Cognitive Deficits in Healthy Elderly Population With "Normal" Scores on the Mini-Mental State Examination.

This study investigated whether healthy older adults with Mini-Mental State Examination (MMSE) scores above 23 exhibit cognitive impairment on neuropsychological tests. Participants completed the MMSE and a neuropsychological battery including tests of 10 domains. Results were compared to published normative data. On neuropsychological testing, participants performed well on measures of naming and recall but showed mild to moderate impairment in working memory and processing speed and marked impairment in inhibition, sustained attention, and executive functioning. Almost everyone (91%) scored at least 1 standard deviation (SD) below the mean in at least 1 domain. The median number of domains in which individuals scored below 1 SD was 3.0 of 10.0, whereas over 21% scored below 1 SD in 5 domains or more. With the strictest of definitions for impairment, 20% of this population scored below 2.0 SDs below the norm in at least 2 domains, a necessary condition for a diagnosis of dementia. The finding that cognitive impairment, particularly in attention and executive functioning, is found in healthy older persons who perform well on the MMSE has clinical and research implications in terms of emphasizing normal variability in performance and early identification of possible impairment.

Patient Mood and Instrumental Activities of Daily Living in Alzheimer Disease: Relationship Between Patient and Caregiver Reports.

This retrospective study investigated the relationship between self-reports and caregiver perceptions of patients' depressive symptoms and the respective ability of these reports to predict instrumental activities of daily living (IADLs) beyond what is accounted for by cognitive abilities in 71 patients with mild Alzheimer disease. Patients completed the Geriatric Depression Scale-Short Form, and caregivers completed the Behavior Rating Scale for Dementia assessing their perception of patients' depressive symptoms. Caregivers also completed IADL items from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory. Cognitive measures included the Mini-Mental State Examination, Logical Memory from the Wechsler Memory Scale III, and Trail Making Test, Part B. The relationship between self-reported depressive symptoms and caregiver report of patients' depressive symptoms showed a trend toward significance (r = .22, P = .06). Measures of depressive symptoms significantly predicted 12.5% of the variance in IADLs performance, beyond that accounted for by patient demographics and cognitive functioning. Interestingly, patients' reports, rather than caregivers', were particularly useful in this prediction.

Personality differences among patients with chronic aphasia predict improvement in speech-language therapy.

BACKGROUND: Negative affectivity and neurocognitive deficits including executive dysfunction have been shown to be detrimental to rehabilitation therapies. However, research on the relationship between neuropsychological deficits and improvement in speech-language therapy (SLT) for aphasia is sparse. OBJECTIVE: To examine the relationships among neurocognitive and psychological functioning and improvement in SLT following aphasia due to stroke. METHODS: Fifty patients who were ≥ 9 months post stroke and enrolled in outpatient SLT to treat aphasia participated. Using standard language assessment measures, the authors evaluated language functioning at initiation of the study and after participants completed various SLT protocols. Executive functioning, visuospatial skills, attention, and memory also were assessed to provide indices of convergent and discriminant validity. Participants' mood and affectivity were evaluated by self-report, and their functional abilities and recovery of function since stroke were assessed via caregiver report. RESULTS: A multiple regression model testing the combined powers of neurocognitive and psychological variables was significant (P = .004, R2 = 0.33), with psychological and neurocognitive functioning accounting for 15% of the variance in relative language change beyond that accounted for by stroke severity and gross cognitive functioning. Negative affectivity expressed on the Positive and Negative Affectivity Scale made unique contributions to the model. CONCLUSIONS: Improvement in SLT is substantially related to neurocognitive and psychological functioning, particularly affectivity. Assessment of these characteristics may assist in identifying patients who are likely to improve and in tailoring treatment programs to yield optimal outcomes.

Internalizing, Externalizing, and Interpersonal Components of the MMPI-2-RF in Predicting Weight Change After Bariatric Surgery.

BACKGROUND: The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is commonly used to assess psychological factors that may adversely impact weight loss. Research is limited on the specific MMPI-2-RF scales that may predict poor postoperative outcomes following bariatric surgery. The current study compared preoperative MMPI-2-RF profiles associated with postoperative weight change to novel component scores in a bariatric surgery sample. METHODS: One hundred twenty-seven patients completed a preoperative medical evaluation, a test of reading ability, and the MMPI-2-RF. Percent weight loss was obtained postoperatively at 6 and 12 months. RESULTS: Principal components analysis (PCA) generated five novel subcomponents from within the internalizing, externalizing, and interpersonal substantive scales of the MMPI-2-RF. Among these components, higher externalizing and social conflict scores at baseline were predictive of less percent weight change postoperatively at 6 months. A similar trend was observed with higher insecurity scores predicting less weight loss at 6 months postoperatively. At 12-month follow-up, higher insecurity scores at baseline remained predictive of lower percentage weight loss, while social conflict trended toward significance in the same direction. Model comparisons of traditional MMPI-2-RF scales were found to be more sensitive than the novel subcomponents. Specifically, demoralization (RCd), antisocial behavior (RC4), hypomanic activation (RC9), family problems (FML), and shyness (SHY) significantly predicted weight change after surgery. CONCLUSION: Results suggested that specific problems scales were not more effectively differentiated into more sensitive and specific component scores, but demonstrated supportive evidence that the traditional MMPI-2-RF scales indicating higher degrees of behavioral dysregulation, poor self-efficacy, and lower social support predict reduced postoperative weight loss.

Factor structure, construct validity, and age- and education-based normative data for the Parametric Go/No-Go Test.

The Parametric Go/No-Go (PGNG) test assesses cognitive domains including attention and executive functioning with three levels of increasing difficulty. Level 1 measures accuracy and response time to three targets. Level 2 adds a nonrepeating rule, measuring response time to two targets, accuracy for targets, and accuracy for appropriate inhibition. Level 3 has three targets with the same nonrepeating rule. The task shows good construct validity, and factor analyses show adequate ability to distinguish between processing speed, sustained attention, and inhibition. Normative data for the PGNG, stratified by age and education, as well as strategies for identifying atypical responding, are presented.

The Relationship between Depressive Symptoms, Disease State, and Cognition in Amyotrophic Lateral Sclerosis.

Cognitive impairment (CI) in amyotrophic lateral sclerosis (ALS) may present a serious barrier to a patient's wellbeing and significantly decrease quality of life. Although reports of CI in ALS without frank dementia are becoming quite common, questions remain regarding the specific cognitive domains affected, as well as how other psychological and medical factors may impact cognitive functioning in these patients. Additionally, the influence of depressive symptoms on disease processes is not known. We aimed to address these questions by completing extensive neuropsychological tests with 22 patients with ALS and 17 healthy volunteers. A subgroup of these patients also completed questionnaires to measure depressive and vegetative symptoms. We tested for overall cognitive differences between groups, the influence of physical (e.g., bulbar and limb), vegetative (e.g., fatigue), and depressive symptoms on cognitive performance, and the relationship between depressive symptoms and disease severity in ALS. Overall, patients performed more poorly than healthy controls (HCs), most notably on tests of executive functioning and learning and memory. Results suggest that true cognitive performance differences exist between patients with ALS and HCs, as these differences were not changed by the presence of vegetative or depressive symptoms. There was no effect of limb or bulbar symptoms on cognitive functioning. Also, patients were not any more depressed than HCs, however increased depressive scores correlated with faster disease progression and decreased limb function. Collectively, it is suggested that translational advances in psychological intervention for those with CI and depression become emphasized in future research.