Cognition and health-related quality of life in long-term survivors of high-grade glioma: an interactive perspective from patient and caregiver.

BACKGROUND: The health-related quality of life (HRQoL) and cognition are important indicators for the quality of survival in patients with high-grade glioma (HGG). However, data on long-term survivors and their caregivers are scarce. We aim to investigate the interaction between cognition and HRQoL in long-term survivors, their caregivers' evaluations, and the effect on caregiver strain and burden. METHODS: 21 long-term HGG (8 WHO grade III and 13 WHO grade IV) survivors (survival ≥ 5 years) and 15 caregivers were included. Cognition (verbal memory, attention, executive functioning, and language), HRQoL, anxiety and depression, caregiver strain, and caregiver burden were assessed with standardized measures. Questionnaires were completed by patients and/or their caregivers. RESULTS: Mean survival was 12 years (grade III) and 8 years (grade IV). Cognition was significantly impaired with a large individual variety. Patients' general HRQoL was not impaired but all functioning scales were deviant. Patient-proxy agreement was found in most HRQoL subscales. Three patients (14%) showed indications of anxiety or depression. One-third of the caregivers reported a high caregiver strain or a high burden. Test scores for attention, executive functioning, language, and/or verbal memory were correlated with perceived global health status, cognitive functioning, and/or communication deficits. Caregiver burden was not related to cognitive deficits. CONCLUSIONS: In long-term HGG survivors maintained HRQoL seems possible even when cognition is impaired in a large variety at the individual level. A tailored approach is therefore recommended to investigate the cognitive impairments and HRQoL in patients and the need for patient and caregiver support.

Leisure and social participation in patients 4-10 years after aneurysmal subarachnoid haemorrhage.

OBJECTIVE: To investigate the long-term resumption of leisure and social activities in patients with aneurysmal subarachnoid haemorrhage (aSAH) and to determine the role of executive dysfunction and aneurysms in anterior brain regions in particular. METHOD: Leisure and social functioning of 200 patients with aSAH having anterior or posterior aneurysms was determined using the Role Resumption List (RRL). Executive functioning was investigated using the Dysexecutive Questionnaire (DEX) and sub-scales Social Convention (SC) and Executive Cognition (EC). Mood, fatigue and cognitive problems were investigated with the Hospital Anxiety and Depression Scale (HADS) and Brain Injury Symptom Checklist (BISC). RESULTS: Of all patients, 46.5% reported complete return to previous leisure activities and 61.5% reported no changes in social interactions. HADS depression score, fatigue, DEX-EC sub-scale score and work status post-aSAH were predictors of leisure resumption. For social re-integration, HADS depression score, cognitive problems and fatigue were predictors. Aneurysm location did not influence leisure and social re-integration. CONCLUSIONS: A substantial number of the patients still experience problems in resuming previous activities in the chronic phase post-aSAH, influenced by cognitive, executive and depressive problems, as well as current work status and fatigue. Aneurysm location does not seem to influence this resumption.

Motor and non-motor determinants of health-related quality of life in young dystonia patients.

OBJECTIVES: To systematically investigate the relationship between motor and non-motor symptoms, and health-related quality of life (HR-QoL) in children and young adults with dystonia. METHODS: In this prospective observational cross-sectional study, 60 patients (6-25 years) with childhood-onset dystonia underwent a multidisciplinary assessment of dystonia severity (Burke-Fahn-Marsden Dystonia Rating Scale, Global Clinical Impression), motor function (Gross Motor Function Measure, Melbourne Assessment of Unilateral Upper Limb Function), pain (visual analogue scale), intelligence (Wechsler Intelligence Scale), executive functioning (Behavior Rating Inventory of Executive Function) and anxiety/depression (Child/Adult Behavior Checklist). Measures were analyzed using a principal component analysis and subsequent multiple regression to evaluate which components were associated with HR-QoL (Pediatric Quality of life Inventory) for total group, and non-lesional (primary) and lesional (secondary) subgroups. RESULTS: Patients (29 non-lesional, 31 lesional dystonia) had a mean age of 13.6 ±â€¯5.9 years. The principal component analysis revealed three components: 1) motor symptoms; 2) psychiatric and behavioral symptoms; and 3) pain. HR-QoL was associated with motor symptoms and psychiatric and behavioral symptoms (R2 = 0.66) for the total sample and lesional dystonia, but in the non-lesional dystonia subgroup only with psychiatric and behavioral symptoms (R2 = 0.51). CONCLUSIONS: Non-motor symptoms are important for HR-QoL in childhood-onset dystonia. We suggest a multidisciplinary assessment of motor and non-motor symptoms to optimize individual patient management.

Social cognition impairments after aneurysmal subarachnoid haemorrhage: Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness.

Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal-subcortical circuits underlying social cognition. Therefore, we aimed to investigate social cognition after aSAH and its associations with behavioural problems (deficits in interpersonal behaviour, apathy, and impaired self-awareness) and focal as well as diffuse brain damage. 88 aSAH patients (in the subacute phase post-aSAH) and 60 age-, sex- and education-matched healthy controls participated. Tasks for emotion recognition, Theory of Mind (ToM), and empathy as well as questionnaires were used. Cortical infarctions in frontal and non-frontal areas on MRI, aneurysm circulation and aSAH-related events were taken into account. Compared to healthy controls, aSAH patients performed significantly worse on tasks for emotion recognition, ToM and empathy. Poor performance on ToM and emotion recognition was associated with proxy-ratings indicating impaired interpersonal behaviour and apathy and with indications of impaired self-awareness. No associations were found between deficits in social cognition and frontal or non-frontal cortical lesions on MRI. Also, aneurysm circulation and aSAH-related events such as hydrocephalus, vasospasm, and treatment method did not explain why and how social cognitive deficits did occur after aSAH. In conclusion, emotion recognition, ToM and empathy were clearly impaired in aSAH patients and these deficits were related to apathy and deficits in interpersonal behaviour as reported by proxies and to impaired self-awareness. This association strengthens the assumption of impaired social cognition as an underlying construct of behavioural problems after aSAH. Consequently, social cognition tests and proxy-ratings should be used in clinical practice, irrespective of lesion location on MRI or aneurysm circulation, to improve the detection and treatment of apathy and deficits in interpersonal behaviour after aSAH.

Cognitive deficits after aneurysmal and angiographically negative subarachnoid hemorrhage: Memory, attention, executive functioning, and emotion recognition.

OBJECTIVE: The authors' aim was to investigate cognitive outcome in patients with aneurysmal and angiographically negative subarachnoid hemorrhage (aSAH and anSAH), by comparing them to healthy controls and to each other. Besides investigating cognitive functions as memory and attention, they focused on higher-order prefrontal functions, namely executive functioning (EF) and emotion recognition. METHOD: Patients and healthy controls were assessed with tests measuring memory (15 Words Test, Digit Span), attention and processing speed (Trail Making Test A and B), EF (Zoo Map, Letter Fluency, Dysexecutive Questionnaire), and emotion recognition (Facial Expressions of Emotion Stimuli and Tests). Between-groups comparisons of test performances were made. RESULTS: Patients with aSAH scored significantly lower than healthy controls on measures of memory, processing speed, and attention, but anSAH patients did not. In the higher-order prefrontal functions (EF and emotion recognition), aSAH patients were clearly impaired when compared to healthy controls. However, anSAH patients did not perform significantly better than aSAH patients on the majority of the tests. CONCLUSIONS: In the subacute phase after SAH, cognitive functions, including the higher-order prefrontal functions EF and emotion recognition, were clearly impaired in aSAH patients. Patients with anSAH did not perform better than aSAH patients, which indicates that these functions may also be affected to some extent in anSAH patients. Considering the importance of these higher-order prefrontal functions for daily life functioning, and following the results of the present study, tests that measure emotion recognition and EF should be part of the standard neuropsychological assessment after SAH. (PsycINFO Database Record

Age of acquisition and naming performance in Frisian-Dutch bilingual speakers with dementia.

Age of acquisition (AoA) of words is a recognised variable affecting language processing in speakers with and without language disorders. For bi- and multilingual speakers their languages can be differentially affected in neurological illness. Study of language loss in bilingual speakers with dementia has been relatively neglected. OBJECTIVE: We investigated whether AoA of words was associated with level of naming impairment in bilingual speakers with probable Alzheimer's dementia within and across their languages. METHODS: Twenty-six Frisian-Dutch bilinguals with mild to moderate dementia named 90 pictures in each language, employing items with rated AoA and other word variable measures matched across languages. Quantitative (totals correct) and qualitative (error types and (in)appropriate switching) aspects were measured. RESULTS: Impaired retrieval occurred in Frisian (Language 1) and Dutch (Language 2), with a significant effect of AoA on naming in both languages. Earlier acquired words were better preserved and retrieved. Performance was identical across languages, but better in Dutch when controlling for covariates. However, participants demonstrated more inappropriate code switching within the Frisian test setting. On qualitative analysis, no differences in overall error distribution were found between languages for early or late acquired words. There existed a significantly higher percentage of semantically than visually-related errors. CONCLUSION: These findings have implications for understanding problems in lexical retrieval among bilingual individuals with dementia and its relation to decline in other cognitive functions which may play a role in inappropriate code switching. We discuss the findings in the light of the close relationship between Frisian and Dutch and the pattern of usage across the life-span.

A idade de aquisição (IA) de palavras é uma variável reconhecida que interfere no processamento da linguagem em falantes com e sem distúrbios de linguagem. Para falantes bilíngues e multilíngues, a linguagem pode ser afetada diferenciadamente nas doenças neurológicas. O estudo da deterioração de linguagem em indivíduos falantes bilíngues com demência tem sido relativamente negligenciado. OBJETIVO: Nós investigamos se a IA de palavras estava associada ao grau de comprometimento da nomeação em indivíduos bilíngues com demência de Alzheimer provável em uma língua e entre as línguas faladas por eles. MÉTODOS: Trinta e seis bilíngues Frisio-holandeses com demência de grau leve a moderado nomearam 90 figuras em cada uma das línguas, pareadas quanto a IA e outras variáveis. Aspectos quantitativos (numero de acertos) e qualitativos (tipos de erros e trocas inadequadas de código) foram mensurados. RESULTADOS: Déficits de resgate lexical ocorreram no Frisio (Língua 1) e Holandês (Língua 2) com efeito significante da IA na nomeação em ambas as línguas. Palavras adquiridas mais precocemente foram mais preservadas e melhor resgatadas. O desempenho foi idêntico entre as línguas, mas melhor no Holandês, quando as covariáveis foram controladas. Entretanto, os participantes demonstraram mais mudanças impróprias de código no contexto do teste em Frísio. Na análise qualitativa não houve diferenças na distribuição global dos erros entre as línguas tanto para as palavras adquiridas precoce ou tardiamente. Houve uma porcentagem significativamente mais alta de erros semanticamente relacionados em relação aos visualmente relacionados. CONCLUSÃO: Os achados tem implicações para a compreensão de distúrbios de resgate lexical em indivíduos bilíngues com demência e a sua relação com o declínio em outras funções cognitivas que pode desempenhar um papel na inadequada mudança de código. Nós discutimos os achados à luz da estreita relação entre Frisio e Holandês e o padrão de uso durante a vida.

Social cognition impairments in relation to general cognitive deficits, injury severity, and prefrontal lesions in traumatic brain injury patients.

Impairments in social behavior are frequently found in moderate to severe traumatic brain injury (TBI) patients and are associated with an unfavorable outcome with regard to return to work and social reintegration. Neuropsychological tests measuring aspects of social cognition are thought to be sensitive to these problems. However, little is known about the effect of general cognitive problems on these tests, nor about their sensitivity to injury severity and frontal lesions. In the present study 28 chronic TBI patients with a moderate to severe TBI were assessed with tests for social cognition (emotion recognition, Theory of Mind, and empathy), and for general, non-social cognition (memory, mental speed, attention, and executive function). The patients performed significantly worse than healthy controls on all measures, with the highest effect size for the emotion recognition test, the Facial Expressions of Emotion-Stimuli and Tests (FEEST). Correlation analyses yielded no significant (partial) correlations between social and non-social cognition tests. Consequently, poor performance on social cognition tests was not due to general cognitive deficits. In addition, the emotion recognition test was the only measure that was significantly related to post-traumatic amnesia (PTA) duration, Glasgow Coma Scale (GCS) score, and the presence of prefrontal lesions. Hence, we conclude that social cognition tests are a valuable supplement to a standard neuropsychological examination, and we strongly recommend the incorporation of measurements of social cognition in clinical practice. Preferably, a broader range of social cognition tests would be applied, since our study demonstrated that each of the measures represents a unique aspect of social cognition, but if capacity is limited, at least a test for emotion recognition should be included.

Age of acquisition and naming performance in Frisian-Dutch bilingual speakers with dementia / Idade de aquisição e tarefa de nomeação em falantes bilingues Frísio-Holandeses com demência

Age of acquisition (AoA) of words is a recognised variable affecting language processing in speakers with and without language disorders. For bi- and multilingual speakers their languages can be differentially affected in neurological illness. Study of language loss in bilingual speakers with dementia has been relatively neglected. Objective: We investigated whether AoA of words was associated with level of naming impairment in bilingual speakers with probable Alzheimer?s dementia within and across their languages. Methods: Twenty-six Frisian-Dutch bilinguals with mild to moderate dementia named 90 pictures in each language, employing items with rated AoA and other word variable measures matched across languages. Quantitative (totals correct) and qualitative (error types and (in)appropriate switching) aspects were measured. Results: Impaired retrieval occurred in Frisian (Language 1) and Dutch (Language 2), with a significant effect of AoA on naming in both languages. Earlier acquired words were better preserved and retrieved. Performance was identical across languages, but better in Dutch when controlling for covariates. However, participants demonstrated more inappropriate code switching within the Frisian test setting. On qualitative analysis, no differences in overall error distribution were found between languages for early or late acquired words. There existed a significantly higher percentage of semantically than visually-related errors. Conclusion: These findings have implications for understanding problems in lexical retrieval among bilingual individuals with dementia and its relation to decline in other cognitive functions which may play a role in inappropriate code switching. We discuss the findings in the light of the close relationship between Frisian and Dutch and the pattern of usage across the life-span.

A idade de aquisição (IA) de palavras é uma variável reconhecida que interfere no processamento da linguagem em falantes com e sem distúrbios de linguagem. Para falantes bilíngues e multilíngues, a linguagem pode ser afetada diferenciadamente nas doenças neurológicas. O estudo da deterioração de linguagem em indivíduos falantes bilíngues com demência tem sido relativamente negligenciado. Objetivo: Nós investigamos se a IA de palavras estava associada ao grau de comprometimento da nomeação em indivíduos bilíngues com demência de Alzheimer provável em uma língua e entre as línguas faladas por eles. Métodos: Trinta e seis bilíngues Frisio-holandeses com demência de grau leve a moderado nomearam 90 figuras em cada uma das línguas, pareadas quanto a IA e outras variáveis. Aspectos quantitativos (numero de acertos) e qualitativos (tipos de erros e trocas inadequadas de código) foram mensurados. Resultados: Déficits de resgate lexical ocorreram no Frisio (Língua 1) e Holandês (Língua 2) com efeito significante da IA na nomeação em ambas as línguas. Palavras adquiridas mais precocemente foram mais reservadas e melhor resgatadas. O desempenho foi idêntico entre as línguas, mas melhor no Holandês, quando as covariáveis foram controladas. Entretanto, os participantes demonstraram mais mudanças impróprias de código no contexto do teste em Frísio. Na análise qualitativa não houve diferenças na distribuição global dos erros entre as línguas tanto para as palavras adquiridas precoce ou tardiamente. Houve uma porcentagem significativamente mais alta de erros semanticamente relacionados em relação aos visualmente relacionados. Conclusão: Os achados tem implicações para a compreensão de distúrbios de resgate lexical em indivíduos bilíngues com demência e a sua relação com o declínio em outras funções cognitivas que pode desempenhar um papel na inadequada mudança de código. Nós discutimos os achados à luz da estreita relação entre Frisio e Holandês e o padrão de uso durante a vida.