Verbal Fluency Tasks: Influence of Age, Gender, and Education and Normative Data for the Spanish Native Adult Population.

OBJECTIVE: Phonological and semantic verbal fluency (VF) tasks are frequently used to assess language and executive functions in both clinical and research settings. F, A, and S are the most commonly used letters in phonological tasks across languages and cultures. Unfortunately, the lack of norms for the native Spanish population for these letters, and for certain semantic categories such as "proper names," may lead to misinterpretation of scores due to demographic differences. The aim of the present study was to provide normative data for F, A, and S and for "proper names," "animals," and "fruits and vegetables" for the native Spanish population. METHOD: 257 healthy subjects took part in the study (ages: 17-100 years, 3-20 years of education). Correlation, multiple regression, and t-tests were used to select the most appropriate variables for stratification. RESULTS: Education was the best predictor of performance in all tasks, followed by age. Given that t-test results showed no differences related to gender, with the only exception of the semantic category "animals," this variable was not considered for stratification. Consequently, the data were stratified in two education levels (<13, ≥13 years of education) and in two age levels (<60, ≥60) within the low-educational level group. Mean, standard deviation, and percentile scores for each group are provided. CONCLUSIONS: The present norms provide a reference for clinicians assessing VF. This data may also facilitate comparisons with other normative studies in cross-cultural and cross-linguistic research.

Cognitive deficits and clinical symptoms in patients with treatment-refractory obsessive-compulsive disorder: The role of slowness in information processing.

Patients with Obsessive-Compulsive Disorder (OCD) present neuropsychological deficits across different cognitive domains, especially in executive functioning and information processing speed. Some studies have even suggested that speed deficits may underlie poor neuropsychological performance. However, this hypothesis remains unanswered in both OCD general population and OCD refractory subgroup. In addition, it is not clear whether such deficits are secondary to the clinical symptoms or may constitute a primary deficit. The aim of this study was to explore the speed of processing hypothesis in treatment-refractory OCD patients, and to clarify to what extent slowness is related to psychopathological symptoms. Both clinical and neuropsychological examination was conducted to assess 39 OCD refractory patients candidates for neurosurgery and 39 healthy matched individuals. Principal component analysis revealed a three-component structure in the neuropsychological battery being used, including a speed of processing, working memory, and conflict monitoring components. Group comparisons revealed that OCD patients performed significantly worse than healthy individuals in speed measures, but no differences were found in executive tests not influenced by time. Correlation analyses revealed a lack of association between neuropsychological and clinical measures. The results suggest that treatment-refractory OCD patients exhibit a primary deficit in information processing speed independent of clinical symptoms.

Components determining the slowness of information processing in parkinson's disease.

INTRODUCTION: Bradyphrenia is a key cognitive feature in Parkinson's disease (PD). There is no consensus on whether information processing speed is impaired or not beyond motor performance. OBJECTIVE: This study aims to explore which perceptual, motor, or cognitive components of information processing are involved in the slowdown affecting cognitive performance. METHODS: The study included 48 patients with PD (age: 63, 3 ± 8, 18; HY I-III; UPDRS 15,46 ± 7,76) and 53 healthy controls (age: 60,09 ± 12,83). Five reaction time (RT) tasks were administered to all participants. The average RT in each of the tasks and the percentage of correct answers were measured. Patients with PD were in "ON state" at the time of the evaluation. Perceptual, motor, and cognitive components were isolated by means of a series of ANCOVAs. RESULTS: As expected, the motor component was slowed down in patients with PD. Moreover, while patients with PD showed slower RT than controls in all tasks, differences between groups did not exponentially increase with the increasing task complexity. ANCOVA analyses also revealed that the perceptual and sustained alert component resulted to be slowed down, with no differences being found in any of the remaining isolated cognitive components (i.e., response strategy-inhibition, decisional, visual search, or interference control). CONCLUSIONS: The results revealed that slowness of information processing in PD was mainly associated with an impaired processing speed of the motor and perceptual-alertness components analyzed. The results may help designing new neurorehabilitation strategies, focusing on the improvement of perceptual and alertness mechanisms.

Construct Validity of the Stroop Color-Word Test: Influence of Speed of Visual Search, Verbal Fluency, Working Memory, Cognitive Flexibility, and Conflict Monitoring.

OBJECTIVE: 85 years after the description of the Stroop interference effect, there is still a lack of consensus regarding the cognitive constructs underlying scores from standardized versions of the test. The present work aimed to clarify the cognitive mechanisms underlying direct (word-reading, color-naming, and color-word) and derived scores (interference, difference, ratio, and relative scores) from Golden's standardized version of the test. METHOD: After a comprehensive review of the literature, five cognitive processes were selected for analysis: speed of visual search, phonemic verbal fluency, working memory, cognitive flexibility, and conflict monitoring. These constructs were operationalized by scoring five cognitive tasks (WAIS-IV Digit Symbol, phonemic verbal fluency [letter A], WAIS-IV Digit Span, TMT B-A, and reaction times to the incongruent condition of a computerized Stroop task, respectively). About 83 healthy individuals (mean age = 25.2 years) participated in the study. Correlation and regression analyses were used to clarify the contribution of the five cognitive processes on the prediction of Stroop scores. RESULTS: Data analyses revealed that Stroop word-reading reflected speed of visual search. Stroop color-naming reflected working memory and speed of visual search. Stroop color-word reflected working memory, conflict monitoring, and speed of visual search. Whereas the interference score was predicted by both conflict monitoring and working memory, the ratio score (color-word divided by color-naming) was predicted by conflict monitoring alone. CONCLUSION: The present results will help neuropsychologists to interpret altered patient scores in terms of a failure of the cognitive mechanisms detailed here, benefitting from the solid background of preceding experimental work.

Identifying Perceptual, Motor, and Cognitive Components Contributing to Slowness of Information Processing in Multiple Sclerosis with and without Depressive Symptoms.

Increasing findings suggest that different components of the stimulus-response pathway (perceptual, motor or cognitive) may account for slowed performance in Multiple Sclerosis (MS). It has also been reported that depressive symptoms (DS) exacerbate slowness in MS. However, no prior studies have explored the independent and joint impact of MS and DS on each of these components in a comprehensive manner. The objective of this work was to identify perceptual, motor, and cognitive components contributing to slowness in MS patients with and without DS. The study includes 33 Relapsing-Remitting MS patients with DS, 33 without DS, and 26 healthy controls. Five information processing components were isolated by means of ANCOVA analyses applied to five Reaction Time tasks. Perceptual, motor, and visual search components were slowed down in MS, as revealed by ANCOVA comparisons between patients without DS, and controls. Moreover, the compounding effect of MS and DS exacerbated deficits in the motor component, and slowed down the decisional component, as revealed by ANCOVA comparisons between patients with and without DS. DS seem to exacerbate slowness caused by MS in specific processing components. Identifying the effects of having MS and of having both MS and DS may have relevant implications when targeting cognitive and mood interventions.

Evolución de las alteraciones cognitivas tras un traumatismo craneoencefálico: ¿hay mejoría tras controlar el efecto de la práctica? / Evolution of cognitive impairment after a traumatic brain injury: is there any improvement after controlling the practice effect?

Introducción: La importancia de conocer el patrón de evolución de los déficits cognitivos en los primeros meses tras un traumatismo craneoencefálico (TCE) ha fomentado el desarrollo de numerosos estudios longitudinales. Sin embargo, los resultados de la mayoría de ellos deberían tomarse con cautela debido a la falta de un control adecuado del efecto de la práctica, que puede llevar a sobreestimar la recuperación genuina de los procesos cognitivos. Objetivo: Describir los cambios cognitivos entre las fases aguda y subaguda del TCE controlando el efecto de la práctica. Pacientes y métodos: Veintidós pacientes realizaron dos evaluaciones neuropsicológicas tras el TCE (inmediata y tras seis meses) mediante los siguientes tests: Trail Making Test (A, B, B/A y B-A), test de Stroop (P, C, PC e interferencia), clave de números, búsqueda de símbolos, dígitos directos e inversos, fluidez verbal y memoria inmediata. Para controlar el efecto de la práctica se realizó una transformación de las puntuaciones aplicando el procedimiento propuesto por Calamia et al. Resultados: Antes de controlar el efecto de la práctica, se evidenció una mejoría en las puntuaciones de todos los tests (p > 0,001). Sin embargo, tras él, la mejoría permaneció sólo en el Trail Making Test-B, B/A y B-A, la clave de números, la búsqueda de símbolos, el test de Stroop PC y los dígitos inversos. Conclusiones: La falta de control del efecto de la práctica en estudios longitudinales puede generar interpretaciones erróneas sobre el perfil de evolución de los déficits cognitivos. El patrón de recuperación tras un TCE varía en función del proceso cognitivo

Introduction: The importance of knowing the pattern of evolution of cognitive deficits in the first months after a traumatic brain injury (TBI) has encouraged the development of numerous longitudinal studies. However, the results of most of them should be taken with caution due to the lack of adequate control of practice effects that can lead to overestimating the genuine recovery of cognitive processes. Aim. To describe the cognitive changes between the acute and subacute phases of the TBI controlling the effect of the practice. Patients and methods: Twenty-two patients were assessed in two different time points after TBI (immediately and after six months) using the following tests: Trail Making Test (A, B, B/A, B-A), Stroop Test (W, C, CW, interference), Digit Symbol-Coding, Symbol Search, Digits Forward and Backward, Verbal Fluency and Short-term Memory. To control for the practice effects, a transformation of the scores was performed applying the procedure proposed by Calamia et al. Results: Before controlling the practice effects, the scores of all tests improved (p > 0.001). However, afterward, the improvement remained only in the Trail Making Test-B, B/A and B-A, Digit Symbol-Coding, Symbol Search, Stroop CW and Digits Backward. Conclusions: The lack of control of practice effects in longitudinal studies can generate misleading interpretations about the evolution of cognitive deficits. The pattern of recovery after a TBI varies depending on the cognitive process

Computerized Simple Reaction Time and Balance in Nondemented Parkinson's Patients.

BACKGROUND: Parkinson's disease (PD) patients are known to suffer from subtle cognitive and balance deficits from the early stages although they usually manifest in advanced stages. Postural instability (PI) has been correlated with slower information processing speed. Simple reaction time (SRT) tasks can be used to measure the speed of information processing. The main objective of this study was to examine the usefulness of SRT as a valid predictor of balance in PD, thus providing a simple and complementary assessment method. METHODS: This cross-sectional study included 52 PD patients without dementia who were evaluated for balance using the pull test (PT) maneuver and Biodex® limits of stability (LOS). In addition, a reaction time task was used to measure processing speed. Correlation and linear regression analyses were performed. RESULTS: The performance of SRT tasks was correlated with the evaluation of LOS% and PT, suggesting that the SRT may be a predictor of balance performance. Longer reaction time and poorer postural stability were also associated with disease duration but not with age. CONCLUSIONS: Poor performance in a simple reaction task can predict altered PI and can complement staging and evaluation in PD patients.

Identifying perceptual, motor, and cognitive components contributing to slowness of information processing in multiple sclerosis with and without depressive symptoms

Increasing findings suggest that different components of the stimulus-response pathway (perceptual, motor or cognitive) may account for slowed performance in Multiple Sclerosis (MS). It has also been reported that depressive symptoms (DS) exacerbate slowness in MS. However, no prior studies have explored the independent and joint impact of MS and DS on each of these components in a comprehensive manner. The objective of this work was to identify perceptual, motor, and cognitive components contributing to slowness in MS patients with and without DS. The study includes 33 Relapsing-Remitting MS patients with DS, 33 without DS, and 26 healthy controls. Five information processing components were isolated by means of ANCOVA analyses applied to five Reaction Time tasks. Perceptual, motor, and visual search components were slowed down in MS, as revealed by ANCOVA comparisons between patients without DS, and controls. Moreover, the compounding effect of MS and DS exacerbated deficits in the motor component, and slowed down the decisional component, as revealed by ANCOVA comparisons between patients with and without DS. DS seem to exacerbate slowness caused by MS in specific processing components. Identifying the effects of having MS and of having both MS and DS may have relevant implications when targeting cognitive and mood interventions

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Melodic intonation therapy in post-stroke nonfluent aphasia: a randomized pilot trial.

OBJECTIVE:: To collect data to estimate the sample size of a definitive randomized controlled trial to evaluate the effects of Melodic Intonation Therapy in post-stroke nonfluent aphasia. DESIGN:: A randomized, crossover, interventional pilot trial. SETTING:: Departments of Neurology and Rehabilitation from a university general hospital. PARTICIPANTS:: Stroke survivors with post-stroke nonfluent aphasia. INTERVENTIONS:: Patients randomized to group 1 had treatment with Melodic Intonation Therapy first (12 sessions over six weeks) followed by no treatment; the patients in group 2 started active treatment between three and six months after their inclusion in the study, serving as waiting list controls for the first phase. MAIN MEASURES:: The Communicative Activity Log (CAL) questionnaire and the Boston Diagnostic Aphasia Examination (BDAE) were evaluated at baseline, and at six and 12 weeks. RESULTS:: Twenty patients were included. Four of the patients allocated to group 2 crossed over to group 1, receiving the treatment at first. Intention-to-treat analysis: after adjustment for baseline scores, the mean difference in the CAL evaluation from baseline in the treated group was 8.5 points (95% confidence interval (CI), 0.11-17.0; P = .043), with no significant change in any of the BDAE sections. Per-protocol analysis showed similar results with a clear treatment effect ( P = .043) on the CAL. CONCLUSION:: Melodic Intonation Therapy might have a positive effect on the communication skills of stroke survivors with nonfluent aphasia as measured by the CAL questionnaire. A full-scale trial with at least 27 patients per group is necessary to confirm these results.

Eficacia de la rehabilitación cognitiva de la atención, funciones ejecutivas y memoria operativa en los trastornos psicóticos. Revisión sistemática / Efficacy of cognitive rehabilitation of attention, executive functions, and working memory in psychotic disorders: A systematic review

Los déficits cognitivos se consideran una parte primaria de la esquizofrenia y se postula que puedan estar en la base de la enfermedad dado su carácter independiente, persistente y determinante en el pronóstico. Paralelamente al desarrollo de los estudios de investigación sobre los déficits cognitivos en los trastornos psicóticos, se han ido desarrollando estrategias de intervención para la rehabilitación cognitiva de estos pacientes. La atención, la memoria operativa y las funciones ejecutivas están entre las funciones más afectadas, y se encuentran íntimamente relacionadas con la funcionalidad de estos pacientes. El objetivo de este trabajo fue estudiar la eficacia de la rehabilitación cognitiva de la atención, funciones ejecutivas y memoria operativa en personas diagnosticadas de trastorno psicótico (principalmente la esquizofrenia). Para ello se realizó una búsqueda electrónica exhaustiva en las bases de datos PubMed y PsycINFO hasta enero de 2016 y se seleccionaron los artículos que estudiaban una técnica terapéutica orientada a la mejoría de una o varias de las funciones mencionadas, en pacientes mayores de 16 años diagnosticados de trastorno psicótico. Se seleccionaron estudios con diversidad metodológica que posteriormente se organizaron según su nivel de evidencia. Finalmente se estudiaron 34 artículos de los que se puede extraer que la rehabilitación de las funciones mencionadas produce mejorías a nivel cognitivo. En cuanto a su influencia sobre otras variables como el funcionamiento social y la sintomatología, los resultados son promisorios (AU)

Cognitive impairment is a core aspect of schizophrenia. Studies have postulated that it is the basis of the disease as evidenced by its independent and persistent quality and its relation to prognosis. Research on cognitive deficits in psychotic disorders has led to the development of intervention strategies for the cognitive rehabilitation of these patients. Attention, working memory, and executive functions are among the most widely affected functions and are closely related to the functionality of these patients. This work aims to study the effectiveness of cognitive rehabilitation targeting attention, executive functions, and working memory in people diagnosed with a psychotic disorder (mostly schizophrenia). An exhaustive search in PubMed and PsycINFO was conducted up to January 2016. All research papers that were included studied a therapeutic technique to improve one or more of the aforementioned functions in patients over age 16 years diagnosed with psychotic disorder. Studies with methodological diversity were included, which were afterwards organized by levels of evidence. Thirty-four papers were studied, from which we can conclude that cognitive rehabilitation of the aforementioned cognitive functions brings about improvements in cognition. As a result of the influence of cognitive rehabilitation on other variables such as social functioning and symptoms of the disease, the results are promising (AU)

Efficacy of cognitive rehabilitation of attention, executive functions, and working memory in psychotic disorders: A systematic review.

dies have postulated that it is the basis of the disease as evidenced by its independent and persistent quality and its relation to prognosis. Research on cognitive deficits in psychotic disorders has led to the development of intervention strategies for the cognitive rehabilitation of these patients. Attention, working memory, and executive functions are among the most widely affected functions and are closely related to the functionality of these patients. This work aims to study the effectiveness of cognitive rehabilitation targeting attention, executive functions, and working memory in people diagnosed with a psychotic disorder (mostly schizophrenia). An exhaustive search in PubMed and PsycINFO was conducted up to January 2016. All research papers that were included studied a therapeutic technique to improve one or more of the aforementioned functions in patients over age 16 years diagnosed with psychotic disorder. Studies with methodological diversity were included, which were afterwards organized by levels of evidence. Thirty-four papers were studied, from which we can conclude that cognitive rehabilitation of the aforementioned cognitive functions brings about improvements in cognition. As a result of the influence of cognitive rehabilitation on other variables such as social functioning and symptoms of the disease, the results are promising.

The contribution of depressive symptoms to slowness of information processing in relapsing remitting multiple sclerosis.

BACKGROUND: Slowness of information processing has been suggested as a fundamental factor modulating cognitive impairment in multiple sclerosis (MS). However, the contribution of depressive symptoms (DS) to slowness remains unclear. One of the most accepted hypotheses on the impact of depression on the general population suggests that depression interferes only with tasks requiring high cognitive demands. However, no studies have investigated if the same pattern occurs in MS. OBJECTIVE: The aim of this study was to determine the profile of the contribution of DS to slowness. METHODS: Four Reaction Time (RT) tasks requiring an increasing level of cognitive demands were administered to 35 relapsing remitting MS patients with DS, 33 MS patients without DS, 17 depressed non-MS patients and 27 controls. RESULTS: MS patients without DS obtained longer RTs than controls in all the tasks. On the contrary, depressed non-MS patients were slower than controls only in the most demanding task. Finally, MS patients with DS were slower than MS patients without DS not only in the most demanding task but also in the task requiring a lower level of cognitive demands. CONCLUSION: The contribution of DS to slowness depends on the level of cognitive demands. However, its impact on MS is more deleterious than on the general population.

Clinical Spanish norms of the Stroop Test for traumatic brain injury and schizophrenia

The Stroop Color-Word Test is a useful tool to evaluate executive attention and speed of processing. Recent studies have provided norms for different populations of healthy individuals to avoid misinterpretation of scores due to demographic and cultural differences. In addition, clinical norms may improve the assessment of cognitive dysfunction severity and its clinical course. Spanish normative data are provided for 158 closed traumatic brain injury (TBI) and 149 first-episode schizophrenia spectrum disorder (SCH) patients. A group of 285 Spanish healthy individuals (HC) was also considered for comparison purposes. Differences between groups were found in all Stroop scores with HC outperforming both clinical groups (p < .002 in all cases; d > .3 in all cases). TBI patients scored lower than SCH patients in wordreading (p < .001 and d = .6), and color-naming conditions (p < .001 and d = .4), but not in the color-word condition (p = .34 and d = .03). However, SCH patients exhibited a higher interference effect as compared to TBI (p < .002 and d = .5). Three sets of norms stratified by age and education (HC), and by education (TBI and SCH) are presented for clinical use (AU)

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Clinical Spanish norms of the Stroop test for traumatic brain injury and schizophrenia.

The Stroop Color-Word Test is a useful tool to evaluate executive attention and speed of processing. Recent studies have provided norms for different populations of healthy individuals to avoid misinterpretation of scores due to demographic and cultural differences. In addition, clinical norms may improve the assessment of cognitive dysfunction severity and its clinical course. Spanish normative data are provided for 158 closed traumatic brain injury (TBI) and 149 first-episode schizophrenia spectrum disorder (SCH) patients. A group of 285 Spanish healthy individuals (HC) was also considered for comparison purposes. Differences between groups were found in all Stroop scores with HC outperforming both clinical groups (p .3 in all cases). TBI patients scored lower than SCH patients in word-reading (p < .001 and d = .6), and color-naming conditions (p < .001 and d = .4), but not in the color-word condition (p = .34 and d = .03). However, SCH patients exhibited a higher interference effect as compared to TBI (p < .002 and d = .5). Three sets of norms stratified by age and education (HC), and by education (TBI and SCH) are presented for clinical use.

Velocidad de procesamiento en la esclerosis múltiple remitente recurrente: el papel de los síntomas depresivos / Processing speed in relapsing-remitting multiple sclerosis: the role played by the depressive symptoms

Introducción. La disminución de la velocidad de procesamiento parece ser una característica neuropsicológica prototípica en la esclerosis múltiple (EM). Sin embargo, el impacto de los frecuentes síntomas depresivos de estos pacientes sobre la velocidad de procesamiento aún no se ha definido con precisión, debido a algunas limitaciones metodológicas presentes en la mayoría de los estudios previos. Sujetos y métodos. Cuarenta y dos pacientes con EM remitente recurrente, 20 con síntomas depresivos (inventario de depresión de Beck > 13) y 22 sin ellos, fueron comparados con 24 controles sanos en tests neuropsicológicos de velocidad de procesamiento -Symbol Digit Modality Test (SDMT), test de Stroop, Trail Making Test (TMT) y Paced Auditory Serial Addition Test-batería neuropsicológica breve (PASAT-BNB)-. Resultados. Los pacientes con EM sin síntomas depresivos realizaron significativamente peor que los controles los tests de Stroop -palabra (P), color (C) y palabra-color (PC)- y PASAT-BNB (tiempo de ejecución), mientras que los pacientes con síntomas depresivos obtuvieron puntuaciones significativamente peores que los controles sanos en Stroop (P, C y PC), SDMT, TMT (A, B y B-A) y PASAT-BNB (tiempo de ejecución y errores). La ejecución de los pacientes con EM y síntomas depresivos fue significativamente peor que la de los pacientes sin síntomas depresivos en el SDMT, TMT (A, B y B-A) y PASAT-BNB (tiempo de ejecución). Conclusiones. El impacto de la enfermedad no se evidenció de forma generalizada en el rendimiento neuropsicológico de los pacientes con EM remitente recurrente. Los síntomas depresivos parecen desempeñar un papel importante en la determinación de los déficits de velocidad. Mientras que la EM redujo la velocidad de procesamiento, los síntomas depresivos en la EM se asociaron a un déficit específico en ciertos procesos cognitivos diferentes de los de velocidad (AU)

Introduction. Reduced speed of information processing seems to characterize neuropsychological performance in multiple sclerosis (MS) patients. However, the impact in speed of information processing of depressive symptoms, that are highly prevalent in this population, has not been precisely defined yet due to the presence of some methodological limitations in most preceding studies. Subjects and methods. 42 MS remittent recurrent patients, 20 with depressive symptoms (BDI > 13), and 22 without, were compared to 24 healthy controls in neuropsychological tasks of speed of processing (SDMT, Stroop, TMT y PASAT-BNB). Results. MS patients without depressive symptoms performed significantly worse than healthy controls the Stroop (W, C and WC), and the PASAT-BNB (execution time) tests. MS patients with depressive symptoms performed significantly worse than healthy controls the Stroop (W, C and WC), SDMT, TMT (A, B and B-A), and the PASAT-BNB (execution time and errors) tests. MS patients with depressive symptoms performed significantly worse than MS patients without depressive symptoms the SDMT, TMT (A, B and B-A), and the PASAT-BNB (execution time) tests. Conclusions. MS impact was not generalized in neuropsychological performance of patients. Depressive symptoms seem to play and important role determining the speed deficit. While MS reduced speed of information processing, depressive symptoms were associated to specific cognitive deficit different from speed ones (AU)