Journal of the International Neuropsychological Society最新文献

Background: The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.

Methods: Men in the Vietnam Era Twin Study of Aging (VETSA; n = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.

Results: Moderate-to-severe, but not mild, chronic pain intensity (β = -.10) and interference (β = -.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (HR = 1.75) and interference (HR = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (β = -.18) and a higher risk of amnestic MCI (HR = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all p-values > .05).

Discussion: Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.

Objective: Impairments in emotion recognition, a crucial component of social cognition, have been previously demonstrated in patients with behavioral variant frontotemporal dementia (bv-FTD) and Alzheimer's disease (AD). However, to date, it is unclear whether patients with early-stage vascular dementia (VaD) display deficient emotion recognition. We investigated profiles of impairments in emotion recognition and non-social cognitive functions, comparing VaD patients to bv-FTD and AD patients, and healthy control participants (HC).

Method: Eighty-one memory clinic patients with early-stage VaD (n = 30), bv-FTD (n = 21) and AD (n = 30), and 40 HCs were included and performed Ekman 60 Faces Test (EFT; emotion recognition), Auditory Verbal Learning Test (AVLT; memory - encoding and retrieval) and Trailmaking Test (TMT A, TMT B, TMT B/A; information processing speed, executive functions). Differences between groups were analyzed with analysis of variance (ANOVA), using age, education and sex adjusted norm Z scores.

Results: All patient groups performed significantly worse than HCs on EFT (p < .001). Mean performance of VaD patients was in between bv-FTD and AD (only bv-FTD < AD, p < .01). All patient groups were also impaired on AVLT encoding, TMT-B and TMT B/A. Social and non-social neurocognitive functions differed between groups, with specific impairments in processing speed in VaD, emotion recognition in bv-FTD and memory retrieval in AD, and memory encoding and cognitive control impaired in all three groups.

Conclusions: We found significantly different profiles in VaD, bv-FTD and AD. Assessing emotion recognition has additive value in the distinction between patient groups, allowing for more timely and accurate diagnosis in clinical practice.

Objective: Recent functional magnetic resonance imaging (fMRI) studies have shown that interpersonal synchronization of brain activity can be measured between people sharing similar emotional, narrative, or attentional states. There is evidence that odors can modulate the activity of brain regions involved in memory, emotion and social cognition, suggesting a link between shared olfactory experiences and synchronized brain activity in social contexts.

Method: We used fMRI to investigate the effects of a positively-valenced odor on inter-subject correlation (ISC) of brain activity in healthy volunteers watching movies. While being inside an MRI scanner, participants (N = 20) watched short movie clips to induce either positive (happiness, tenderness) or negative (sadness, fear) emotions. Two movie clips were presented for each emotional category. Participants were scanned in two separate randomized sessions, once while watching the movie clips in the presence of an odor, and once without.

Results: When all emotional categories were combined, the odor condition showed significantly higher ISC compared to the control condition in bilateral superior temporal gyri (STG), right middle temporal gyrus, left calcarine, and lingual gyrus. When splitting the movies according to valence, odor-induced increases in ISC were stronger for the negative movies. For the negative movies, ISC in the supramarginal gyrus and STG was larger in the second compared to first movie clips, indicating a time-by odor interaction.

Conclusion: These findings show that odor increases ISC and that its effects depend on emotional valence. Our results further emphasize the critical role of the STG in odor-based social communication.

Objective: Impairments in social interaction are common symptoms of dementia and necessitate the use of validated neuropsychological instruments to measure social cognition. We aim to investigate the Hinting Task - Dutch version (HT-NL), which measures the ability to infer intentions behind indirect speech to assess Theory of Mind, in dementia.

Method: Sixty-six patients with dementia, of whom 22 had behavioral variant frontotemporal dementia (bvFTD), 21 had primary progressive aphasia, and 23 had Alzheimer's disease (AD), and 99 healthy control participants were included. We examined the HT-NL's psychometric properties, including internal consistency, between-group differences using analyses of covariance with Bonferroni-adjusted post hoc comparisons, discriminative ability and concurrent validity using the area under the receiver operating characteristic curve (AUC), and construct validity using Spearman rank correlations with other cognitive tests.

Results: Internal consistency was acceptable (Cronbach's α = 0.74). All patient groups scored lower on the HT-NL than the control group. Patients with bvFTD scored lower than patients with AD dementia. The HT-NL showed excellent discriminative ability (AUC = 0.83), comparable to a test of emotion recognition (ΔAUC = 0.03, p = .67). The HT-NL correlated significantly with a test for emotion recognition (r = .45), and with measures of memory and language (r = [.31, .40]), but not with measures of information processing speed, executive functioning, or working memory (r = [.00, .17]). Preliminary normative data are provided.

Conclusions: The HT-NL is a psychometrically sound and valid instrument and is useful for identifying Theory of Mind impairments in patients with dementia.

Objective: Cognitive intra-individual variability (IIV) is a neuropsychological marker reflecting divergent performance across cognitive domains. In this brief communication, we examined whether clinical severity, apolipoprotein E (APOE) ε4 carriers, and higher polygenic risk were associated with higher cognitive IIV, and whether higher polygenic risk and cognitive IIV synergistically influence clinical severity.

Method: This large study involved up to 24,248 participants (mean age = 72) from the National Alzheimer's Coordinating Center (NACC) and multiple regression controlling for age, sex, and education was used to analyze the data.

Results: We found that disease severity (B = 0.055, SE = 0.001, P < 0.001), APOE ε4 carriers (B = 0.02, SE = 0.003, P < 0.001), and higher polygenic risk (B = 0.02, SE = 0.004, P < 0.001) were associated with higher cognitive IIV. Polygenic risk and cognitive IIV also interacted to influence clinical severity, beyond APOE ε4 (B = 0.11, SE = 0.05, P = 0.02), such that individuals with high polygenic risk and cognitive IIV had the greatest clinical severity.

Conclusions: Heightened polygenic risk and increased cross-domain cognitive variation are implicated in dementia and may impact clinical decline in tandem.

Objective: Diagnosing HIV-Associated Neurocognitive Disorders (HAND) requires attributing neurocognitive impairment and functional decline at least partly to HIV-related brain effects. Depressive symptom severity, whether attributable to HIV or not, may influence self-reported functioning. We examined longitudinal relationships among objective global cognition, depressive symptom severity, and self-reported everyday functioning in people with HIV (PWH).

Methods: Longitudinal data from 894 PWH were collected at a university-based research center (2002-2016). Participants completed self-report measures of everyday functioning to assess both dependence in instrumental activities of daily living (IADL) and subjective cognitive difficulties at each visit, along with depressive symptom severity (BDI-II). Multilevel modeling examined within- and between-person predictors of self-reported everyday functioning outcomes.

Results: Participants averaged 6 visits over 5 years. Multilevel regression showed a significant interaction between visit-specific global cognitive performance and mean depression symptom severity on likelihood of dependence in IADL (p = 0.04), such that within-person association between worse cognition and greater likelihood of IADL dependence was strongest among individuals with lower mean depressive symptom severity. In contrast, participants with higher mean depressive symptom severity had higher likelihoods of IADL dependence regardless of cognition. Multilevel modelling of subjective cognitive difficulties showed no significant interaction between global cognition and mean depressive symptom severity (p > 0.05).

Conclusions: The findings indicate a link between cognitive abilities and IADL dependence in PWH with low to moderate depressive symptoms. However, those with higher depressive symptoms severity report IADL dependence regardless of cognitive status. This is clinically significant because everyday functioning is measured through self-report rather than performance-based assessments.

Objective: The cognitive trajectory of aging individuals with childhood-onset epilepsy is poorly understood. Our aim was to examine cognitive change over a 7-year period in aging individuals with epilepsy, originally recruited for prospective follow up in the early 1960's.

Method: 36 participants with childhood-onset epilepsy from a prospective population-based cohort and 39 controls participated in the 50-year and 57-year follow-up data collections. Eight participants had active epilepsy, 28 were in remission. Eleven neuropsychological tests were used to measure language/semantic function, episodic memory and learning, executive function, visuomotor function, and working memory. Regression-based standardized change scores were used to control for sources of error in test-retest assessments.

Results: Participants with epilepsy lacked a test-retest effect in language functions. A significant decline was found in participants with active epilepsy in episodic memory functions overall, and in those with remitted epilepsy in learning, immediate recall and set-shifting. The risk of clinically significant general cognitive decline was higher in participants with active epilepsy (OR 61.25, 95% CI 5.92-633.81, p = .0006). Among those with remitted epilepsy the risk was lower and non-significant (OR 2.19, 95% CI 0.58-8.23, p = .24).

Conclusions: Our results demonstrate poorer cognitive trajectories in participants with childhood-onset epilepsy compared to controls, particularly in those with active epilepsy. The risk of general cognitive decline was lower in participants with remitted epilepsy, but a decline in episodic memory functions was observed. Our findings likely reflect faster brain aging in childhood-onset epilepsy, even in individuals with early remission.

Objective: To examine the relationship between children's adaptive functioning and neighborhood resources - such as school quality, access to healthy food, green spaces, and housing quality - using a large, diverse clinical outpatient sample.

Method: Pediatric outpatients (N = 6,942; age M = 10.44 years; 67.0% male; 50.3% White; 33.9% Medicaid), aged 1-18, who underwent neuropsychological or psychological evaluation were included if their caregiver completed the Adaptive Behavior Assessment System, 3rd Edition (ABAS-3) and had a nationally normed Child Opportunity Index (COI) score, a composite measure of 29 geo-coded neighborhood characteristics.

Results: Children from higher-opportunity neighborhoods demonstrated significantly stronger adaptive functioning across conceptual, social, and practical domains. Those in the top 40% of neighborhood advantage exhibited stronger adaptive skills than those in the bottom 60%. Neighborhood resources and family financial resources were associated with greater adaptive skills beyond child age, sex, and racial/ethnic background.

Conclusion: Neighborhood resources are linked to children's adaptive functioning, possibly due to increased opportunities to practice these skills in safer, more supportive environments. These findings emphasize the importance of considering environmental factors in assessing adaptive skills and highlight the need for public health investments and legislation related to community resources.

Objective: Despite advances in antiretroviral treatment (ART), human immunodeficiency virus (HIV) can detrimentally affect everyday functioning. Neurocognitive impairment (NCI) and current depression are common in people with HIV (PWH) and can contribute to poor functional outcomes, but potential synergies between the two conditions are less understood. Thus, the present study aimed to compare the independent and combined effects of NCI and depression on everyday functioning in PWH. We predicted worse functional outcomes with comorbid NCI and depression than either condition alone.

Methods: PWH enrolled at the UCSD HIV Neurobehavioral Research Program were assessed for neuropsychological performance, depression severity (≤minimal, mild, moderate, or severe; Beck Depression Inventory-II), and self-reported everyday functioning.

Results: Participants were 1,973 PWH (79% male; 66% racial/ethnic minority; Age: M = 48.6; Education: M = 13.0, 66% AIDS; 82% on ART; 42% with NCI; 35% BDI>13). ANCOVA models found effects of NCI and depression symptom severity on all functional outcomes (ps < .0001). With NCI and depression severity included in the same model, both remained significant (ps < .0001), although the effects of each were attenuated, and yielded better model fit parameters (i.e., lower AIC values) than models with only NCI or only depression.

Conclusions: Consistent with prior literature, NCI and depression had independent effects on everyday functioning in PWH. There was also evidence for combined effects of NCI and depression, such that their comorbidity had a greater impact on functioning than either alone. Our results have implications for informing future interventions to target common, comorbid NCI and depressed mood in PWH and thus reduce HIV-related health disparities.

Objective: This study aims to investigate action language processing abilities in Parkinson's disease (PD) compared to healthy controls (HCs), specifically examining whether the involvement of motor systems is influenced by task context. By focusing on implicit versus explicit task demands, the study evaluates how semantic processing differs in PD and whether these differences align with a flexible embodied cognition framework.

Methods: The study analyzed the performance of participants on two tasks: an explicit task (semantic judgment task, SJ) and an implicit task (letter detection task, LD). PD outpatients (n = 31, mean age 64.58 years) referred to the Parkinson and Movement Disorders Unit of ICS Maugeri Hermitage were enrolled, along with a group of healthy controls (n = 31, mean age 64.19 years). Performance was measured through reaction times (RTs) and accuracy scores (Acc) during the processing of action verbs and abstract verbs.

Results: PD patients exhibited slower RTs and lower accuracy when processing action verbs compared to abstract verbs, but only during the SJ task. Slower RTs in the SJ task were predicted by language and executive functioning (semantic fluency) and disease progression (Hoehn and Yahr stages) for both action and abstract verbs. In the LD task, slower RTs were predicted by executive functioning for action verbs and attention (measured by Trail Making Test Part B and Stroop task) for abstract verbs.

Conclusions: The findings suggest a context-dependent involvement of the motor system in action language processing, supporting a flexible, embodied approach to conceptual semantic processing rather than an automatic one.