p < 0.01), concentration problem (r = 0.21; **p < 0.01), mental & physical in coordination (r = 0.37; **p < 0.01) and depression (r = 0.22; **p < 0.01). Fear of intimacy has negative impact on QoL (r = -0.25; *p > 0.05). Similarly, neuropsychological impairment was found to be negatively associated with QoL (r = -0.52; **p > 0.01). The relationship between fear of intimacy and neuropsychological impairment was found to be significantly mediated by QoL. Furthermore, the findings revealed that mental toughness significantly moderated the relationship between fear of intimacy and neuropsychological impairment. Conclusion: Overall, infertile men in Pakistan had relatively high levels of fear of intimacy, which largely caused neuropsychological impairment. This study can help neuropsychological researchers, mental health professionals, as well as policymakers in improving clinical mental health practices for infertile patients.

Neuropsychological Impairments in Patients With Post-traumatic Epilepsy: A Scoping Review.

OBJECTIVES: To date, the research on the prognosis of the neuropsychological function of patients with post-traumatic seizure (PTE) is sparse. This study aimed to systematically map the literature's extent, range, and characteristics regarding PTE and neuropsychological impairments. METHODS: A systematic literature search was conducted in CINAHL, Cochrane, Embase, Medline, PubMed, Scopus, Web of Science, and ScienceDirect databases. The search terms were related to PTE and neuropsychological impairments. RESULTS: This scoping review included seven studies, two of which examined the impact of PTE on neuropsychological outcomes. Among the three studies that used neuropsychological assessments, attention/concentration, and memory were the most frequently assessed domains. Only one study reported a significant difference between PTE and non-PTE patients. The cognitive rating scale findings in the other four studies were similar, indicating that patients with PTE performed worse than those without PTE. CONCLUSIONS: The results of this review suggest that patients with PTE may have neuropsychological function impairments. More attention needs to be paid to older patients and those with higher brain injury and seizure severity. Additional investigation is necessary to determine the clinical characteristics of TBI and PTE and elucidate the relations between PTE and specific neuropsychological domains.

HIV viremia contributes to neurocognitive impairments in persons who use cocaine.

Persons with HIV (PWH) who use illicit drugs are at elevated risk for neurocognitive impairment (NCI). This study investigated the effects of HIV disease and HIV viremia on NCI among adults who use cocaine. PWH who were not virologically suppressed showed greater global deficits compared to participants with HIV viral suppression and HIV-negative participants, but no differences emerged between the latter two groups. These findings highlight the adverse effects of poorly controlled HIV disease on NCI, beyond the independent effects of cocaine on cognition, and underscore the importance of strengthening the HIV care continuum for persons who use cocaine.

Neuropsychological and Neuropsychiatric Features of Chronic Migraine Patients during the Interictal Phase.

This study aimed to examine the presence of neuropsychological deficits and their relationships with clinical, pharmacological, and neuropsychiatric characteristics in chronic migraine (CM) patients assessed during a headache-free period. We enrolled 39 CM patients (mean age: 45.4 years; male/female ratio: 3/36) and 20 age-, sex-, and education-matched healthy controls (HCs, mean age: 45.5 years; male/female ratio: 2/18) in a case-control study. All CM patients underwent a full and extensive clinical, neuropsychiatric, and neuropsychological evaluation to evaluate cognitive domains, including sustained attention (SA), information processing speed (IPS), visuospatial episodic memory, working memory (WM), and verbal fluency (VF), as well as depressive and anxiety symptoms. CM patients exhibited higher scores than HCs for all clinical and neuropsychiatric measures, but no differences were found in personality characteristics. Although more than half of the CM patients (54%) showed mild-to-severe neuropsychological impairment (NI), with the most frequent impairments occurring in short- and long-term verbal episodic memory and inhibitory control (in approximately 90% of these patients), almost half of the patients (46%) showed no NI. Moreover, the severity of NI was positively associated with the number of pharmacological treatments received. Remarkably, disease-related symptom severity and headache-related disability explained global neuropsychological performance in CM patients. The presence of cognitive and neuropsychiatric dysfunction during the interictal phase occurred in more than half of CM patients, increasing migraine-related disability and possibly exerting a negative impact on health-related quality of life and treatment adherence.

Executive dysfunction in eating disorders: Relationship with clinical features.

Eating disorders (ED) are severe mental disorders that may result in significant functional impairment and disability. Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation. In this study, impairment of executive functioning is investigated in patients with eating disorders and the associations with clinical features and clinical subtypes are analyzed. METHOD: 75 female patients (m = 22.01 years, sd = 9.15) with eating disorder (43 restrictive anorexia, 30 binge-eating anorexia and 13 bulimia nervosa) and 37 healthy controls (m = 18.54 years, sd = 4.21) were included in the study. An extensive assessment of executive function domains (verbal fluency, set shifting, attention span, selective attention, working memory, inhibitory control and processing speed) was carried out in both groups. Clinical scales for food intake restriction, binge-eating/purging, depression, anxiety and impulsivity were also administered and correlated with scores on executive function tests. RESULTS: Patients with an ED had significantly lower scores than healthy controls in performance of several executive function tests, particularly in set shifting, interference control and processing speed (p < .01, in all three domains). Executive function impairment was related to anxious, depressive and eating disorder symptoms (p < .05), regardless of clinical subtype. CONCLUSIONS: Executive function impairment in eating disorders is associated with greater ED symptomatic severity and might involve a negative treatment outcome. Therefore, cognitive remediation techniques should probably be considered in a number of severe patients with ED.

College students who believe they have ADHD report more neuropsychological deficits than non-ADHD peers.

Objective: Attention-deficit/hyperactivity disorder (ADHD) diagnosis in college students has been associated with poor academic outcomes and greater neuropsychological and emotional difficulties. The present study sought to determine whether college students who believe they have ADHD report more neuropsychological deficits than non-ADHD peers. Method: College students (N = 1,520) completed a confidential online survey designed to explore ADHD beliefs and subjective neuropsychological impairment. MANOVA was used to examine the association between ADHD beliefs and neuropsychological symptoms. LSD post hoc analysis was used to examine pairwise comparisons across groups. Results: College students who believe they have ADHD reported more neuropsychological deficits than those without ADHD and similar levels of neuropsychological impairment as peers with a self-reported diagnosis of ADHD. Conclusion: Results show a statistically and clinically significant relationship between ADHD belief and neuropsychological impairment among college students. These findings highlight the need for qualified ADHD assessment in college students who believe they have ADHD.

Brain fog of post-COVID-19 condition and Chronic Fatigue Syndrome, same medical disorder?

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by persistent physical and mental fatigue. The post-COVID-19 condition patients refer physical fatigue and cognitive impairment sequelae. Given the similarity between both conditions, could it be the same pathology with a different precipitating factor? OBJECTIVE: To describe the cognitive impairment, neuropsychiatric symptoms, and general symptomatology in both groups, to find out if it is the same pathology. As well as verify if the affectation of smell is related to cognitive deterioration in patients with post-COVID-19 condition. METHODS: The sample included 42 ME/CFS and 73 post-COVID-19 condition patients. Fatigue, sleep quality, anxiety and depressive symptoms, the frequency and severity of different symptoms, olfactory function and a wide range of cognitive domains were evaluated. RESULTS: Both syndromes are characterized by excessive physical fatigue, sleep problems and myalgia. Sustained attention and processing speed were impaired in 83.3% and 52.4% of ME/CFS patients while in post-COVID-19 condition were impaired in 56.2% and 41.4% of patients, respectively. Statistically significant differences were found in sustained attention and visuospatial ability, being the ME/CFS group who presented the worst performance. Physical problems and mood issues were the main variables correlating with cognitive performance in post-COVID-19 patients, while in ME/CFS it was anxiety symptoms and physical fatigue. CONCLUSIONS: The symptomatology and cognitive patterns were similar in both groups, with greater impairment in ME/CFS. This disease is characterized by greater physical and neuropsychiatric problems compared to post-COVID-19 condition. Likewise, we also propose the relevance of prolonged hyposmia as a possible marker of cognitive deterioration in patients with post-COVID-19.

The Societal Response to Psychopathy in the Community.

The harm usually associated with psychopathy requires therapeutically, legally, and ethically satisfactory solutions. Scholars from different fields have, thus, examined whether empirical evidence shows that individuals with psychopathic traits satisfy concepts, such as responsibility, mental disorder, or disability, that have specific legal or ethical implications. The present paper considers the less discussed issue of whether psychopathy is a disability. As it has been shown for the cases of the responsibility and mental disorder status of psychopathic individuals, we argue that it is undecided whether psychopathy is a disability. Nonetheless, based on insights from disability studies and legislations, we propose that interventions to directly modify the propensities of individuals with psychopathic tendencies should be balanced with modifications of the social and physical environments to accommodate their peculiarities. We also suggest how this social approach in some practical contexts that involve non-offender populations might be effective in addressing some of the negative effects of psychopathy.

Neuropsychological disorders after COVID-19. Urgent need for research and clinical practice.

Purpose: Numerous studies suggest that infection with coronavirus SARS-CoV-2, which causes acute respiratory distress syndrome and COVID-19 illness, can lead to changes in the central nervous system (CNS). Consequently, some individuals with SARS-CoV-2 infection may also present the symptoms of neuropsychological disorders. The goals of this literature review is the synthesis of various perspectives and up-to-date scientific knowledge as well as the formulation of initial recommendations for clinical practice. Views: According to current state of knowledge, numerous SARS-CoV-2 infection-specific and nonspecific risk factors exist for brain damage, which might lead to neuropsychological impairments in individuals who have recovered from COVID-19. The emerging evidence suggests significant behavioral and cognitive deficits in COVID-19 survivors, which are present in the early phase after recovery and persist for several months. Neuropsychological disturbances can potentially include a wide spectrum of disorders, yet deficits of attention, memory, executive functions, language and visuospatial orientation are among most commonly identified. The relationship between cognitive impairment, emotional disturbances and severity of COVID-19 symptoms needs to be submitted to further research. Conclusions: The scientific knowledge resulting from neuropsychological empirical studies during the COVID-19 pandemic allows for a postulate of an urgent evidence-based systematic neuropsychological research to be conducted among COVID-19 survivors. More than anything, the recovered individuals must be provided with adequate neuropsychological help in the form of neuropsychological diagnosis, monitoring and rehabilitation.

Thiamine and phosphate esters concentrations in whole blood and serum of patients with alcohol use disorder: a relation with cognitive deficits.

Background: In this study, we investigated (1) the effect of chronic and excessive alcohol consumption on whole blood (WB) and serum concentrations of thiamine and its metabolites after supplementation, and (2) the relationship between the perturbations of thiamine metabolism and neuropsychological abilities.Methods: WB and serum samples were collected in patients with Alcohol Use Disorder (AUD) and in healthy control subjects (after oral thiamine supplementation, or without supplementation). Thiamine (Th), thiamine monophosphate (TMP) and thiamine diphosphate (TDP) were quantified. The Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI) and the Montreal Cognitive Assessment (MoCA) were performed by each AUD participant. Based on the BEARNI score, two groups of AUD patients were studied: AUD patients with no or mild cognitive impairment (AUD COG+), and AUD patients with moderate-to-severe cognitive impairment (AUD COG-).Results: In WB, Th concentrations were significantly higher, and percentages of phosphate esters of thiamine were significantly lower in AUD COG- patients compared to controls. In serum, Th concentrations were significantly higher in AUD COG- patients compared to controls. The percentage of Th in serum was significantly higher in AUD COG- patients compared to AUD COG+ patients, and to the groups of controls. When adjusted on education level, the percentage of Th in serum in AUD patients negatively correlated with the scores at BEARNI and MoCA, and Th concentration in serum negatively correlated with MoCA.Conclusions: These data support an impairment of metabolism and/or distribution of thiamine in AUD patients, and a relationship with the development of alcohol-related cognitive deficits.

Iron Rims in Patients With Multiple Sclerosis as Neurodegenerative Marker? A 7-Tesla Magnetic Resonance Study.

Introduction: Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system, characterized by inflammatory-driven demyelination. Symptoms in MS manifest as both physical and neuropsychological deficits. With time, inflammation is accompanied by neurodegeneration, indicated by brain volume loss on an MRI. Here, we combined clinical, imaging, and serum biomarkers in patients with iron rim lesions (IRLs), which lead to severe tissue destruction and thus contribute to the accumulation of clinical disability. Objectives: Subcortical atrophy and ventricular enlargement using an automatic segmentation pipeline for 7 Tesla (T) MRI, serum neurofilament light chain (sNfL) levels, and neuropsychological performance in patients with MS with IRLs and non-IRLs were assessed. Methods: In total 29 patients with MS [15 women, 24 relapsing-remitting multiple sclerosis (RRMS), and five secondary-progressive multiple sclerosis (SPMS)] aged 38 (22-69) years with an Expanded Disability Status Score of 2 (0-8) and a disease duration of 11 (5-40) years underwent neurological and neuropsychological examinations. Volumes of lesions, subcortical structures, and lateral ventricles on 7-T MRI (SWI, FLAIR, and MP2RAGE, 3D Segmentation Software) and sNfL concentrations using the Simoa SR-X Analyzer in IRL and non-IRL patients were assessed. Results: (1) Iron rim lesions patients had a higher FLAIR lesion count (p = 0.047). Patients with higher MP2Rage lesion volume exhibited more IRLs (p <0.014) and showed poorer performance in the information processing speed tested within 1 year using the Symbol Digit Modalities Test (SDMT) (p <0.047). (2) Within 3 years, patients showed atrophy of the thalamus (p = 0.021) and putamen (p = 0.043) and enlargement of the lateral ventricles (p = 0.012). At baseline and after 3 years, thalamic volumes were lower in IRLs than in non-IRL patients (p = 0.045). (3) At baseline, IRL patients had higher sNfL concentrations (p = 0.028). Higher sNfL concentrations were associated with poorer SDMT (p = 0.004), regardless of IRL presence. (4) IRL and non-IRL patients showed no significant difference in the neuropsychological performance within 1 year. Conclusions: Compared with non-IRL patients, IRL patients had higher FLAIR lesion counts, smaller thalamic volumes, and higher sNfL concentrations. Our pilot study combines IRL and sNfL, two biomarkers considered indicative for neurodegenerative processes. Our preliminary data underscore the reported destructive nature of IRLs.

Effects of mood episodes and comorbid anxiety on neuropsychological impairment in patients with bipolar spectrum disorder.

OBJECTIVES: Cases of patients with bipolar disorder (BD) having neuropsychological impairment have been reported, although inconsistently. The possibility of comorbidity with anxiety disorder (AD) has been suggested. The association between mood episodes and AD comorbidity on neuropsychological performance is unclear and thus was investigated in the current study. METHODS: All participants were informed about and agreed to participate in this study. Patients with BD were recruited from outpatient and inpatient settings, and healthy controls (HCs) were recruited as a comparison group. Six hundred and twenty-eight participants (175 HCs and 453 BD-56 BDI and 397 BDII) were studied based on their current mood episode, namely, depressive (BDd ), manic/hypomanic (BDm), mixed (BDmix), and euthymic (BDeu), compared with/without AD comorbidity (164 with AD). RESULTS: Compared to HCs, all BD groups had significantly more impaired neuropsychological profiles, but the BDeu group was found to have less impairment in memory and executive function than the episodic BD groups. The percentage of AD comorbidity in BDd, BDm, BDmix, and BDeu was 33.9%, 40.3%, 33.0%, and 35.6%, respectively (χ2  = 1.61, p > .05). The results show that AD plays a different role in neuropsychological impairment across various mood episodes in BD. CONCLUSION: Memory impairment and executive dysfunction may be state-like cognitive phenotypes and are affected by AD comorbidity during mixed and depressive episodes in BD, while sustained attention deficiencies are more like trait markers, regardless of mood episodes, and persist beyond the course of the illness. The AD comorbidity effect on attentional deficit is greater when suffering from a manic episode.

Neurocognitive functioning in MDR-TB patients with and without HIV in KwaZulu-Natal, South Africa.

OBJECTIVES: Optimising medication adherence is one of the essential factors in reversing the tide of a TB-HIV syndemic in sub-Saharan Africa, especially South Africa. Impairment in key neurocognitive domains may impair patients' ability to maintain adherence to treatment, but the level of cognition and its relationship to HIV status has not been examined in individuals with drug-resistant TB. We therefore investigated performance on several key neurocognitive domains in relationship to HIV status in a multidrug-resistant tuberculosis patients (MDR-TB) sample. METHODS: We enrolled microbiologically confirmed MDR-TB inpatients at a TB-specialist referral hospital in KwaZulu-Natal province, South Africa. We collected cross-sectional data on sociodemographic, clinical and neurocognitive function (e.g. attention, memory, executive functioning, language fluency, visual-spatial, eye-hand coordination). For the primary analysis, we excluded participants with major depressive episode/substance use disorder (MDE/SUD). We fitted adjusted Poisson regression models to explore the association between HIV and neurocognitive function. RESULTS: We enrolled 200 people with MDR-TB; 33 had MDE/SUD, and data of 167 were analysed (151 HIV+, 16 HIV-). The mean age of participants was 34.2 years; the majority were female (83%), and 53% had not completed secondary school. There was evidence of impaired neurocognitive functioning across all domains in both HIV+/- study participants. Based on the regression analyses, individuals with co-infection (MDR-TB/HIV+), as well as those who had longer duration of hospital stays experienced significantly lower cognitive performance in several domains. Poor cognitive performance was significantly related to older age and lower educational attainment. The presence of major depression or substance use disorders did not influence the significance of the findings. CONCLUSIONS: Adults with MDR-TB have significant neurocognitive impairment, especially if HIV positive. An integrated approach is necessary in the management of MDR-TB as cognitive health influences the ability to adhere to chronic treatment, clinical outcomes and functionality.

OBJECTIFS: L'optimisation de l'adhésion au traitement est l'un des facteurs essentiels pour inverser la tendance d'un syndrome TB-VIH en Afrique subsaharienne, en particulier en Afrique du Sud. Des déficiences dans des domaines neurocognitifs clés peuvent entraver la capacité des patients à maintenir l'adhésion au traitement, mais le niveau de cognition et sa relation avec le statut VIH n'ont pas été examinés chez les personnes atteintes de TB résistante aux médicaments. Nous avons donc étudié les performances de plusieurs domaines neurocognitifs clés en relation avec le statut VIH dans un échantillon de tuberculose multirésistante (TB-MDR). MÉTHODES: Nous avons recruté des patients hospitalisés pour une TB-MDR confirmée microbiologiquement dans un hôpital de référence spécialisé dans la TB dans la province du KwaZulu-Natal, en Afrique du Sud. Nous avons recueilli des données transversales sur les fonctions sociodémographiques, cliniques et neurocognitives (par exemple l'attention, la mémoire, le fonctionnement exécutif, la maîtrise du langage, la coordination visuelle-spatiale et œil-main). Pour l'analyse primaire, nous avons exclu les participants souffrant d'un épisode dépressif majeur ou d'un trouble lié à la consommation de substances (EDM/TCS). Nous avons appliqué des modèles de régression de Poisson ajustés pour explorer l'association entre le VIH et la fonction neurocognitive. RÉSULTATS: Nous avons recruté 200 personnes atteintes de TB-MDR, 33 d'entre elles étaient atteintes de EDM/TCS, les données des 167 autres ont été analysées (151 VIH-positives, 16 VIH-négatives). L'âge moyen des participants était de 34,2 ans; la majorité étaient des femmes (83%) et 53% n'avaient pas terminé leurs études secondaires. Les participants à l'étude VIH+ et VIH- présentaient des signes de dysfonctionnement neurocognitif dans tous les domaines. D'après les analyses de régression, les personnes coinfectées (TB-MDR/VIH), ainsi que celles qui ont été hospitalisées pendant une longue période, présentent des performances cognitives nettement inférieures dans plusieurs domaines. Les mauvaises performances cognitives étaient significativement liées à l'âge plus élevé et à un niveau d'éducation plus faible. La présence d'une dépression majeure ou de troubles liés à la consommation de substances n'a pas influencé la signification des résultats. CONCLUSIONS: Les adultes atteints de TB-MDR présentent une importante déficience neurocognitive, surtout s'ils sont VIH-positifs. Une approche intégrée est nécessaire dans la prise en charge de la TB-MDR car la santé cognitive influence la capacité d'adhésion à un traitement chronique, les résultats cliniques et la fonctionnalité.

Cognitive Impairment in Multiple Sclerosis Is Reflected by Increased Susceptibility to the Sound-Induced Flash Illusion.

Objective: To determine whether the performance of multiple sclerosis (MS) patients in the sound-induced flash illusion (SiFi), a multisensory perceptual illusion, would reflect their cognitive impairment. Methods: We performed the SiFi task as well as an extensive neuropsychological testing in 95 subjects [39 patients with relapse-remitting MS (RRMS), 16 subjects with progressive multiple sclerosis (PMS) and 40 healthy control subjects (HC)]. Results: MS patients reported more frequently the multisensory SiFi than HC. In contrast, there were no group differences in the control conditions. Essentially, patients with progressive type of MS continued to perceive the illusion at stimulus onset asynchronies (SOA) that were more than three times longer than the SOA at which the illusion was already disrupted for healthy controls. Furthermore, MS patients' degree of cognitive impairment measured with a broad neuropsychological battery encompassing tests for memory, attention, executive functions, and fluency was predicted by their performance in the SiFi task for the longest SOA of 500 ms. Conclusions: These findings support the notion that MS patients exhibit an altered multisensory perception in the SiFi task and that their susceptibility to the perceptual illusion is negatively correlated with their neuropsychological test performance. Since MS lesions affect white matter tracts and cortical regions which seem to be involved in the transfer and processing of both crossmodal and cognitive information, this might be one possible explanation for our findings. SiFi might be considered as a brief, non-expensive, language- and education-independent screening test for cognitive deficits in MS patients.

The Effect of Oxygen Enrichment on Cardiorespiratory and Neuropsychological Responses in Workers With Chronic Intermittent Exposure to High Altitude (ALMA, 5,050 m).

It is estimated that labor activity at high altitudes in Chile will increase from 60,000 to 120,000 workers by the year 2020. Oxygenation of spaces improves the quality of life for workers at high geographic altitudes (<5,000 m). The aim of this study was to determine the effect of a mobile oxygen module system on cardiorespiratory and neuropsychological performance in a population of workers from Atacama Large Millimeter/submillimeter Array (ALMA, 5,050 m) radiotelescope in the Chajnantor Valley, Chile. We evaluated pulse oximetry, systolic and diastolic arterial pressure (SAP/DAP), and performed neuropsychological tests (Mini-Mental State examination, Rey-Osterrieth Complex Figure test) at environmental oxygen conditions (5,050 m), and subsequently in a mobile oxygenation module that increases the fraction of oxygen in order to mimic the higher oxygen partial pressure of lower altitudes (2,900 m). The use of module oxygenation at an altitude of 5,050 m, simulating an altitude of 2,900 m, increased oxygen saturation from 84 ± 0.8 to 91 ± 0.8% (p < 0.00001), decreased heart rate from 90 ± 8 to 77 ± 12 bpm (p < 0.01) and DAP from 96 ± 3 to 87 ± 5 mmHg (p < 0.01). In addition, mental cognitive state of workers (Mini-Mental State Examination) shown an increased from 19 to 31 points (p < 0.02). Furthermore, the Rey-Osterrieth Complex Figure test (memory) shown a significant increase from 35 to 70 (p < 0.0001). The results demonstrate that the use of an oxygen module system at 5,050 m, simulating an altitude equivalent to 2,900 m, by increasing FiO2 at 28%, significantly improves cardiorespiratory response and enhances neuropsychological performance in workers exposed to an altitude of 5,050 m.