Electroconvulsive therapy and cognitive performance from the Global ECT MRI Research Collaboration.

The Global ECT MRI Research Collaboration (GEMRIC) has collected clinical and neuroimaging data of patients treated with electroconvulsive therapy (ECT) from around the world. Results to date have focused on neuroimaging correlates of antidepressant response. GEMRIC sites have also collected longitudinal cognitive data. Here, we summarize the existing GEMRIC cognitive data and provide recommendations for prospective data collection for future ECT-imaging investigations. We describe the criteria for selection of cognitive measures for mega-analyses: Trail Making Test Parts A (TMT-A) and B (TMT-B), verbal fluency category (VFC), verbal fluency letter (VFL), and percent retention from verbal learning and memory tests. We performed longitudinal data analysis focused on the pre-/post-ECT assessments with healthy comparison (HC) subjects at similar timepoints and assessed associations between demographic and ECT parameters with cognitive changes. The study found an interaction between electrode placement and treatment number for VFC (F(1,107) = 4.14, p = 0.04). Higher treatment was associated with decreased VFC performance with right unilateral electrode placement. Percent retention showed a main effect for group, with post-hoc analysis indicating decreased cognitive performance among the HC group. However, there were no significant effects of group or group interactions observed for TMT-A, TMT-B, or VFL. We assessed the current GEMRIC cognitive data and acknowledge the limitations associated with this data set including the limited number of neuropsychological domains assessed. Aside from the VFC and treatment number relationship, we did not observe ECT-mediated neurocognitive effects in this investigation. We provide prospective cognitive recommendations for future ECT-imaging investigations focused on strong psychometrics and minimal burden to subjects.

Executive deficits after SARS-CoV-2 infection: A cross-sectional population study.

Importance: Despite the major implications of executive deficits in day-to-day functioning, few studies have investigated this in post-acute sequelae of SARS-CoV-2 infection using standardized measures that differentiate between aspects of executive function. Objective: Examine whether SARS-CoV-2 infection is associated with deficits in executive functions and if so, investigate the duration of this association. Design Setting and Participants: The present research has a cross-sectional design and uses data from the Norwegian Covid-19 Cohort study. The current cohort (n = 8102) completed the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A) electronically between April 2021 and September 2021. During the assessment, 4183 of the included participants had a prior positive polymerase chain reaction test (PCR) for SARS-CoV-2 and 3919 were untested or had a confirmed negative PCR test. Exposure: Laboratory-confirmed SARS-CoV-2 infection. Main outcomes and measures: Executive functions were measured using the BRIEF-A, a self-report questionnaire comprising 75 items within nine theoretically and empirically distinct clinical scales. All participants self-reported on demographical variables and comorbidity. Information on sex and age was derived from the personal identification number, and vaccination status was obtained from the Norwegian Immunization Registry (SYSVAK). Results: Participants with a positive SARS-CoV-2 status reported executive deficits in everyday life above the clinical threshold (T-score ≥65) more often than non-infected controls (383 vs. 225). Specifically, the SARS-CoV-2 positive status group indicated significantly more deficits related to metacognition, with the greatest difference demonstrated for working memory. This difference remained when adjusting for various demographic factors and comorbidities, with significantly greater odds of reporting above the clinical threshold following SARS-CoV-2 infection, as observed on the global executive composite score 6-12 months after infection (OR 1.97; 95% CI 1.51 to 2.55). Conclusions: Our study confirms more perceived executive deficits following SARS-CoV-2 infection compared to non-infected controls, with metacognitive aspects being the most affected. These findings shed light on the potential functional difficulties that individuals may encounter during the post-acute phase of SARS-CoV-2 infection and may guide further development of targeted interventions addressing metacognitive domains of executive functioning.

Spatial Orientation Assessment in the Elderly: A Comprehensive Review of Current Tests.

Spatial orientation and navigation are complex cognitive functions that integrate sensory information, attention, and memory, enabling individuals to locate themselves in their environment. These abilities decline with age, signaling cognitive impairment in neurological patients, and significantly limit the autonomy of the elderly. Current neuropsychological assessments fall short in accurately measuring everyday wayfinding abilities, particularly in borderline cases of cognitive decline. This paper reviews various neuropsychological assessments, including Benton's Judgment of Line Orientation Test, the Almeria Spatial Memory Recognition Test, the Spatial Span subtest from the Wechsler Memory Scale, and the Spatial Orientation in Immersive Virtual Environment Maze Test, evaluating their effectiveness in delineating spatial orientation and navigation skills. The review identifies significant gaps in the validity and reliability of these tests, particularly in their shortened versions, and highlights the potential of virtual reality environments as promising tools for improving diagnostic precision. The findings underscore the need for further research to refine these tools, ensuring they accurately capture cognitive decline and improve the differential diagnosis of neurodegenerative conditions like Alzheimer's disease. Such advancements hold promise for enhancing the quality of care and autonomy for the elderly.

Neuropsychological Characteristics and Quantitative Electroencephalography in Skogholt's Disease-A Rare Neurodegenerative Disease in a Norwegian Family.

Members of three generations of a Norwegian family (N = 9) with a rare demyelinating disease were studied. Neuropsychological testing was performed using the Mini Mental Status Examination (MMSE), Wechsler Intelligence Scale-III (WAIS-III), and Hopkins Verbal Learning Test-Revised (HVLT-R). EEGs were recorded with grand averaging spectrograms and event-related potentials (ERPs) in rest and cued GO/NOGO task conditions. The results were within the normal range on the MMSE. Full-scale WAIS-III results were in the range of 69-113, with lower scores in verbal understanding than in perceptual organization, and low scores also in indications of working memory and processing speed difficulties. The HVLT-R showed impairment of both immediate and delayed recall. Quantitative EEG showed an increase in low alpha (around 7.5 Hz) activity in the temporofrontal areas, mostly on the left side. There was a deviation in the late (>300 ms) component in response to the NOGO stimuli. A strong correlation (r = 0.78, p = 0.01) between the Hopkins Verbal Learning Test (delayed recall) and the amplitude of the NOGO ERP component was observed. The EEG spectra showed deviations from the healthy controls, especially at frontotemporal deviations. Deviations in the ERP component of the NOGO trials were related to delayed recall in the Hopkins Verbal learning test.

Mild Cognitive Impairment: Quantifying a Qualitative Disorder.

Mild cognitive impairment (MCI) has been described as a transitional state between normal aging and dementia, which can be both identified and tracked over time from qualitative and/or quantitative perspectives. Each definition of MCI involves some subjective cognitive complaint, some level of objective cognitive impairment, and generally intact daily functioning. Progression to dementia is common on follow-up in MCI, but stability and reversion to normal cognition can also occur. Quantitative methods might allow health care providers to evaluate and follow the subtle declines in MCI, as well as examine possible benefits of interventions with this at-risk condition.

Neuropsychology and Vascular Cognitive Impairment and Dementia.

Neuropsychology is an integral component of health care assessment for persons with vascular contributions to cognitive impairment and dementia. Since syndromes of vascular cognitive decline have multiple and varying pathophysiologies, anatomic brain locations, and levels of severity, neuropsychological assessment can be critical to clarify the cognitive manifestations of the disease, potential consequences for the patient and family, as well as the prognosis for future life planning. Cognitive profiles of vascular cognitive declines and relevant neuropsychological literature are reviewed here to provide the practicing physician with guidance for best clinical care practices.

Neuropsychology and Movement Disorders.

Neuropsychology is important in differential diagnosis, treatment planning, surgical work-up, and support of patients with movement disorders and their families. The cognitive profiles of several movement disorders are reviewed here. The authors also review relevant neuropsychologic literature related to neurosurgic intervention and cognitive-enhancing medication for patients with movement disorders.

Neuropsychology for Neurologists.

Clinical neuropsychology plays an important role in the evaluation and treatment of known or suspected neurocognitive dysfunction across the lifespan. The field has a rich history of research into the quantitative assessment and understanding of neurological functioning. The analysis of neurospychological profiles and consideration of quantitative, as well as qualitative features of cognitive performance allows for the determination of the presence, extent, and nature of neurocognitive deficits.

Epilepsy and Neuropsychology.

Neuropsychological evaluation is an essential component of clinical care for people with epilepsy and also has a specialized role in predicting cognitive outcome after epilepsy surgery. Neuropsychological research in the field of epilepsy has had a significant impact on our knowledge regarding memory and language systems, lateralization of cognitive functions, and the heterogeneity in cognitive phenotypes among people with epilepsy. Interventions that consider the impact of health disparities, cognition, psychological functioning, individual risk and resilience factors, and modifiable lifestyle factors, are critical for optimizing cognitive functioning, psychological health, and quality of life for people with epilepsy.

Traumatic Brain Injury.

Advances in trauma care have allowed persons with traumatic brain injury to survive at increasingly greater rates. However, they commonly go on to experience complex symptoms including changes in cognitive, emotional, and behavioral functioning that together limit functioning and quality of life. Clinical neuropsychology is uniquely skilled to work together with other rehabilitation professionals, using a patient centered approach, evidence-based treatments, and increasingly using emerging technology while adhering to ethical principles of respect, beneficence, and justice. Doing so will most effectively manage these changes, leading to the best possible quality of life and maximum improvement in functioning.

Validation of regression-based change formulae for mild cognitive impairment and Alzheimer's disease.

INTRODUCTION: Identification of cognitive decline is critical in older adults at risk for dementia. In a 2020 study reported in Archives of Clinical Neuropsychology, Kiselica and colleagues developed standardized regression-based (SRB) change formulae for the Uniform Data Set 3.0 Neuropsychological Battery in cognitively unimpaired older adults. However, validation of their applicability in impaired individuals is needed. METHODS: Using longitudinal data on 5974 participants (cognitively unimpaired, mild cognitive impairment, dementia) from the National Alzheimer's Coordinating Center, SRB change scores were calculated for each individual and compared across groups. RESULTS: Across 6 to 24 months, minimal cognitive change was observed in cognitively unimpaired participants. Modest declines were seen in those with mild cognitive impairment and substantial declines in those with dementia. Change scores were negatively correlated with the Clinical Dementia Rating scale. In impaired individuals, SRB scores indicated more decline in those with positive amyloid scans. DISCUSSION: Validation of SRB scores affords greater confidence in employing them in clinical and research settings. Highlights: Validation of regression-based cognitive change scores in impaired samples.Clear differences on change scores across three groups (intact, MCI, dementia).Largely stable scores in intact participants, but notable decline in MCI and dementia.Moderate to strong relationship between change scores and the Clinical Dementia Rating scale sum of boxes.

Reliability of the assessment of the clinical dementia rating scale from the analysis of medical records in comparison with the reference method.

BACKGROUND: The Clinical Dementia Rating (CDR) scale allows to detect the presence of dementia and to assess its severity, however its evaluation requires a significant time (45 min). We evaluated the agreement between two methods of collection of the CDR: face-to-face interview or based on the information available in the patient's medical record. METHODS: The CLIMER study was conducted among patients attending a memory center. The CDR scale was evaluated during face-to-face interviews between neuropsychologists and patients and their caregivers and based on blind analysis of the information of the patients' medical record by neuropsychologists. The agreement of the CDR sum of boxes (CDR-SB), the 5-point scale CDR and the different domains of the CDR evaluated between the different methods was measured using intraclass correlation (ICC) coefficient, Bland and Altman method, and linearly weighted Kappa. RESULTS: The study included 139 patients (means ± SD age 80.1 ± 6, 58.3% women, 71.9% with dementia). The ICC for the CDR-SB score assessed by face-to-face and with all the information available in the patient's medical record was 0.95 (95% CI: 0.93-0.97). The mean difference between the CDR-SB score assessed by face-to-face and with the medical record was 0.098 ± 1.036, and 92.4% of the patients lay within the 95% limits of agreement. The ICC for the 5-point scale CDR assessed by face-to-face and with the patient's medical record was 0.92 (95% CI: 0.88-0.95) when all the available information of the patient's medical record was used. The linear weighted Kappa coefficients was 0.79 (95% CI: 0.68-0.91) for the 5-point scale CDR comparison between the two evaluation methods. The analysis by domain of the CDR showed ICC ranging from 0.65 to 0.91 depending of the domains and the methods of evaluation. CONCLUSION: This study showed an excellent level of agreement of the evaluation of the CDR- SB and the 5-point scale CDR when using all the information of the patient's medical record compared to the face-to-face interview. TRIAL REGISTRATION: https//clinicaltrials.gov/ct2/show/NCT04763941 Registration Date 02/17/2021.

Exploring autonomic dysfunction in functional dysphonia: A protocol for a case-control study and a randomized controlled trial.

BACKGROUND: Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes. OBJECTIVES: The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender- and age-matched vocally healthy controls, using a case-control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT). METHODS: Case-control study: Autonomic (dys)function of patients with FD will be compared with gender- and age-matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient-reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase. EXPECTED RESULTS: Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre-ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self-report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. WHAT THIS PAPER ADDS: What is already known on the subject Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender- and age-matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work? Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence-based practice in the field of voice.

THE EFFECTS OF GLIBENCLAMIDE ON COGNITIVE PERFORMANCE, QUALITY OF LIFE, AND EMOTIONAL ASPECTS AMONG PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE: A RANDOMIZED CONTROLLED TRIAL.

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with a high incidence of long-term cognitive impairment, decreased quality of life (QoL), and psychiatric disorders. The effects of glibenclamide on such outcomes in the setting of aSAH is unknown. OBJECTIVE: To assess the impact of glibenclamide in patients with aSAH on cognitive performance, QoL, and emotional aspects. METHODS: Patients identified with aSAH were randomly allocated to receive 5mg of glibenclamide for 21 days or placebo, starting within 96 hours of the ictus. After six months, patients were evaluated with MoCA test (cognitive performance), SF-36 (QoL), and HADS and SPTSS (emotional aspects). RESULTS: The mean MoCA score was 22.5 ± 6.2. No statistically significant difference was found between groups, with a mean score of 21.7 ± 6.4 in the Glibeclamide group and 23.4 ± 6.2 in the placebo group (p=0.392). A score <23 was observed in 16 patients (35.6%) and its frequency was similar between groups (p=0.900). The most frequently impaired domains were Attention (N=21/45; 46.7%) and Visuospatial (18/45; 40.0%). Impairment of each domain was similar between groups (p>0.05). In each domain, the mean score was similar between groups (p>0.05). The HADS scores did not differ between groups (p>0.05). The mean SPTSS score as well as the mean scores of its domains were similar between groups (p>0.05). CONCLUSIONS: Glibenclamide did not improve cognitive performance, QoL, and emotional aspects after six months of follow-up of aSAH survivors.

Challenges in evaluating cognitive impairment in diabetics in the Democratic Republic of the Congo.

Dementia is a global public health issue, with 57.5 million people living with at least one type of dementia in 2019 worldwide, and projected to rise to 152 million by 2050. Objective: We assessed the cognitive function in diabetic patients aged 60 or older in Bukavu city, in the eastern Republic of the Congo (DRC). Methods: This case-control study involved 123 patients with established diabetes mellitus (DM) and 123 controls over 60-year-olds also with high rates of illiteracy. Cognitive function was assessed using the Swahili version of the Community Screening Instrument for Dementia (CSI-D). Results: Foremost, our study revealed language-related differences between Swahili spoken in other eastern African countries such as Tanzania and Kenya, where the Swahili CSI-D is readily applied, compared to the Swahili spoken in Bukavu (DRC). Our results also showed that cognitive impairment was present in 18.7% of the total 246 participants. Remarkably, the prevalence rate of cognitive impairment was higher in the non-diabetic group (12.2 versus 25.2%; p=0.009). Participants aged 80 or older were more likely to present with cognitive impairment compared to those aged less than 80 (adjusted odds ratio - aOR=70.27; 95% confidence interval - 95%CI 3.94-125.15; p=0.004). We also found that patients living with DM for more than 20 years were three times more likely to be impaired compared to those who were recently diagnosed with DM (aOR=3.63; 95%CI 1.70-18.81; p=0.026). Conclusion: This study revealed that cognitive impairment was relatively high in Bukavu city. It emphasizes the lack of effective tools to assess cognitive function. This requires, therefore, that research be adapted to the intellect and cultural experiences of the patients.

A demência é uma questão de saúde pública global, afetando 57,5 milhões de pessoas com pelo menos um tipo de demência em 2019 em todo o mundo, com uma previsão de aumento para 152 milhões até 2050. Objetivo: Avaliou-se a função cognitiva em pacientes diabéticos com 60 anos ou mais na cidade de Bukavu, no leste da República Democrática do Congo (RDC). Métodos: Este estudo de caso-controle incluiu 123 pacientes com diabetes mellitus (DM) estabelecido e 123 controles com mais de 60 anos, com altas taxas de analfabetismo. A função cognitiva foi avaliada utilizando a versão swahili do Instrumento de Triagem Comunitária para Demência (Community Screening Instrument for Dementia ­ CSI-D). Resultados: O presente estudo revelou diferenças relacionadas à linguagem entre o swahili falado em outros países do leste da África, como Tanzânia e Quênia, onde o CSI-D swahili é prontamente aplicado, em comparação com o swahili falado em Bukavu (RDC). Observou-se também deficiência cognitiva em 18,7% dos 246 participantes. Notadamente, a taxa de prevalência de deficiência cognitiva foi maior no grupo não diabético (12,2 versus 25,2%; p=0,009). Participantes com 80 anos ou mais tiveram maior probabilidade de apresentar deficiência cognitiva em comparação com aqueles com menos de 80 anos (odds ratios ajustados ­ aOR=70,27; intervalo de confiança de 95% ­ IC95% 3,94­125,15; p=0,004). Também observou-se que pacientes vivendo com DM por mais de 20 anos tinham três vezes mais chances de serem afetados em comparação com aqueles que foram recentemente diagnosticados com DM (aOR=3,63; IC95% 1,70­18,81; p=0,026). Conclusão: Este estudo revelou que a deficiência cognitiva era relativamente alta na cidade de Bukavu. Enfatizou-se a falta de ferramentas eficazes para avaliar a função cognitiva, o que requer, portanto, que a pesquisa seja adaptada ao intelecto e às experiências culturais dos pacientes.

Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis With Ambulatory Cognitive Tests: Protocol for the Longitudinal Observational CogDetect-MS Study.

BACKGROUND: Cognitive dysfunction is a common problem in multiple sclerosis (MS). Progress toward understanding and treating cognitive dysfunction is thwarted by the limitations of traditional cognitive tests, which demonstrate poor sensitivity and ecological validity. Ambulatory methods of assessing cognitive function in the lived environment may improve the detection of subtle changes in cognitive function and the identification of predictors of cognitive changes and downstream effects of cognitive change on other functional domains. OBJECTIVE: This paper describes the study design and protocol for the Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis (CogDetect-MS) study, a 2-year longitudinal observational study designed to examine short- and long-term changes in cognition, predictors of cognitive change, and effects of cognitive change on social and physical function in MS. METHODS: Participants-ambulatory adults with medically documented MS-are assessed over the course of 2 years on an annual basis (3 assessments: T1, T2, and T3). A comprehensive survey battery, in-laboratory cognitive and physical performance tests, and 14 days of ambulatory data collection are completed at each annual assessment. The 14-day ambulatory data collection includes continuous wrist-worn accelerometry (to measure daytime activity and sleep); ecological momentary assessments (real-time self-report) of somatic symptoms, mood, and contextual factors; and 2 brief, validated cognitive tests, administered by smartphone app 4 times per day. Our aim was to recruit 250 participants. To ensure standard test protocol administration, all examiners passed a rigorous examiner certification process. Planned analyses include (1) nonparametric 2-tailed t tests to compare in-person to ambulatory cognitive test scores; (2) mixed effects models to examine cognitive changes over time; (3) mixed effects multilevel models to evaluate whether ambulatory measures of physical activity, sleep, fatigue, pain, mood, and stress predict changes in objective or subjective measures of cognitive functioning; and (4) mixed effects multilevel models to examine whether ambulatory measures of cognitive functioning predict social and physical functioning over short (within-day) and long (over years) time frames. RESULTS: The study was funded in August 2021 and approved by the University of Michigan Medical Institutional Review Board on January 27, 2022. A total of 274 adults with MS (first participant enrolled on May 12, 2022) have been recruited and provided T1 data. Follow-up data collection will continue through March 2026. CONCLUSIONS: Results from the CogDetect-MS study will shed new light on the temporal dynamics of cognitive function, somatic and mood symptoms, sleep, physical activity, and physical and social function. These insights have the potential to improve our understanding of changes in cognitive function in MS and enable us to generate new interventions to maintain or improve cognitive function in those with MS. TRIAL REGISTRATION: ClinicalTrials.gov NCT05252195; https://clinicaltrials.gov/study/NCT05252195. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59876.

Finding Integration in a Splintered World: Contemporary Psychoanalytic Thoughts on Clinical Work.

Practitioners interested in the process of helping people change are confronted today with such a burgeoning array of perspectives, theories, and treatment modalities that even the most diligent can feel overwhelmed by the number of choices. This plethora of approaches calls into question whether there is anything that can tie them together. Asking if the psychoanalytic field is destined to be splintered into fragments that defy cohesion or if it is possible to generate a way of thinking and working that is more inclusive, this paper takes a historical and integrationist approach, grounded in a clinical focus on mental organization and Leo Rangell's total composite theory. It discusses trends in the development of psychoanalysis and argues for the importance of integration of the findings from neuropsychology and neuropsychoanalysis into psychoanalytic clinical work.

The neuropsychology of early childhood and infancy.

OBJECTIVES: Piaget's theory emphasizes the biological structures children utilize to make sense of their environment and based on those experiences become able to adapt. Many factors can intervene in the gradual and complex process of development, causing an array of issues both acute and chronic. METHOD: Several studies have found that disability in the early months is a strong predictor of cognitive impairment in preschool. The presence of early functional anomalies may represent developmental delay and/or neurodevelopmental disorders. RESULTS: Understanding the risk factors and detecting such signs early on is important to prevent or minimize later cognitive, behavioral, and psychosocial problems. The study aims to emphasize how critical the early years are to a child's future cognitive, physical, emotional, and social development as well as their overall well-being. DISCUSSION: In addition, the fact that crucial developmental stages can be hampered or obstructed by a variety of factors is highlighted.

Neuropsychological outcomes of patients with haematological malignancies undergoing chimeric antigen receptor T-cell therapy: protocol for a prospective study.

Introduction: Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common side-effect of chimeric antigen receptor T-cell (CAR-T) therapy, with symptoms ranging from mild to occasionally life-threatening. The neurological, cognitive, psychiatric and psychosocial sequelae of ICANS are diverse and not well defined, posing a challenge for diagnosis and management. The recovery trajectory of the syndrome is uncertain. Patients are rarely examined in this population pretherapy, adding a layer of complexity to specifying symptoms pertinent solely to CAR-T treatment. We present a protocol of a prospective longitudinal research study of adult patients in a single Australian haematology service undergoing CAR-T therapy. The study will describe neurocognitive features specific to ICANS, characterise the underlying syndrome, capture recovery, identify predictors of differential postinfusion outcomes and determine a set of cognitive instruments necessary to monitor patients acutely. Methods and analysis: This is a prospective longitudinal study that comprises neuropsychological and neurological examinations occurring prior to CAR-T, during the acute post-treatment period, 28 days, 6 months and 12 months post infusion. Data will be sourced from objective psychometric measures, clinical examinations, self-report questionnaires of psychopathology and accounts of subjective cognitive complaint. Ethics and dissemination: This study aims to guide diagnosis, management and monitoring of neurocognitive features of CAR-T cell therapy. Results of this study will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences. All procedures involving human subjects/patients were approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (21/145).

Cognitive outcomes following unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: findings from two cohorts.

Magnetic resonance-guided, focused ultrasound thalamotomy is a neurosurgical treatment for refractory essential tremor. This study examined cognitive outcomes following unilateral magnetic resonance-guided, focused ultrasound thalamotomy, targeting the ventral intermediate nucleus of the thalamus for essential tremor. The research was conducted at two sites: Sunnybrook Research Institute in Toronto, Canada, and West Virginia University School of Medicine Rockefeller Neuroscience Institute in West Virginia, USA. The study focused on cognitive changes at both the group and individual levels. Patients with refractory essential tremor completed cognitive testing before and after magnetic resonance-guided, focused ultrasound thalamotomy at both sites. The cognitive testing assessed domains of attention, processing speed, working memory, executive function, language and learning/memory. Postoperative changes in cognition were examined using paired t-tests and Wilcoxon signed-rank tests, as appropriate. Reliable change indices were calculated to assess clinically significant changes at the individual level. A total of 33 patients from Toronto and 22 patients from West Virginia were included. Following magnetic resonance-guided, focused ultrasound thalamotomy, there was a significant reduction in tremor severity in both cohorts. At the group level, there were no significant declines in postoperative cognitive performance in either cohort. The reliable change analyses revealed some variability at the individual level, with most patients maintaining stable performance or showing improvement. Taken together, the results from these two independent cohorts demonstrate that unilateral magnetic resonance-guided, focused ultrasound thalamotomy significantly reduces tremor severity without negatively impacting cognition at both the group and individual levels, highlighting the cognitive safety of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor.