G but not g: In search of the evolutionary continuity of intelligence.

Conceptualizing intelligence in its biological context, as the expression of manifold adaptations, compels a rethinking of measuring this characteristic in humans, relying also on animal studies of analogous skills. Mental manipulation, as an extension of object manipulation, provides a continuous, biologically based concept for studying G as it pertains to individual differences in humans and other species.

Does normal fetal brain ultrasound predict normal neurodevelopmental outcome in congenital cytomegalovirus infection?

OBJECTIVE: We evaluated the neuropsychological outcome of children with proven congenital cytomegalovirus (CMV) infection and normal consecutive fetal neurosonographic examinations. METHODS: We retrospectively reviewed laboratory and imaging findings of children with congenital CMV infection. The study group consisted of children with a positive polymerase chain reaction (PCR) in amniotic fluid and virus isolation in urine in the first week of life, and normal fetal ultrasonographic (US) examination findings, including a normal multiplanar neurosonographic evaluation. Patients with abnormal magnetic resonance (MR) findings were not excluded. The study and control groups were evaluated for cognitive, language, and motor development at one follow-up examination conducted at 11-81 months of age. RESULTS: Children with congenital CMV infection and normal fetal brain findings in the US examination did not differ from the control group in terms of cognitive, language, motor, emotional-behavioral, and executive functioning. There were no differences between congenitally infected children who had a normal fetal brain MR examination and children whose fetal brain MR examination raised suspicion of a possible brain insult. CONCLUSIONS: Normal neurosonographic examinations during pregnancy appear to predict a normal early neuropsychological outcome in fetuses with congenital CMV infection. Outcome did not correlate with suspected abnormal white matter on fetal MR imaging.

The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology.

Research into cognitive functions across psychological disorders suggests that cognitive deficiencies may be present across multiple disorders, potentially pointing to a transdiagnostic phenomenon. More recently, a single dimension model of psychopathology, the p factor, has been proposed, in which cognitive deficits are thought to be an intrinsic construct, assumed to be transdiagnostic. However, no systematic investigation to date tested this hypothesis. The aim of the present study was to systematically review meta-analyses to assess the hypothesis that the C factor (cognitive dysfunction) is transdiagnostic in psychopathology and review potential moderators that may account for such a phenomenon. We conducted a systematic review of meta-analyses examining cognitive function across all disorders for which data were available. Included meta-analyses (n = 82), comprising 97 clinical samples, yielded 1,055 effect sizes. Twelve major disorders/categories (e.g., bipolar disorder, substance use disorders) were included, comprising 29 distinct clinical entities (e.g., euthymic bipolar disorder; alcohol use disorder). Results show that all disorders reviewed are associated with underperformance across cognitive domains, supporting the hypothesis that the C factor (or cognitive dysfunction) is a transdiagnostic factor related to p. To examine moderators that may explain or contribute to c, we first consider important interpretative limitations of neuropsychological data in psychopathology. More crucially, we review oft-neglected motivational and emotional transdiagnostic constructs of p, as prominent contributing constructs to the C factor. These constructs are offered as a roadmap for future research examining these constructs related to p, that contribute, and may account for cognitive dysfunctions in psychopathology.

[Microcephaly diagnosed during pregnancy].

Microcephaly is defined postnatally as small head circumference (below the norm by more than two standard deviations (SD)). Incidence at birth: 1:6250-8500. The prenatal diagnosis of microcephaly, particularly in cases of primary microcephaly, is usually difficult before the 3rd trimester. Congenital microcephaly may present as an isolated finding, in this case it is known as primary microcephaly or microcephaly vera and may also be associated with a wide range of central nervous system (CNS) and non-CNS pathologies. The association between microcephaly and intellectual capabilities has frequently been searched but there is no definite correlation with prenatal diagnosis of microcephaly. Postnatally, the risk for developmental disabilities for microcephaly is 11% when head circumference is -2SD, 50-75% in -3SD and 100% when head circumference is smaller than -4SD. The lack of knowledge regarding the prognosis when microcephaly is found during pregnancy makes counselling difficult. In this review, the authors describe and define microcephaly and the association with intellectual disabilities, emphasizing the importance of prenatal diagnosis.

[The importance of prenatal neuroimaging in prediction of developmental outcome of fetuses infected with cytomegalovirus].

Cytomegalovirus (CMV) infection is the most common viral cause of congenital infection and one of the most common contributors to neurodevelopmental disabilities in children. The physiological condition of the infants at birth is a good predictor of long-term cognitive functioning, while children who manifest clinical symptoms at birth (symptomatic) are more likely to develop future cognitive impairments. Brain imaging studies from prenatal diagnosed children are scant, focusing mainly on fetuses with brain signs of CMV infection. While several studies demonstrate a poor outcome for children with neurosonographic findings during pregnancy, a systematic investigation regarding long-term neurodevelopmental outcome of fetuses infected with CMV, but without fetal ultrasonographic brain findings, has not been reported.

[Developmental outcome of fetal macrocephaly and associated syndromes].

Macrocephaly is defined as an enlargement of the head circumference above the 98th percentile or greater than two standard deviations above the mean normalized for age and gender. The diagnosis of enlarged head circumference can be made by ultrasound, during pregnancy. This condition may be caused by enlargement of any of the head's compartments. When resulting from excessive brain tissue, the condition is defined as megalencephaly. Macrocephaly can be associated with many genetic disorders. Emphasis is placed on its outcome. Although the literature concerning macrocephaly and its neurodevelopmental features is vast, there is no general consensus concerning its outcome. Several studies claim macrocephaly is usually a benign, familial condition without any clinical significance, while others claim an association between macrocephaly and learning and attention difficulties, visuo-motor problems and expressive and receptive deficits. Based on these reports, concerning macrocephaly identified in utero, doctors find it difficult to assess prognosis and provide clear guidelines for parents.

Unwanted intrusive and worrisome thoughts in adults with Attention Deficit\Hyperactivity Disorder.

Attention Deficit/Hyperactivity Disorder (ADHD) is associated with deficient motor and cognitive inhibitory mechanisms. The aim of this article is to examine two symptoms associated with cognitive disinhibition, namely: intrusive unwanted thoughts, worrisome thoughts and their suppression. Thirty-seven college students diagnosed with ADHD and 23 healthy college students were compared on the Distressing Thoughts Questionnaire and on the Anxious Thoughts Inventory. Results show that in comparison to the control group, participants with ADHD experienced significantly higher ratings on all intrusive thoughts scales, and three worrisome thoughts scales. Our results suggest that worrisome intrusive thoughts are an important phenotypical expression of adults with ADHD. A neurobiological explanation for this phenomenon is suggested, and clinical implications are discussed.

Dual-task decrements in gait: contributing factors among healthy older adults.

BACKGROUND: The factors that contribute to the dual tasking (DT) changes in performance that occur when older adults walk while simultaneously performing other tasks are not well known. We hypothesized that cognitive and motor reserve (e.g., executive function [EF], postural control, and walking abilities) and affect (e.g., anxiety, depressive symptoms) influence the DT decrements (DTDs) in gait. METHODS: Two hundred twenty-eight community-living, healthy older adults (mean: 76.2 +/- 4.2 years; 59% women) walked with and without DT, for example, subtracting 7s and phoneme monitoring. Mobility (e.g., the Dynamic Gait Index), cognitive function (e.g., memory, EF), and affect (e.g., Geriatric Depression Scale) were quantified. Bivariate and multivariate analyses identified factors associated with the DTD in gait speed (a general measure of locomotor function), swing time, (reflecting balance during gait), and swing time variability (a measure of stride-to-stride consistency). RESULTS: Gait speed and swing time decreased (p <.001) and swing time variability increased (became worse) (p <.001) during all DTs. The DTD in gait speed was correlated with comfortable walking gait speed, but not with tests of mobility or cognitive function. The DTD in swing time variability was correlated with EF, mobility, and affect (e.g., depressive symptoms). Much of the variance in the DTDs was unexplained. CONCLUSIONS: Usual walking abilities and cognitive function contribute to the DT effects on gait, but these relationships depend on specifics of the DT, the gait feature being studied, and the particulars of the cognitive domain. Meeting the everyday challenges of walking while dual tasking apparently relies on multiple factors including a consistent gait pattern and EF.

Adjustment of cognitive scores with a co-normed estimate of premorbid intelligence: implementation using mindstreams computerized testing.

Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of +/-1 SD and 6 normalized units for scores of +/-2 SD. The present approach shows promise as a practical solution for assessment of high- and low-intelligence individuals.

Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays.

BACKGROUND: Patient non-attendance is an expensive and persistent problem worldwide with rates between 5-39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic. METHODS: Records were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008-2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic. RESULTS: In the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004). DISCUSSION: Our data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients' ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments. CONCLUSION: Our results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide.

Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms.

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n=72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n=88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly with depression.

Towards practical cognitive assessment for detection of early dementia: a 30-minute computerized battery discriminates as well as longer testing.

Early detection of cognitive decline may lead to more effective treatment. Clinical cognitive assessment is essential for early detection, but must be brief with easily interpretable results. The present study defines and evaluates a 30-minute cognitive battery consisting of a subset of tests that comprise a longer computerized battery recently validated in detecting mild cognitive impairment (MCI). Participants were from three tertiary care memory clinics and an assisted living facility (final group: N=161) with consensus diagnoses of cognitively healthy, MCI, or mild dementia. A comprehensive NeuroTrax battery evaluated memory, executive function, visual spatial perception, verbal function, information processing speed, and motor skills. Validity of a single summary measure ('MCI Score') designed for dementia detection and built exclusively from tests of memory, executive function, and visual spatial perception was evaluated with receiver operating characteristic (ROC) analysis. Discriminant validity (area under the curve: AUC) was at least as large for the 6-parameter MCI Score as for a 20-parameter score necessitating administration of the entire battery. Further, the MCI Score had a larger AUC with reduced variance relative to its constituent parameters. AUC for distinguishing dementia was 0.886; AUC for distinguishing cognitively healthy was 0.823. Finally, the MCI Score discriminated among all three diagnostic groups (ANOVA; F[2,150]=52.54, p<0.001). Hence a reduced NeuroTrax battery (30 minutes) with MCI Score is a useful clinical tool for summarizing cognitive data relevant to early dementia detection.

Response inhibition in a subclinical obsessive-compulsive sample.

BACKGROUND AND OBJECTIVES: Inconsistent findings across studies challenge the viability of response inhibition (RI) as an endophenotype of obsessive-compulsive disorder (OCD). Contemporary conceptualization of endophenotypes in psychiatric disorders suggests that these markers vary continuously in the general population, highlighting the importance of analogue sample research. Although neuropsychological functions have been studied in subclinical obsessive-compulsive (OC) samples, no study to date had examined RI in the context of the go/no-go paradigm. METHODS: A subclinical OC sample (HOC; n = 27) and a low OC symptoms control sample (LOC; n = 25), as determined by the Obsessive-Compulsive Inventory-Revised, completed a go/no-go task and clinical questionnaires. RESULTS: The groups did not differ on age, gender, or state anxiety. Controlling for depressive severity, the HOC group made significantly more commission errors and exhibited larger response time variability on the go/no-go task. However, standardized scores produced using population norms revealed that the HOC group performed within normative range. LIMITATIONS: This study used a non-clinical sample and no structured clinical screening was performed. CONCLUSIONS: Compared to LOC participants, a psychometrically-defined subclinical OC sample exhibited deficient RI and sustained attention. However, when raw scores were converted to age and education adjusted standardized scores according to the test's population norms, the HOC group task performance was in the normative range. These results, are in line with findings in OCD samples, suggesting that moderate degree of RI deficiencies is associated with the presence of OC symptomatology regardless of clinical status. However, the conceptualization of RI underperformance as an OCD disorder-specific impairment, remains controversial.

Neuropsychological investigations in obsessive-compulsive disorder: A systematic review of methodological challenges.

The inconsistent nature of the neuropsychology literature pertaining to obsessive-compulsive disorder (OCD) has long been recognized. However, individual studies, systematic reviews, and recent meta-analytic reviews were unsuccessful in establishing a consensus regarding a disorder-specific neuropsychological profile. In an attempt to identify methodological factors that may contribute to the inconsistency that is characteristic of this body of research, a systematic review of methodological factors in studies comparing OCD patients and non-psychiatric controls on neuropsychological tests was conducted. This review covered 115 studies that included nearly 3500 patients. Results revealed a range of methodological weaknesses. Some of these weaknesses have been previously noted in the broader neuropsychological literature, while some are more specific to psychiatric disorders, and to OCD. These methodological shortcomings have the potential to hinder the identification of a specific neuropsychological profile associated with OCD as well as to obscure the association between neurocognitive dysfunctions and contemporary neurobiological models. Rectifying these weaknesses may facilitate replicability, and promote our ability to extract cogent, meaningful, and more unified inferences regarding the neuropsychology of OCD. To that end, we present a set of methodological recommendations to facilitate future neuropsychology research in psychiatric disorders in general, and in OCD in particular.

Empirically derived algorithm for performance validity assessment embedded in a widely used neuropsychological battery: Validation among TBI patients in litigation.

INTRODUCTION: Validity of neuropsychological assessment depends, inter alia, on the cooperation of the examinee, requiring separate assessment. Stand-alone tests devised for detecting negative response bias (NRB) are exposed to potential threats to their validity. In this study, an algorithm was developed for assessing NRB within a standardized, computerized neuropsychological battery (NeuroTrax), making it difficult to detect and circumvent. METHOD: Data were collected from the archived medical records of 75 outpatients with mild to moderate head injury, all in litigation. Participants were classified as low or high likelihood for NRB, using a known test for effort assessment (Test of Memory Malingering). RESULTS: Variables judged to be prone for exaggeration and showing large differences between the groups were entered into a logistic regression analysis. The resulting formula exhibited high specificity (98.0%) and sensitivity (87.5%), classifying correctly 94% of the cases. CONCLUSION: It is suggested that the algorithm developed empirically using scores on the NeuroTrax computerized battery can be a useful tool for assessing effort. This algorithm should resist threats to its validity and can be automatically computed while assessing a range of cognitive skills.

Validity of the Mindstreams computerized cognitive battery for mild cognitive impairment.

The NeuroTrax Mindstreams computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate the elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined. A two-center study was designed to assess the discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer's disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups. Mindstreams outcome parameters across multiple cognitive domains significantly discriminated between MCI and healthy elders with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains. Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elders at high risk for dementia.

The effects of second-language acquisition on verbal fluency among elderly israelis.

The present study investigated the effect of age of second-language acquisition (Hebrew) on verbal fluency in a random sample of 196 elderly Israelis from four distinct ethnic groups. Using conventional statistics, it was shown that phonemic fluency, particularly switching, is associated with education and the age of Hebrew acquisition, while semantic fluency, particularly clustering, is associated with age. Ethnic differences were not significant after controlling for the age of Hebrew acquisition and education. Additional analyses show that the tendency of subjects to use borrowed, non-Hebrew words on the phonemic fluency task was associated with lower total scores on this task and later age of Hebrew acquisition. In contrast, the tendency to use non-Hebrew words on the semantic fluency task was associated with age and higher total scores. These findings are discussed with regard to recent functional imaging studies of bilingual subjects. Such findings indicate that native and second languages form distinct areas of activation in the dominant anterior language area, an area often associated with phonemic processing and switching, whereas an overlap of activation of various languages has been demonstrated within the posterior language areas, those that are often associated with semantic processing.

Validity of a novel computerized cognitive battery for mild cognitive impairment.

BACKGROUND: The NeuroTrax Mindstreams computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined. METHODS: A 2-center study was designed to assess discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer's disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups. RESULTS: Mindstreams outcome parameters across multiple cognitive domains significantly discriminated among MCI and healthy elderly with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains. CONCLUSIONS: Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elderly at high risk for dementia.

Costeff syndrome: clinical features and natural history.

Costeff syndrome (CS) is a rare autosomal-recessive neurological disorder, which is known almost exclusively in patients of Iraqi Jewish descent, manifesting in childhood with optic atrophy, ataxia, chorea and spastic paraparesis. Our aim was to study the clinical spectrum of CS and natural history using a cross-sectional study design. Consecutive patients with CS were recruited to the study. Patients were diagnosed based on clinical features, along with elevated urinary levels of methylglutaconic and methylglutaric acid, and by identification of the disease-causing mutation in the OPA3 gene in most. All patients were examined by a neurologist and signs and symptoms were rated. 28 patients with CS (16 males, 21 families, age at last observation 28.6 ± 16.1 years, range 0.5-68 years) were included. First signs of neurological deficit appeared in infancy or early childhood, with delayed motor milestones, choreiform movements, ataxia and visual disturbances. Ataxia and chorea were the dominant motor features in childhood, but varied in severity among patients and did not seem to worsen with age. Pyramidal dysfunction appeared later and progressed with age (r = 0.71, p < 0.001) leading to spastic paraparesis and marked gait impairment. The course of neurological deterioration was slow and the majority of patients could still walk beyond the fifth decade. While visual acuity seemed to deteriorate, it did not correlate with age. CS is a rare neurogenetic disorder that causes serious disability and worsens with age. Spasticity significantly increases over the years and is the most crucial determinant of neurological dysfunction.

Correlates of physical activity with intrusive thoughts, worry and impulsivity in adults with attention deficit/hyperactivity disorder: a cross-sectional pilot study.

BACKGROUND: Physical exercise is known to produce numerous psychological beneficial effects in healthy and clinical populations. Nevertheless, little is known about the relationship between exercise and ADhD symptoms, let alone among adults with ADhD. this study examines the association between exercise and three ADhD symptoms: (1) behavioral impulsivity; (2) intrusive unwanted thoughts and (3) worry. the latter two are cognitive facets of anxiety, a prominent symptom of ADhD. METHODS: Physical activity was measured using a selfreport questionnaire. thirty participants with a diagnosis of ADhD were divided into two groups: Participants engaging in frequent aerobic activity ("high activity" group), and participants engaging in non-frequent physical activity ("low activity" group). RESULTS: Adults with ADhD engaging in frequent aerobic physical activity report significantly less behavioral impulsivity and experience significantly less worrisome and intrusive thoughts. CONCLUSIONS: Our results reflect an association between physical activity and reduced symptoms of impulsivity and intrusive and worrisome thoughts in an adult ADhD sample. the results of this pilot study may encourage further investigations emphasizing the causal link between physical activity and ADhD symptoms. Suggested underlying neurobiological mechanisms, clinical implications and limitations are discussed.