Neuropsychological Evaluation for Oncology.

Cognitive dysfunction is common in cancers and their treatments. Factors that can contribute to cognitive dysfunction include direct and indirect effects of cancer, surgery, radiation, systemic therapy, as well as comorbidities, fatigue, and mood disturbance. Using objective, validated measures, a neuropsychological evaluation can provide information regarding patterns of cognitive function. Emphasis of cognitive domains assessed may vary depending on disease and treatment history. Cognitive interventions can minimize the effects of cancer-related cognitive dysfunction on daily life.

Cognitive decline and political leadership.

The cognitive deterioration of politicians is a critical emerging issue. As professions including law and medicine develop and implement cognitive assessments, their insights may inform the proper strategy within politics. The aging, lifetime-appointed judiciary raises legal and administrative questions of such assessments, while testing of older physicians experiencing cognitive decline provides real-life examples of implementation. In politics, cognitive assessment must contend with the field's unique challenges, also taking context-dependent interpretations of cognitive-neuropsychological status into account. These perspectives, from legal and medical experts, political scientists, and officeholders, can contribute toward an equitable, functioning, and non-discriminatory system of assessing cognition that educates the public and enables politicians to maintain their public responsibilities. With proper implementation and sufficient public knowledge, we believe cognitive assessments for politicians, particularly political candidates, can be valuable for maintaining properly functioning governance. We offer recommendations on the development, implementation, and execution of such assessments, grappling with their democratic and legal implications.

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.

Neuropsychological Manifestations of Multiple Sclerosis.

This review article summarizes the literature on the cognitive impairment seen amongst people with multiple sclerosis (MS) and how that impairment can impact not only their lives but also how their care needs to be managed. Recommendations regarding screening and monitoring of cognitive issues are reviewed, as well as how common comorbidities can further impact cognition. The current literature with respect to treatment options is also summarized. Finally, the article reviews the literature on some special populations living with MS.

Leptin bioavailability and markers of brain atrophy and vascular injury in the middle age.

INTRODUCTION: We investigated the associations of leptin markers with cognitive function and magnetic resonance imaging (MRI) measures of brain atrophy and vascular injury in healthy middle-aged adults. METHODS: We included 2262 cognitively healthy participants from the Framingham Heart Study with neuropsychological evaluation; of these, 2028 also had available brain MRI. Concentrations of leptin, soluble leptin receptor (sOB-R), and their ratio (free leptin index [FLI]), indicating leptin bioavailability, were measured using enzyme-linked immunosorbent assays. Cognitive and MRI measures were derived using standardized protocols. RESULTS: Higher sOB-R was associated with lower fractional anisotropy (FA, ß = -0.114 ± 0.02, p < 0.001), and higher free water (FW, ß = 0.091 ± 0.022, p < 0.001) and peak-width skeletonized mean diffusivity (PSMD, ß = 0.078 ± 0.021, p < 0.001). Correspondingly, higher FLI was associated with higher FA (ß = 0.115 ± 0.027, p < 0.001) and lower FW (ß = -0.096 ± 0.029, p = 0.001) and PSMD (ß = -0.085 ± 0.028, p = 0.002). DISCUSSION: Higher leptin bioavailability was associated with better white matter (WM) integrity in healthy middle-aged adults, supporting the putative neuroprotective role of leptin in late-life dementia risk. HIGHLIGHTS: Higher leptin bioavailability was related to better preservation of white matter microstructure. Higher leptin bioavailability during midlife might confer protection against dementia. Potential benefits might be even stronger for individuals with visceral obesity. DTI measures might be sensitive surrogate markers of subclinical neuropathology.

Assessing the perception of emotional prosody in healthy ageing.

BACKGROUND: Emotional prosody is the reflection of emotion types such as happiness, sadness, fear and anger in the speaker's tone of voice. Accurately perceiving, interpreting and expressing emotional prosody is an inseparable part of successful communication and social interaction. There are few studies on emotional prosody, which is crucial for communication, and the results of these studies have inconsistent information regarding age and gender. AIMS: The primary aim of this study is to assess the perception of emotional prosody in healthy ageing. The other aim is to examine the effects of variables such as age, gender, language and neurocognitive capacity on the prediction of emotional prosody recognition skills. METHODS AND PROCEDURES: Sixty-nine participants between the ages of 18-75 were included in the study. Participants were grouped as the young group aged 18-35 (n = 26), the middle-aged group aged 36-55 (n = 24) and the elderly group aged 56-75 (n = 19). Perceptual emotional prosody test, motor response time test, and neuropsychological test batteries were administered to the participants. Participants were asked to recognise the emotion in the sentences played on the computer. Natural (neutral, containing neither positive nor negative emotion), happy, angry, surprised and panic emotions were evaluated with sentences composed of pseudoword stimuli. RESULTS AND OUTCOMES: It was observed that the elderly group performed worse in recognising angry, panic, natural and happy emotions and in total recognition, which gives the correct recognition performance in recognition of all emotions. There was no age-related difference in recognition of the emotion of surprise. The women were more successful in recognising angry, panic, happy and total emotions compared to men. Age and Motor Reaction Time Test scores were found to be significant predictors in the emotional response time regression model. Age, language, attention and gender variables were found to have a significant effect on the regression model created for the success of total recognition of emotions (p < 0.05). CONCLUSIONS AND IMPLICATIONS: This was a novel study in which emotional prosody was assessed in the elderly by eliminating lexical-semantic cues related to emotional prosody and associating emotional prosody results with neuropsychiatric tests. All our findings revealed the importance of age for the perception of emotional prosody. In addition, the effects of cognitive functions such as attention, which decline with age, were found to be important. Therefore, it should not be forgotten that many factors contribute to the success of recognising emotional prosody correctly. In this context, clinicians should consider variables such as cognitive health and education when assessing the perception of emotional prosody in elderly individuals. WHAT THIS PAPER ADDS: What is already known on the subject Most of the studies compare young and old groups, and these studies evaluate the perception of emotional prosody by using sentences formed by observing the speech sounds, syllables, words and grammar rules in the vocabulary of the language. It has been reported that the perception of emotional prosody is lower, mostly in the elderly group, but there is inconsistent information in terms of age and gender. What this paper adds to existing knowledge Perceptual Prosody Recognition was evaluated with an experimental design in which sentence structures consisting of lexemes were used as stimuli and neurocognitive tests were included, taking into account the phonological and syntactic rules of language. This study was a novel study in diagnosing emotional prosody in terms of comparing different age groups and determining the factors affecting multidimensional emotional prosody, including neuropsychiatric features. What are the clinical implications of this work? All our findings revealed the importance of age for the perception of emotional prosody. In addition, it was determined that the effects of cognitive functions such as attention were important with age.

Neurologic and Neuropsychological Outcomes for Treatment of Unruptured Middle Cerebral Artery Aneurysms: Standard Pterional Versus Minipterional Approach in a Retrospective Single-Center Analysis.

BACKGROUND: In accordance with technique advancement and minimal invasiveness surgical approaches, the minipterional has progressively replaced the standard pterional approach for treatment of unruptured middle cerebral artery (MCA) aneurysms. Nowadays, multimodal intraoperative resources including microDoppler and microflow probes, indocyanine green videoangiography, and neurophysiologic monitoring constitute a fundamental prerequisite for increasing the safety of the clipping procedure. Our study investigated and compared in a single-center experience the effect of the evolution of a minimally invasive and multimodal approach in unruptured MCA aneurysm surgery by measuring postoperative complication rate, recovery time, and long-term neuropsychological and functional outcomes. METHODS: One hundred and thirty-one patients who underwent surgical treatment for unruptured MCA aneurysms at our institution were evaluated retrospectively. Patients' clinical, radiologic, and surgical reports were collected. Cognitive evaluation and quality of life were assessed through validated tests in telephone interviews. Patients who met the inclusion criteria were divided into 2 groups: "PT (pterional)" and "MPT (minipterional)." RESULTS: Ninety-two patients were included in the analysis. A significant reduction of postoperative complication rates and new-onset postoperative seizures was recorded in the MPT group (P value = 0.006). Severe cognitive deficits were lower in the MPT group, although without a clear statistical correlation. CONCLUSIONS: Decreased complication rates, faster recovery time, and a trend toward better cognitive and functional performances were documented for the MPT group of patients. In our experience, the minipterional approach with multimodality-assisted microsurgery reduced neurologic complications and recovery time and improved long-term cognitive outcome and quality of life.

Carotid-femoral pulse wave velocity score, an estimator of cognitive performance in the elderly: results from the Toledo Study for Healthy Aging.

Ageing-related changes in the vascular wall influence the function of different organs; for this reason, we assessed how arterial stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) modulates: the basal cognitive performance and the change in cognitive performance over the follow-up time. We developed a prospective, population-based cohort study with 1581 participants aged > 65 years were obtained from the Toledo Study for Healthy Aging. Participants from the second wave (2011-2013) were selected for the cross-sectional analysis. Those who also performed the cognitive assessment in the third wave (2015-2017) were selected for the prospective analysis. Arterial stiffness was evaluated by cf-PWV. Multivariate segmented regression models were used to evaluate the association between cf-PWV scores and basal neuropsychological evaluation scores and change of neuropsychological evaluation scores along follow-up. Cross-sectional analysis showed that as cf-PWV grew within the cf-PWV (5- < 10) category an improvement was observed in 7-min test, free short-term memory, and hole peg test. Furthermore, in the cf-PWV (> 13-18) category a decrease was observed in total short-term memory, free long-term memory, and total long-term memory. Prospective analysis showed a progressive worsening of cognitive function as cf-PWV increases within the cf-PWV (> 13-18) category in 7-min test, object denomination, immediate and short-term memory, and hole peg test, while in the cf-PWV (5- < 10) category, there was observed a decrease in Cumulative Executive Dysfunction Index score and short-term memory. In conclusion, a higher cf-PWV score is associated with worse cognitive performance, and with a worse evolution, reinforcing the need to plan interventions to delay arterial stiffness and its consequences.

A scoping review of neuropsychological assessment for Asian Indians in the United States - research and clinical recommendations.

Objective: There is an increasing focus on understanding health disparities among various cultural groups in the United States. The need for heterogeneity in norms and test stimuli across ethnically diverse individuals are being increasingly recognized. However, to date it remains unknown whether and to what extent differences in cognitive norms and tests exist in Asian Indians, a fast-growing population in the U.S. It is essential to understand these differences to improve diagnostic accuracy and provide timely and appropriate clinical care. Method: In this study, we conducted a scoping review of available cognitive tests that were normed, developed, or adapted for Asian Indians living in the U.S. Results: The results suggested a paucity of norms and tests specifically examining cognition in this community. Conclusions: Based on the findings, we provide suggestions for research directions focusing on the development of culturally sensitive neuropsychological tools, normative data representative of this demographic, and interventions addressing healthcare access barriers. Overall, this review provides readers with relevant clinical information to immediately enhance patient care as well as provide actionable items in research to improve the future utility of neuropsychology for Asian Indians in the United States.

The neuropsychological evaluation of face identity recognition.

Facial identity recognition (FIR) is arguably the ultimate form of recognition for the adult human brain. Even if the term prosopagnosia is reserved for exceptionally rare brain-damaged cases with a category-specific abrupt loss of FIR at adulthood, subjective and objective impairments or difficulties of FIR are common in the neuropsychological population. Here we provide a critical overview of the evaluation of FIR both for clinicians and researchers in neuropsychology. FIR impairments occur following many causes that should be identified objectively by both general and specific, behavioral and neural examinations. We refute the commonly used dissociation between perceptual and memory deficits/tests for FIR, since even a task involving the discrimination of unfamiliar face images presented side-by-side relies on cortical memories of faces in the right-lateralized ventral occipito-temporal cortex. Another frequently encountered confusion is between specific deficits of the FIR function and a more general impairment of semantic memory (of people), the latter being most often encountered following anterior temporal lobe damage. Many computerized tests aimed at evaluating FIR have appeared over the last two decades, as reviewed here. However, despite undeniable strengths, they often suffer from ecological limitations, difficulties of instruction, as well as a lack of consideration for processing speed and qualitative information. Taking into account these issues, a recently developed behavioral test with natural images manipulating face familiarity, stimulus inversion, and correct response times as a key variable appears promising. The measurement of electroencephalographic (EEG) activity in the frequency domain from fast periodic visual stimulation also appears as a particularly promising tool to complete and enhance the neuropsychological assessment of FIR.