Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial.

PURPOSE: Epilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person's quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. METHODS: This was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. RESULTS: A total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups. Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. CONCLUSION: The lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.

Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults.

OBJECTIVES: Subjective memory complaints (SMCs) in the elderly are associated with poor recovery in performing activities of daily living. This study was designed to examine SMCs and their association with recovery and health outcomes of older persons within 1 year following hospital discharge after hip-fracture surgery. METHODS: Data were collected between 2012 and 2015 from 194 hip-fractured elders in northern Taiwan. SMCs were assessed by the Prospective and Retrospective Memory Questionnaire. Recovery outcomes included self-care ability (activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), physical function (range of motion and maximal muscle strength), cognitive function, delirium, depressive symptoms, and health-related quality of life (HRQoL). Outcomes were assessed before discharge and 1, 3, 6, and 12 months afterwards. Associations of SMCs with participants' recovery outcomes were examined by the generalized estimating equation approach. RESULTS: Participants with SMCs had significantly poorer recovery outcomes than those without SMCs. Additionally, the interaction term for time-by-SMC was significant on ADLs, IADLs, maximal strength of quadriceps muscles, maximal strength of hip abductor muscles, ankle dorsiflexion, and HRQoL, suggesting that negative associations with SMCs increased over time. Participants with SMCs were at significantly higher risk for cognitive impairment and delirium than those without SMCs. CONCLUSIONS: Participants with SMCs not only had worse recovery than those without SMCs, but their rate of recovery was also slower during the first year following hip-fracture surgery. Therefore, SMCs need to be assessed to identify patients at high risk for worse recovery outcomes following hip fracture.

Diminution of context association memory structure in subjects with subjective cognitive decline.

Alzheimer's disease (AD) progresses insidiously from the preclinical stage to dementia. While people with subjective cognitive decline (SCD) have normal cognitive performance, some may be in the preclinical stage of AD. Neurofibrillary tangles appear first in the transentorhinal cortex, followed by the entorhinal cortex in the clinically silent stage of AD. We expected the earliest changes in subjects with SCD to occur in medial temporal subfields other than the hippocampal proper. These selective structural changes would affect specific memory subcomponents. We used the Family Picture subtest of the Wechsler Memory Scale-III, which was modified to separately compute character, activity, and location subscores for episodic memory subcomponents. We recruited 43 subjects with SCD, 44 subjects with amnesic mild cognitive impairment, and 34 normal controls. MRI was used to assess cortical thickness, subcortical gray matter volume, and fractional anisotropy. The results demonstrated that SCD subjects showed significant cortical atrophy in their bilateral parahippocampus and perirhinal and the left entorhinal cortices but not in their hippocampal regions. SCD subjects also exhibited significantly decreased mean fractional anisotropy in their bilateral uncinate fasciculi. The diminution of cortical thickness over the mesial temporal subfields corresponded to brain areas with early tangle deposition, and early degradation of the uncinate fasciculus was in accordance with the retrogenesis hypothesis. The parahippocampus and perirhinal cortex contribute mainly to context association memory while the entorhinal cortex, along with the uncinate fasciculus, contributes to content-related contextual memory. We proposed that context association and related memory structures are vulnerable in the SCD stage.

Arbitrary and semantic associations in subjective memory impairment and amnestic mild cognitive impairment among Taiwanese individuals: A cross-sectional study.

BACKGROUND/PURPOSE: Researchers have recently proposed a preclinical stage of dementia of Alzheimer's type (DAT), referred to as subjective memory impairment (SMI), with the aim of developing methods for the early detection of DAT and subsequent intervention. It has been proposed that the objective memory functions of individuals with SMI are normal; however, arbitrary and semantic associations are both used to describe the processes of memory. No previous studies have investigated these processes among individuals with SMI. METHODS: Cross-sectional analysis was used to compare the memory function of individuals with SMI, amnestic mild cognitive impairment (aMCI), or DAT. One hundred and eighty-three participants were recruited from the Memory Clinic of National Taiwan University Hospital and communities in northern Taiwan, including individuals with no memory complaints (HC, n = 30) and individuals with SMI (n = 61), aMCI-single domain (n = 24), aMCI-multiple domain (n = 33), or DAT (n = 35). The Word Sequence Learning Test (WSLT) was used to assess the formation of arbitrary associations and the Logical Memory subtest of the Wechsler Memory Scale-Third Edition was used to assess the formation of semantic associations. RESULTS: Compared to the HC group, the SMI group performed poorly only on the WSLT, whereas the other groups performed poorly on both of the memory tasks. This study demonstrated that SMI individuals tend to perform poorly in the formation of arbitrary associations. CONCLUSION: Our findings suggest that tasks requiring arbitrary associations may provide greater sensitivity in the detection cognitive changes associated with preclinical DAT.

Theory of mind and social functioning in patients with temporal lobe epilepsy.

OBJECTIVE: This study aimed to explore the effects of theory of mind (ToM) and related potential risk factors, including cognitive functions, psychiatric status, and seizure-related clinical variables, on social functioning in patients with temporal lobe epilepsy (TLE). METHODS: Sixty-seven patients with intractable TLE who were potential candidates for epilepsy surgery and 30 matched controls were included. All participants completed four tasks measuring different levels of ToM (False Belief, Faux Pas Recognition, Implication Stories, and Visual Cartoon), the Symptom Checklist-90-Revised (SCL-90-R), the Social and Occupational Functioning Scale for Epilepsy (SOFSE), and neuropsychological tests. RESULTS: The patients exhibited impairments in both basic and advanced ToM. Multiple regression analyses revealed the following: (1) the SOFSE total score was significantly predicted by the Faux Pas Recognition (FPR), Global Severity Index (GSI) score of the SCL-90-R, and Full-Scale intelligence quotient (IQ) of the Wechsler Adult Intelligence Scale (WAIS), which accounted for 38%, 11%, and 8% of the variance, respectively; and (2) the FPR was a significant predictor of all SOFSE subscales, whereas the GSI score contributed substantially to the Interpersonal Relationships, Communication, and Occupation subscales of the SOFSE. SIGNIFICANCE: Advanced ToM, measured by impaired faux pas recognition, is a relatively strong predictor of poor social functioning in surgical candidates for intractable TLE. Identifying ToM impairment may help plan nonpharmacologic treatment for improving social functions in patients with intractable TLE.

Prospective memory in subjective cognitive decline: a preliminary study on the role of early cognitive marker in dementia.

Accumulating evidence shows that subjective cognitive decline (SCD) without impairment on conventional neuropsychological tests may indicate increased risk for Alzheimer disease. Previous studies of mild cognitive impairment have demonstrated the potential role of prospective memory (PM) in the early detection of cognitive decline. We thus aimed to investigate the performance of people with SCD on PM tasks relative to their healthy controls (HCs). Forty-one participants with SCD and demographically matched HCs received regular cognitive testing as well as 2 single-trial naturalistic time-based and event-based PM tasks. Statistical analyses showed that the individuals with SCD performed worse on the time-based PM task, especially on the prospective component, when compared with their HCs. Our findings suggest that PM, especially the time-based one on the prospective component, may be an early cognitive marker of dementia. This implies an underlying difficulty among subjects with SCD in self-initiation that exacerbates their memory difficulties. Further investigation on a large scale is needed.

Distinct Patterns and Clinical Implications of Semantic Memory Deterioration Among Patients With MCI.

Limited research has investigated the effects of executive dysfunction on semantic memory deterioration among patients with amnestic mild cognitive impairment (aMCI). This study examined the cognitive performance of 181 participants from various MCI subgroups, a group of mildly impaired individuals with dementia of the Alzheimer type (DAT) and a group of individuals with subjective memory impairment on various semantic memory tasks. The aMCI-single domain (aMCI-sd) group displayed poor performance on a semantic memory task requiring relatively higher degrees of effortful retrieval, and participants in the aMCI-multiple domain (aMCI-md) group, who also suffered with mild executive dysfunction displayed poor performance on all semantic memory tasks, similar to the DAT group. The nonamnestic MCI (non-a-MCI)-single domain group displayed normal performance across all semantic tasks, whereas the non-a-MCI-multiple domain group displayed a pattern similar to that of the aMCI-sd group. aMCI-sd patients who displayed poor performance on the semantic memory task had higher risk of conversion to DAT, whereas poor performance on tasks requiring relatively less effortful retrieval was associated with higher risk of conversion in the aMCI-md group. Thus, executive function may relate to deterioration of semantic memory retrieval processes. Such patterns of semantic memory impairment could be valuable for characterization of cognitive differences among MCI patients.

Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy.

BACKGROUND/PURPOSE: Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. METHODS: We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. RESULTS: Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. CONCLUSION: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

Plasma tau as a window to the brain-negative associations with brain volume and memory function in mild cognitive impairment and early Alzheimer's disease.

Neurofibrillary tangles are associated with cognitive dysfunction, and hippocampal atrophy with increased CSF tau markers. However, the plasma tau levels of Alzheimer's disease (AD) have not been well studied. We investigated plasma tau by using an immunomagnetic reduction assay in 20 patients with mild cognitive impairment (MCI) due to AD, 10 early AD dementia, and 30 healthy elders (HE). All received a 3D-brain MRI scan and a set of cognitive function test. We explored their relationships with both brain structure and cognitive functions. Images were analyzed to determine the brain volumes and gray matter densities. Patients with MCI or early AD had significantly increased plasma tau levels compared with HE. Plasma tau levels were negatively associated with the performance of logical memory, visual reproduction, and verbal fluency; also negatively associated with volume of total gray matter, hippocampus, amygdala; and gray matter densities of various regions. Regression analyses indicated that logical memory explained 0.394 and hippocampus volume predicted .608 of the variance of plasma tau levels, both P < 0.001. Education years were negatively associated with the gray matter densities of the supramarginal (r = -0.407), middle temporal gyrus (r = -0.40) and precuneus (r = -0.377; all P < 0.05) in HE; and negatively associated with plasma tau levels in patients (r = -0.626). We propose that plasma tau may serve as a window to both structure and function of the brain. Higher education is a protective factor against AD and is associated with lower plasma tau levels in patients.

Selective neuropsychological impairments and related clinical factors in children with moyamoya disease of the transient ischemic attack type.

PURPOSE: Moyamoya disease is characterized by progressive narrowing of bilateral internal carotid arteries. Neuropsychological impairments are suspected due to frequent involvement of the frontotemporal areas. The present study thus aimed to investigate the pattern of neuropsychological function in children diagnosed with moyamoya disease. METHODS: Thirteen children with moyamoya disease of the transient ischemic attack type received standardized neuropsychological tests that evaluate general intellectual function, verbal comprehension, perceptual organization, working memory, processing speed, episodic memory, category fluency and visuospatial function. Related clinical factors were also analyzed. RESULTS: The results showed single-domain cognitive impairment in around 15 % of patients and multiple-domain cognitive impairments in 23 % of patients. Selective impairments of episodic memory and processing speed were especially noted in those with younger age of onset and prolonged symptom duration. CONCLUSIONS: Neuropsychological impairments are not infrequent in children with moyamoya disease despite normal general intellectual functioning. The pattern of cognitive dysfunction is often associated with lesions in frontotemporal areas. Early detection and intervention shall be considered regarding cognitive outcome in pediatric group.

Development of a Revised Version of Subjective Memory Complaints Questionnaire in Taiwan: A Preliminary Study.

OBJECTIVES: Research has suggested that subjective memory complaints (SMC) are predictive of cognitive decline in cases of Alzheimer's disease; however, multidimensional characteristics of SMC make it difficult to formulate causal links. The Subjective Memory Complaints Questionnaire (SMCQ) has proven effective in capturing the nature of SMC. In this study, we developed a revised version of SMCQ (SMCQ-R) with corresponding normative data for application in Taiwan. METHODS: This study recruited 100 cognitively normal participants (> 45 years) stratified according to demographic characteristics. Assessments were performed to evaluate test-retest reliability, criterion-related validity, and construct validity of SMCQ-R. SMCQ-R scores of 20 matched patients with mild cognitive impairment (MCI) were also compared with those of normal participants to test construct validity. RESULTS: Reliability of SMCQ-R was satisfactory (0.81-0.95). Factor analysis revealed a three-factor structure: everyday memory problems (EMP), recent severe memory problems (RSMP), and long-term memory problems (LTMP). EMP and RSMP scores were negatively associated with objective cognitive function (r = -.20 to .39). Depressive symptoms were positively associated with all factors (r = .23-.33). Age was positively associated with total (b = 0.09, p < .05) and EMP scores (b = 0.06, p < .01). MCI patients obtained higher scores (p < .05) on all subscales. SMCQ-R scores discriminated between normal and MCI individuals (area under the curve = 0.77). This study established a norm based on scores adjusted to control for effects of age. CONCLUSIONS: SMCQ-R has sound psychometric properties and could potentially be used as a tool to assess SMC in clinical settings.

The Social and Occupational Functioning Scale for Epilepsy (SOFSE): a brief measure of functional status in a Taiwanese sample with epilepsy.

PURPOSE: To develop and validate a scale of social functioning for people with epilepsy (PWE)-the Social and Occupational Functioning Scale for Epilepsy (SOFSE). METHODS: According to the literature review and opinions from a panel of experts, PWE, and caregivers, a total of 31 questions were compiled. Questionnaires were analyzed from 172 adults with epilepsy. KEY FINDINGS: The final scale had 30 items in six dimensions. The results showed that internal consistency coefficients and test-retest reliabilities for each dimension ranged from 0.70 to 0.84 and 0.72 to 0.89, respectively. Retest reliability for the total SOFSE score was 0.92. Seven factors were extracted through principal factor analysis. Moreover, criterion-related validity was demonstrated by the significant correlations between the SOFSE and the following measures: the Mini Mental Status Examination (r = 0.60, p < 0.001), the Quality of Life in Epilepsy-31 (r = 0.53, p < 0.001), and the Global Severity Index of the Symptom Checklist-90-Revised (r = -0.66, p < 0.001). Finally, the differences in functional competence among patients also supported the discriminant validity of the inventory. SIGNIFICANCE: The SOFSE is a brief, psychometrically sound, and easy-to-administer measure of social functioning for use in busy clinical settings.

Theory of mind in patients with temporal lobe epilepsy.

Theory of mind (ToM) is a crucial aspect of social cognition and is mediated by a complex neural network. Studies on temporal lobe epilepsy (TLE) suggest that its neuropathological involvement includes several brain regions. Some regions seem to overlap the neural network responsible for ToM, and this overlap provides an opportunity to explore ToM in TLE patients. Another concern is psychosocial problems in TLE, and the study of ToM in TLE could serve as a basis for further understanding the nature of such psychosocial disturbances. Studies on whether TLE patients evidence ToM deficit, however, are scant and controversial. Consequently, we examine whether ToM deficit is evident in TLE. Thirty-one TLE patients and 24 matched controls were recruited and completed four tasks measuring different levels of ToM: false belief, faux pas recognition, processing of implied meanings, and cartoon ToM. The patients were impaired in both basic and advanced ToM. Right TLE had a more wide-ranging picture of deficit than left TLE. ToM appears to be vulnerable to TLE, especially on the right side. Since ToM might contribute to patients' psychosocial adjustment, we thus suggest that a ToM measure be included in regular neuropsychological assessments of such patients.

Divergent manifestations of irritability in patients with mild and moderate-to-severe traumatic brain injury: perspectives of awareness and neurocognitive correlates.

PRIMARY OBJECTIVES: To evaluate irritability in patients with mild traumatic brain injury (mTBI) and moderate-to-severe traumatic brain injury (msTBI), respectively. RESEARCH DESIGN: A prospective study was conducted at a level I trauma centre. METHODS AND PROCEDURES: A total of 160 participants, which included 80 healthy subjects and 80 patients with TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale and other cognitive functions, which included memory, executive function and information processing, were also evaluated. MAIN OUTCOMES AND RESULTS: The results showed post-injury self-reported irritability in patients with mTBI and family-reported irritability in patients with msTBI were significantly higher than irritability reported by healthy participants. Irritability was significantly associated with information processing ability in patients with mTBI, but it was not associated with any cognitive functions in patients with msTBI. CONCLUSIONS: Irritability was found to be prominent after TBI. Divergent causes of irritability seemed apparent in patients with mTBI and msTBI. Irritability after mTBI appeared might be related to the cognitive functions disrupted after the injury, whereas irritability after msTBI appeared to result directly from the brain lesions involved.

Extending Normative Data of the Paced Auditory Serial Addition Test to Account for Preliminary Psychometric Properties among Elderly Individuals in Taiwan.

OBJECTIVE: The Paced Auditory Serial Addition Test (PASAT) is widely used to assess cognitive performance in clinical settings. However, availability of normative data for Revised Version of PASAT (PASAT-R) is often constrained by sample size among elderly individuals. In this study, we sought to establish normative data for PASAT-R for elderly individuals in Taiwan. METHODS: This study recruited 166 individuals aged over 65 years stratified in accordance with the general population in terms of demographic characteristics, including age, educational level, and sex. We assessed PASAT-R test results in terms of psychometric properties. RESULTS: PASAT-R demonstrated good internal consistency and test-retest reliability. Performance on PASAT-R was correlated with performance on the criterion tests. Performance on PASAT-R was negatively correlated with age and positively correlated with educational level. This study provides normative data for PASAT-R for elderly Taiwanese individuals. CONCLUSIONS: PASAT-R is applicable to neuropsychological assessment among elderly Taiwanese individuals.

Age-related vulnerabilities along the hippocampal longitudinal axis.

Evidence for an anterior-posterior gradient of age-related volume reduction along the hippocampal longitudinal axis has been reported in normal aging, but functional changes have yet to be systematically investigated. The current study applied an advanced brain mapping technique, large deformation diffeomorphic metric mapping (LDDMM), automatically delineating the hippocampus into the anterior and posterior segments based on anatomical landmarks. We studied this anterior-posterior gradient in terms of structural and functional MRI in 66 participants aged from 19 to 79 years. The results showed age-related structural volume reduction in both anterior and posterior hippocampi, with greater tendency for anterior decrease. FMRI task contrasts that robustly activated the anterior (associative/relational processing) and posterior (novelty) hippocampus independently, showed only significant reduction of activation in the anterior hippocampus as age increased. Our results revealed positive correlation between structural atrophy and functional decrease in the anterior hippocampi, regardless of task performance in normal aging. These findings suggest that anatomy and functions related to the anterior hippocampus may be more vulnerable to aging, than previously thought.

Irritability following traumatic brain injury: divergent manifestations of annoyance and verbal aggression.

PRIMARY OBJECTIVES: To evaluate irritability following traumatic brain injury. RESEARCH DESIGN: A prospective study was conducted at a level I trauma centre. METHODS AND PROCEDURES: One hundred and forty-four participants, which included 80 healthy subjects and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS) from patients themselves and their families. MAIN OUTCOMES AND RESULTS: the results showed 14.8% of patients and 29.4% of their families reported patients' problems of irritability. Meanwhile, both self-reported and family-reported irritability post-injury were significantly higher than those reported by the healthy subjects. When evaluating two sub-components of irritability, respectively, both family- and self-reported post-injury annoyance were significantly higher than the pre-injury one, while the self-reported post-injury verbal aggression was not. CONCLUSIONS: TBI patients have remarkable problems of irritability after injuries. Specifically, the results showed that annoyance might be the main characteristic of irritability in TBI patients and patients themselves might be unaware of their verbal aggression post-injury. Hence, it is merited to pay more attention to the annoyance of the patients with TBI and to the reports from significant caregivers when evaluating TBI patients' irritability in clinical settings.

Medium-term course and outcome of schizophrenia depicted by the sixth-month subtype after an acute episode.

BACKGROUND/PURPOSE: The intermediate course of schizophrenia is a complex intertwined with the heterogeneity of the illness. This article attempts to simplify this complexity using a hypothetical tripartite based on the profile of symptoms at 6 months after acute treatment. METHODS: This is a prospective 5-year follow-up study including 163 schizophrenic inpatients in northern Taiwan comparing patients' demographic data at index admission, scores on the Positive and Negative Syndrome Scale (PANSS) for schizophrenia and social function scale measured at admission, 6-month follow-up, and annually, and scores on a neuropsychologic test battery measured approximately 5 years after recruitment. RESULTS: Patients were grouped into three subtypes based on their sixth-month symptomatology by Generalized Association Plots, designated as remitted (RM), persistent delusion/hallucination (PDH), and markedly blunting (MB) groups. These three subtypes presented with similar positive symptom profiles at recruitment, yet during follow-up, the PDH group tended to maintain the highest risk of having worse clinical symptomatology, social functioning, and neuropsychologic functioning, and the RM was the best outcome group. CONCLUSION: This three-subtype model provides a practical reference to predict medium-term outcomes by the subject's response to acute treatment and serves as a model to sort out part of the heterogeneous nature of schizophrenia that still should be examined by further psychopharmacological, neurobiological, and genetic studies.

Neuropsychological performance and seizure-related risk factors in patients with temporal lobe epilepsy: a retrospective cross-sectional study.

The aim of this study was to identify the neuropsychological features in patients with temporal lobe epilepsy (TLE) and their correlation with seizure-related variables. For this purpose, we carried out a retrospective analysis of data from 65 patients with TLE who had undergone a comprehensive neuropsychological assessment. The results suggest that the majority of patients with TLE were impaired in more than one cognitive domain, and among these patients, the mean proportions with defective semantic memory, language, motor/psychomotor speed, verbal episodic memory, and executive function were >50% each. Moreover, age at seizure onset was the strongest predictor of general intellectual impairment, and number of antiepileptic drugs and seizure frequency could significantly predict deficits in verbal memory, language, and psychomotor speed. However, epilepsy duration was a less potent predictor of cognitive deficit than has been reported in cross-sectional studies.

Patient subgroups of schizophrenia based on the Positive and Negative Syndrome Scale: composition and transition between acute and subsided disease states.

The present study focuses on schizophrenia patient subgroups with specific symptom pattern using the Positive and Negative Syndrome Scale (PANSS). In this report, we intend to (1) provide a more appropriate analytic method for exploring the subgroups based on PANSS data, (2) validate identified subgroups with external variables, and (3) estimate probabilities of subgroup changes between 2 disease states. The analyzed data include 219 acute-state patients who had completed the PANSS within 1 week of index admission and 225 subsided-state patients who were living in the community and under family care. Regression extension of latent class analysis was performed. We found that acute schizophrenia can be classified into 4 subgroups--whole syndrome, whole syndrome without hostility, partial syndrome with negative symptoms, and partial syndrome with pure reality distortion--and that subsided schizophrenia can be classified into 3 subgroups--florid symptom, marked negative, and remitted. Patients of the whole syndrome, whole syndrome without hostility, partial syndrome with negative symptoms, and partial syndrome with pure reality distortion subgroups at the acute state were most likely to transit to the florid symptom (61%), florid symptom (48%), marked negative (42%), and remitted (56%) subgroups at the subsided state, respectively. Significant relationships of obtained subgroups with sociodemographic variables and neurocognitive variables were identified. These results of different subgroups will provide the background for facilitating current molecular, genetic, and neurobiological studies of schizophrenia.