Comparative effect of deliberate hypotensive anesthesia using nitroglycerine vs. phentolamine on event related potentials and cognitive functions in patients undergoing septoplasty: a randomized controlled trial.

BACKGROUND: Postoperative cognitive dysfunction is a noteworthy complication of deliberate hypotensive anesthesia. The aim of this work was to compare the effect of deliberate hypotensive anesthesia using nitroglycerine versus phentolamine on event-related potentials and cognitive function in patients undergoing septoplasty surgery. METHODS: This prospective randomized controlled trial was conducted on 80 patients indicated for septoplasty under general anesthesia; 40 patients received intra-operative Nitroglycerine and 40 patients received intra-operative Phentolamine. Cognitive assessment (using Paired Associate Learning test (PALT) and Benton Visual Retention test (BVRT)) and P300 recording were done for all included patients pre-operatively and one week postoperatively. RESULTS: The scores of PALT and Benton BVRT significantly declined one week following surgery in both Nitroglycerine and Phentolamine groups. There was no statistically significant difference between Nitroglycerine and Phentolamine groups in the postoperative decline in either PALT or BVRT (P-value = 0.342, 0.662 respectively). The values of P300 latency showed a significant delay one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but in Nitroglycerine group, the delay is significantly higher than in Phentolamine group (P-value = 0.003). The values of P300 amplitude significantly decreased one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but there was no statistically significant difference between Nitroglycerine and Phentolamine groups (P-value = 0.099). CONCLUSION: Phentolamine is preferred over nitroglycerin in deliberate hypotensive anesthesia because it has less harmful effect on cognitive function than nitroglycerin.

Postoperative cognitive dysfunction and the possible underlying neurodegenerative effect of anaesthesia.

Introduction: There is alarming evidence about the involvement of general anaesthesia in the development of postoperative cognitive dysfunction. Aim: To clarify the impact of general anaesthesia on cognitive function and to study the possible effect of general anaesthesia on serum S100B, the marker of neuronal degeneration. Methods: This is a prospective randomised controlled study carried out on 50 patients undergoing elective laparoscopic cholecystectomy under conventional general anaesthesia. Cognitive assessment for selected patients was done preoperative and 1 week postoperative using Paired Associate Learning test (PALT) for assessment of verbal memory and Benton Visual Retention test (BVRT) for assessment of visual memory. Quantitative determination of serum S100B was done for all patients in the basal sample and postoperative sample by applying an enzyme- linked immunoabsorbent assay technique on am automated ELISA platform. Results: Regarding cognitive tests, there was a statistically significant difference between the mean value of preoperative PALT and postoperative PALT (p-value = .012). There was also a statistically significant difference between the mean value of preoperative BVRT and postoperative BVRT (p-value = .011). Regarding S100B, there was a statistically significant difference between preoperative and postoperative serum level (p-value = .002). There was also a statistically significant negative correlation between postoperative S100B serum level and the postoperative scores of both PALT and BVRT. Conclusion: General anaesthesia is incriminated in the development of postoperative verbal and visual memory impairment and in the postoperative increase in serum S100B, the markers of neuronal degeneration.

Intellectual function and memory in children with moyamoya disease: relationship between Wechsler Intelligence Scale and Benton Visual Retention Test scores and regional cerebral blood flow.

OBJECTIVE: Intellectual function declines in about 30% of children with moyamoya disease (MMD). Memory function underpins higher order brain function, but the relationship between intellectual function and memory in pediatric MMD patients has not been well studied. This study aimed to investigate correlations between scores on the Wechsler Intelligence Scale for Children (WISC) and the Benton Visual Retention Test (BVRT), a visual memory test that can be administered to children, in children with MMD. Relationships between intellectual function or memory and regional cerebral blood flow (rCBF) have also not been well clarified in pediatric MMD patients. The authors also investigated associations between WISC or BVRT scores and rCBF in various brain regions. METHODS: WISC and BVRT scores and rCBF were assessed in 17 children with ischemic-onset MMD before revascularization. Single-photon emission CT with 123I-iodoamphetamine was used to measure rCBF. Relationships between WISC and BVRT scores were evaluated using Spearman's correlation coefficient and multivariate linear regression analysis. Cutoff values were identified for BVRT scores. Sensitivity and specificity were calculated to predict full-scale intelligence quotient (FSIQ) > 85 or ≤ 85. Associations between rCBF and WISC or BVRT scores were evaluated using linear regression analysis. RESULTS: BVRT scores were significantly correlated with FSIQ and scores on the Working Memory Index (WMI), Processing Speed Index, and Verbal Comprehension Index (VCI)/Verbal Intelligence Quotient (VIQ) of WISC. Multivariate linear regression revealed that number correct score and number of errors score of BVRT were associated with FSIQ. As cutoff values, a number correct score of 5 and a number of errors score of 8 offered the most reliable predictors of FSIQ > 85 and ≤ 85, respectively. FSIQ correlated positively with rCBF in the right and left hemispheres, right and left ganglia, right and left thalamus, right and left cerebellum, right middle cerebral artery (MCA) territory, pons, and vermis. WMI score was positively associated with rCBF in the right hemisphere, right anterior cerebral artery territory, right MCA territory, right basal ganglia, right and left thalamus, right and left cerebellum, pons, and vermis. CONCLUSIONS: BVRT score correlated well with WISC index scores, suggesting that BVRT may be helpful in screening for intellectual impairments in children with MMD. In the MCA territory, basal ganglia, thalamus, cerebellum, pons, and vermis, rCBF associated well with WISC index scores, suggesting that reduced rCBF in relevant brain regions may influence intellectual function.

Thalamic-hippocampal-prefrontal disruption in relapsing-remitting multiple sclerosis.

BACKGROUND: Cortical, thalamic and hippocampal gray matter atrophy in relapsing-remitting MS (RRMS) is associated cognitive deficits. However, the role of interconnecting white matter pathways including the fornix, cingulum, and uncinate fasciculus (UF) is less well studied. OBJECTIVE: To assess MS damage to a hippocampal-thalamic-prefrontal network and the relative contributions of its components to specific cognitive domains. METHODS: We calculated diffusion tensor fractional anisotropy (FA) in the fornix, cingulum and UF as well as thalamic and hippocampal volumes in 27 RRMS patients and 20 healthy controls. A neuropsychological battery was administered and 4 core tests known to be sensitive to MS changes were used to assess cognitive impairment. To determine the relationships between structure and cognition, all tests were grouped into 4 domains: attention/executive function, processing speed, verbal memory, and spatial memory. Univariate correlations with structural measures and depressive symptoms identified potential contributors to cognitive performance and subsequent linear regression determined their relative effects on performance in each domain. For significant predictors, we also explored the effects of laterality and axial versus radial diffusivity. RESULTS: RRMS patients had worse performance on the Symbol Digit Modalities Test, but no significant impairment in the 4 cognitive domains. RRMS had reduced mean FA of all 3 pathways and reduced thalamic and hippocampal volumes compared to controls. In RRMS we found that thalamic volume and BDI predicted attention/executive function, UF FA predicted processing speed, thalamic volume predicted verbal memory, and UF FA and BDI predicted spatial memory. CONCLUSIONS: Hippocampal-thalamic-prefrontal disruption affects cognitive performance in early RRMS with mild to minimal cognitive impairment, confirming both white and gray matter involvement in MS and demonstrating utility in assessing functional networks to monitor cognition.

Evidence of criterion validity for the Benton Visual Retention Test: comparison between older adults with and without a possible diagnosis of Alzheimer's disease

The present study sought to provide evidence of criterion validity for the Benton Visual Retention Test by making comparisons between older adults with and without a possible diagnosis of Alzheimer's disease. The control group was composed of 50 older adults, and the clinical group was composed by 16 subjects. Descriptive and inferential statistics were performed, including χ² test, F and Wald statistics, t-test, analyses of covariance with α = .05, and effect size calculations. We used a sociodemographic data form, the Geriatric Depression Scale-15, and Mini Mental State Examination. Despite the small clinical sample size, the results pointed to evidence of validity for the Benton Visual Retention Test for Administration A (Memory) and Administration C (Copy). The clinical group had significantly poorer performance on most scores. These results also indicate important deficits in other neuropsychological functions in Alzheimer's disease...

Teste de Retenção Visual de Benton (BVRT): evidências de validade para idosos / Benton Visual Retention Test (BVRT): evidence of validity for elderly / Prueba de Retención Visual de Benton (BVRT): evidencia de validez para personas mayores

O presente estudo objetivou fornecer evidências de validade convergente entre o Teste de Retenção Visual de Benton (BVRT) e outros dois instrumentos de memória visual: Teste Pictórico de Memória (TEPIC-M) e Figuras Complexas de Rey. A amostra contou com 29 idosos, de ambos os sexos, com 60 a 79 anos e escolaridades baixa e média. Aplicou-se também a Escala de Depressão Geriátrica (GDS-15) e o Mini Exame do Estado Mental (MEEM), para excluir participantes com indício de depressão e/ou demência. Os resultados apontaram evidências de validade convergente entre o BVRT e o TEPIC-M, o que indicou que o BVRT também possui um cunho verbal, apesar de seus estímulos com figuras geométricas abstratas. Porém, houve poucas correlações significativas entre o BVRT e o teste Figuras Complexas de Rey, o que indicou que avaliam as mesmas funções de maneiras diferentes, além de haver diversidades importantes entre suas aplicações.

This study aimed to provide evidences of convergent validity between the Benton Visual Retention Test (BVRT) and two other instruments of visual memory: Teste Pictórico de Memória (TEPIC-M) and Rey Complex Figures. The sample consisted of 29 elderly of both sexes, 60 to 79 years old and low and middle education. Geriatric Depression Scale (GDS-15) and Mini Mental State Examination (MMSE) were used to exclude participants with signs of depression and / or dementia. The results showed evidence of convergent validity between BVRT and TEPIC-M, which indicated that BVRT also have a verbal nature, despite its abstract geometric stimuli. However, there were few significant correlations between BVRT and Rey Complex Figure test, which indicated that both evaluate the same functions in different ways, and there are important differences between their applications.

Este estudio tuvo como objetivo proporcionar evidencias de validez convergente entre el Teste de Retención Visual de Benton (BVRT) y otros dos instrumentos de memoria visual: Teste Pictórico de Memória (TEPIC-M) y Figuras Complexas de Rey. La muestra consistió de 29 ancianos de ambos sexos de 60 a 79 años y escolaridad baja y media. Se aplicó también la Geriatric Depression Scale (GDS-15) y el Mini Mental State Examination (MMSE), para excluir a los sujetos con síntomas de depresión y/o demencia. Los resultados mostraron evidencias de validez convergente entre el BVRT y el TEPIC-M, lo que indica que el BVRT también tiene un carácter verbal, a pesar de sus figuras con los estímulos abstractos geométricos. Sin embargo, hubo pocas correlaciones significativas entre el BVRT y las Figuras Complexas de Rey, lo que indica que evalúan las mismas funciones de diferentes maneras, además de diferencias importantes entre sus aplicaciones.