Journal of clinical and experimental neuropsychology最新文献

Major neurocognitive disorder (MND) is a significant public health concern and a leading cause of disability and dependency among older adults. It is characterized by a chronic and acquired decline in cognitive functioning. For early detection, screening tools such as the Mini-Addenbrooke's Cognitive Examination (M-ACE)-a brief version of the Addenbrooke's Cognitive Examination-III (ACE-III)-have been proposed. This study analyzed data from 1164 adult participants from Antofagasta, Chile, including both the general population and individuals diagnosed with MND. Analyses included reliability estimation, factorial structure assessment using Confirmatory Factor Analysis (CFA), Item Response Theory (IRT) modeling, and diagnostic utility evaluation. Results indicate excellent reliability (McDonald's Omega = 0.926), a robust unidimensional factor structure, and good model fit under IRT. Differential item functioning (DIF) analysis revealed that performance on the clock-drawing item varied significantly according to educational level. Regarding diagnostic accuracy (AUC = 0.924), a cutoff score of ≤25/30 was proposed for the full sample, yielding 98% sensitivity. Consequently, alternative cutoffs stratified by educational level were also established to optimize performance. Findings support the M-ACE as a valid and reliable tool for cognitive screening and initial assessment of cognitive impairment in adults. The relevance of the clock-drawing task for assessing visuospatial abilities is also discussed.

Introduction: Information processing speed (IPS) is frequently impaired in people with multiple sclerosis (PwMS) and can potentially interfere with functioning in other cognitive domains. A relationship between IPS and visuospatial memory has been shown, but the impact of IPS on the separate components of visuospatial memory remains unclear. In this study, we aim to investigate the association between IPS impairment and encoding, active and passive retrieval, and learning indices of visuospatial memory in PwMS.

Methods: Cross-sectional data from 92 PwMS with cognitive complaints and 29 matched healthy controls (HCs) were retrospectively analyzed. IPS and visuospatial memory were measured using the Symbol Digit Modalities Test (SDMT) and the Brief Visuospatial Memory Test - Revised (BVMT-R), respectively. Hierarchical regression analyses were performed to assess the predictive value of IPS impairment (z-score ≤-1.5) for visuospatial encoding, active and passive retrieval, as well as learning indices scores.

Results: In total, 47.8% of PwMS were impaired on the SDMT. IPS impairment significantly predicted lower performance on the second (ß = -0.26, p = 0.011) and third (ß = -0.29, p = 0.003) learning trials, active retrieval (ß = -0.33, p < 0.001), and learning index (ß = -0.28, p = 0.003) of the BVMT-R in PwMS. No significant association was found between IPS impairment and the initial learning and passive retrieval scores. In HCs, no association between IPS and BVMT-R performance was found.

Conclusion: PwMS with IPS impairment perform worse on visuospatial learning and memory, particularly in the later encoding phases and active retrieval of information. These findings highlight the importance of taking IPS impairment into account when interpreting visuospatial memory performance in MS.

In this introduction to this special issue, we describe how rumination (habitual, negative, perseverative thought processes) plays a critical role in the experience of depression and anxiety, the cognitive decrements common to these disorders, and daily functioning. We argue that the traditional concept of depression as a functional disorder is limiting, given what is now known about brain processes underlying depression, in addition to the impact of psychological mechanisms like rumination on cognitive functioning. We go on to summarize the seven original empirical studies that compose this special issue. Together, these studies incorporate work across the lifespan and include multiple contexts and modalities in which depressive symptoms and rumination were meaningfully evaluated. We challenge researchers and clinicians alike to better understand the day-to-day cognitive implications and treatments for rumination. We conclude with recommendations for neuropsychologists in clinical practice that can be easily implemented to provide a better understanding of the role of rumination and other psychological mechanisms common to psychiatric disorders, including measures to include in a test battery and patient behaviors to look for. Ultimately, we hope that this issue can provide guidance for the treatment team, employers, educators, and family members affected by these conditions.

Introduction: Breast cancer patients undergoing adjuvant hormone therapy commonly report adverse effects that can lead to lower quality of life and treatment nonadherence. How hormone therapy, independent of other systemic therapies, may impact patient functioning is a relatively new area of research with few neuroimaging studies delineating the effects. Prior nonspecific neuropsychological findings and the multifaceted role of estrogen in the brain suggest potentially diffuse effects of hormone therapy. The current study examined intrinsic neural functional organization and cognitive correlates unique to breast cancer patients undergoing hormone therapy.

Method: Resting state functional magnetic resonance imaging was acquired from 24 breast cancer patients undergoing hormone therapy and 32 healthy controls. Resting-state functional connectivity (rsFC) was calculated between brain regions. Fractional amplitude of low frequency fluctuations (fALFF) was computed within a rsFC-derived mask to describe the regional properties within sites of dysconnectivity. Objective measures of cognition were obtained using neuropsychological tests and correlated with rsFC.

Results: Patients demonstrated extensive dysconnectivity relative to controls, largely characterized by parietal-occipital hypoconnectivity. Reduced rsFC occurred primarily between regions with increased fALFF. A modest relationship between rsFC and visual working memory was observed in breast cancer patients but not in controls.

Conclusions: This study is the first to examine whole-brain rsFC in breast cancer patients undergoing hormone therapy. We found robust hypoconnectivity in patients, which demonstrated modest relationships with cognition. Identifying the pattern by which breast cancer and hormone therapy affect brain networks may aid in the development of therapeutic options for patients experiencing negative effects of hormone therapy, thus improving quality of life for cancer survivors. Further, the detection of abnormal brain function may help characterize treatment-associated neural changes that are not captured by standard cognitive measures.

Introduction: Despite increasing recognition of pediatric acute-onset neuropsychiatric syndrome (PANS), its neuropsychological underpinnings remain limited, particularly in relation to obsessive-compulsive disorder (OCD) symptoms. PANS manifests abruptly with severe OCD and/or eating restrictions alongside concurrent neuropsychiatric symptoms, causing distress and functional impairment. This study aimed to examine the relationship between neurocognitive performance and OCD symptom severity in children and adolescents with PANS.

Method: Twelve children and adolescents with PANS were assessed on a total of 39 occasions using a novel touchscreen-based button-choice reaction time task. The task was designed to capture subtle aspects of attentional focus, motor precision, and response speed. Analyses examined associations between OCD symptom severity, assessed for each testing session, and performance measures.

Results: Greater OCD symptom severity was associated with heightened attentiveness (noticing the lit-up button) and more centered touch positioning, but not with faster reaction times. A significant interaction was observed, whereby increased attentiveness and precision in touch placement were linked to longer reaction times, suggesting a trade-off between speed and perfectionistic response strategies.

Conclusions: Overall, while OCD symptom severity was not directly associated with reaction time, it significantly shaped response monitoring and touch positioning. These findings indicate a neurocognitive profile in PANS characterized by heightened self-monitoring and meticulousness, potentially reflecting mechanisms underlying OCD symptomatology. Our findings highlight the complex interplay between neurocognitive performance and OCD symptom severity in PANS, as revealed through digital assessment, contributing to a deeper understanding of the condition.

Introduction: The Trail Making Test (TMT) is an important test when assessing for cognitive difficulties in people with Parkinson's Disease (PD). However, the pencil-and-paper format can be susceptible to administration and scoring errors and may disproportionately reflect motor impairments rather than cognitive performance. The current study sought to evaluate the reliability and diagnostic accuracy of two novel computerized versions of the TMT: iTMT-Tap and iTMT-Drag.

Method: This study used a quasi-experimental diagnostic accuracy design, and included 34 healthy controls, 28 people with Parkinson's disease with normal cognition (PD-NC), and 31 people with Parkinson's disease mild cognitive impairment (PD-MCI). Participants were administered a short battery of cognitive tests, including three counterbalanced versions of the TMT (traditional TMT, iTMT-Tap & iTMT-Drag). Additionally, the iTMT-Tap and iTMT-Drag were readministered following a brief break.

Results: Both the iTMT-Tap and iTMT-Drag demonstrated adequate convergent validity and retest reliability and achieved acceptable classification accuracy for identifying PD-MCI. The current study identified hidden indices of measurement which may minimize administration time or the confounding impact of motor functioning, and these indices achieved fair diagnostic accuracy also.

Conclusion: The results of this research suggest that the iTMT-Tap and iTMT-Drag may be a valid substitute for the traditional TMT, and subject to further validation, could be a useful addition to clinical practice. Recommendations for future research and subsequent clinical deployment are discussed.

Introduction: Understanding the risk factors that associate with early cognitive decline in Alzheimer's disease (AD) is important to identify high-risk individuals and initiate early intervention. Existing studies show that APOEε4, systemic inflammation, and diabetes may play roles in cognitive decline, but the extent to which these factors interact with each other remains unclear. Our objective was to examine the main effects and higher-order interactions between APOEε4, high sensitivity-C-reactive protein (hs-CRP) as a measure of systemic inflammation, and diabetes on domain-specific measures of cognitive function in two ancillary studies of post-menopausal women from the Women's Health Initiative (WHI).

Method: We identified 2979 cognitively unimpaired women from the WHI Epidemiology of Cognitive Health Outcomes and the WHI Memory Study of Younger Women with cognitive follow-up of up to 13 years. Linear mixed-effects models examined the main and interactive effects of APOEε4, hs-CRP, and diabetes on longitudinal changes in the personal communication for Cognitive Status-modified Test (TICS-m), East Boston Memory Test (immediate and delayed; EBMT), Oral Trail Making Test (OTMT), Verbal Fluency Test (VF-A), Digit Span Test Backwards (DST-backward), and the California Verbal Learning Test (CVLT). All models were adjusted for baseline age, education, body mass index, the WHI randomization arm, and the cohort.

Results: APOEε4 carriers had steeper cognitive decline in TICS-m, EBMT (immediate and delayed), VF-A, and CVLT scores relative to non-carriers. Higher levels of hs-CRP were associated with steeper cognitive decline in the DST-backwards scores. There was no association of diabetes or any evidence of interactive effects on cognitive decline in our study.

Conclusions: In this large longitudinal study of post-menopausal women, our findings support the hypothesis that genetic risk and systemic inflammation independently influence cognitive decline, but there was no evidence of synergistic effects in postmenopausal women. Further research is needed to elucidate the mechanistic pathways underlying these associations with cognitive decline.

Introduction: Early detection of cognitive decline is critical, yet commonly used screening tools may yield divergent results. This study examined the alignment of four widely used instruments in a community-dwelling cohort.

Method: Seventy-nine participants (M_age = 71.20, SD = 6.29; 39 male, 40 female) were recruited from the general community and assessed under standardized laboratory conditions. Participants completed the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-III (ACE-III), from which scores for the MoCA Memory Index Score (MoCA-MIS) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) were also calculated. Test agreement was examined using observed agreement and Cohen's kappa, and score relationships were evaluated using Pearson correlations.

Results: All but one test pair (M-ACE vs MoCA-MIS) showed strong score correlations. However, agreement between MoCA and ACE-III for classifying participants as below threshold was only fair. MoCA identified twice as many participants as impaired compared with ACE-III, raising the possibility of either greater sensitivity or higher false-positive classification. Overall, 41% of participants (n = 32) scored below threshold on at least one measure, but only 6% (n = 5) were below threshold across all four. Of four participants with a prior mild cognitive impairment (MCI) diagnosis, only one, who had more pronounced deficits, scored below threshold in all tests.

Conclusions: Despite strong inter-test correlations, substantial divergence in classification outcome was observed, particularly between MoCA and ACE-III. Reliance on a single screening instrument risks misclassification, with implications for both over- and under-diagnosis. Greater harmonization between screening tools is needed to improve diagnostic consistency. Clinical practice should therefore combine multiple-instrument approaches, potentially including premorbid function, and interpret screening test scores cautiously. Comprehensive neuropsychological assessment may provide a more complete picture, particularly in cases where diagnostic confidence is low, although this is not routine practice in all services.

Objective: Subjective cognitive decline (SCD) is an important yet heterogeneous indicator of mild cognitive impairment (MCI) and dementia. Sex and health-related disparities in risk are well established, but differences in prevalence and conversion rates from SCD to MCI/Dementia by risk factor remain unclear.

Method: This preregistered study followed PRISMA guidelines to conduct a systematic review with a narrative synthesis and meta-analyses. Random-effects meta-analyses calculated the relative risk (RR) of sex, depression, hypertension, and diabetes in conversion from SCD to MCI/dementia. Q and I² statistics investigated heterogeneity. Prevalence rates were also calculated.

Results: Five cross-cultural studies (N = 1136) were eligible for the meta-analyses. Participants, on average, had less than 12 years of education. Pooled analyses showed no significant differences in the RR of conversion for depression, hypertension, or diabetes. The pooled conversion rate of SCD to MCI was 17.2% and 8.7% to dementia. Evidence of heterogeneity suggested that the aggregated data may mask differences between studies; thus, unpublished conversion rates on comorbid SCD and the health conditions are reported to inform future research.

Conclusions: Relative risk estimates align with the greater literature and extend them to an inclusive cross-cultural sample with lower education. The significant heterogeneity found underscores the complexity of the interactions between cognitive decline and modifiable risk factors. This study provides novel conversion rates to MCI and dementia for individuals with comorbid SCD and depression, hypertension, and diabetes. We recommend that sex-stratified conversion rates are reported, as limited data prevented our meta-analysis from examining this important dimension of risk.

Prior research has shown a strong association between insomnia and affective symptoms including depressive and anxiety symptoms. Rumination, defined as repetitive negative thinking, impacts both insomnia and affective symptoms. However, relying solely on self-reported sleep measures, it remains unclear whether rumination and affective symptoms interact with their subjective-objective sleep discrepancy (SOSD) rather than perceived sleep duration per se. SOSD is defined as a mismatch between perceived and objectively measured total sleep time (TST). Negative SOSD (i.e. underestimating TST) is a phenotype of sleep disturbance that increases the risk of insomnia in daily life. Therefore, the cross-sectional study investigated whether trait anxiety and depression influence SOSD performance in the presence of rumination. We measured SOSD using sleep diaries and actigraphy over five days, and assessed subjective sleep quality, rumination, depression, and trait anxiety through self-reported surveys. We further classified 672 participants (20.66 ± 1.89 years old; 68.0% female) into three SOSD groups: underestimating (UE), correctly estimating (CE), and overestimating (OE) TST. The results showed that the CE and UE groups had similar rumination levels, whereas the OE group exhibited significantly lower rumination. We found no differences in depression or trait anxiety across SOSD groups. Linear regression models showed that greater rumination and affective symptoms significantly and separately predicted lower SOSD values, and females showed more underestimation TST compared to males. When rumination was included, neither depression nor anxiety uniquely predicted SOSD, regardless of sex, though each overall model remained significant. These findings suggest that depression and anxiety share overlapping explanatory variance with rumination in relation to SOSD outcomes among young adults and interventions targeting rumination and affective symptoms may hold promise for populations with negative SOSD, especially for females.