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The Cognitive Change Index (CCI-20) is a validated questionnaire that assesses subjective cognitive complaints (SCCs) across memory, language, and executive domains. We aimed to: (a) examine the internal consistency and construct validity of the CCI-20 in patients with movement disorders and (b) learn how the CCI-20 corresponds to objective neuropsychological and mood performance in individuals with Parkinson’s disease (PD) or essential tremor (ET) seeking deep brain stimulation (DBS).
216 participants (N = 149 PD; N = 67 ET) underwent neuropsychological evaluation and received the CCI-20. The proposed domains of the CCI-20 were examined via confirmatory (CFA) and exploratory (EFA) factor analyses. Hierarchical regressions were used to assess the relationship among subjective cognitive complaints, neuropsychological performance and mood symptoms.
PD and ET groups were similar across neuropsychological, mood, and CCI-20 scores and were combined into one group who was well educated (m = 15.01 ± 2.92), in their mid-60’s (m = 67.72 ± 9.33), predominantly male (63%), and non-Hispanic White (93.6%). Previously proposed 3-domain CCI-20 model failed to achieve adequate fit. Subsequent EFA revealed two CCI-20 factors: memory and non-memory (p < 0.001; CFI = 0.924). Regressions indicated apathy and depressive symptoms were associated with greater memory and total cognitive complaints, while poor executive function and anxiety were associated with more non-memory complaints.
Two distinct dimensions were identified in the CCI-20: memory and non-memory complaints. Non-memory complaints were indicative of worse executive function, consistent with PD and ET cognitive profiles. Mood significantly contributed to all CCI-20 dimensions. Future studies should explore the utility of SCCs in predicting cognitive decline in these populations.
In recent years, there has been a growing recognition that health equity and health inequalities should be a consideration in all aspects of research. Since the Commission on Social Determinants of Health by the World Health Organization was established in 2005, there has been a growing interest in tackling systemic differences in health outcomes, including expanding the scope to health research including evidence synthesis and health technology assessments (HTA). This analysis aims to identify health inequality and health inequity frameworks that exist to help structure and plan research methods in evidence synthesis.
A critical analysis of the existing frameworks used in evidence synthesis to address health inequality and/or inequity was undertaken. Comprehensive, systematic searching of seven social science electronic databases and grey literature was undertaken based on the Behavior/phenomenon of interest, Health context and Model/Theory (BeHEMoTh) model, from 1990 to May 2022 to identify all relevant studies. A narrative synthesis approach was used to critically appraise the existing frameworks.
Sixty-two reviews published between 2008 and 2022 reporting on using a framework to stratify health opportunities and outcomes met the inclusion criteria. Frameworks identified included the PROGRESS (place of residence, race or ethnicity, occupation, gender, religion, educational level, socioeconomic status, and social capital), PROGRESS-Plus (plus age, disability and sexual orientation) and Preferred Reporting Items for Systematic Reviews and Mata Analysis (PRISMA) – Equity checklist.
Currently, there does not seem to be consensus in how evidence of inequality or inequity in evidence synthesis or HTA are reported. As research interests in health inequality and inequity continue to grow, there is a need to develop a framework that provides an in-depth understanding of how inequalities in health and inequities in health should be considered within evidence synthesis and HTA. This will allow researchers to analyze not just the effects of interventions, but also how healthcare outcomes are impacted by inequalities or inequities.
On March 11, 2020, the World Health Organization declared an outbreak of a new viral entity, coronavirus 2019 (COVID-19), to be a worldwide pandemic. The characteristics of this virus, as well as its short- and long-term implications, are not yet well understood. The objective of the current paper was to provide a critical review of the emerging literature on COVID-19 and its implications for neurological, neuropsychiatric, and cognitive functioning.
A critical review of recently published empirical research, case studies, and reviews pertaining to central nervous system (CNS) complications of COVID-19 was conducted by searching PubMed, PubMed Central, Google Scholar, and bioRxiv.
After considering the available literature, areas thought to be most pertinent to clinical and research neuropsychologists, including CNS manifestations, neurologic symptoms/syndromes, neuroimaging, and potential long-term implications of COVID-19 infection, were reviewed.
Once thought to be merely a respiratory virus, the scientific and medical communities have realized COVID-19 to have broader effects on renal, vascular, and neurological body systems. The question of cognitive deficits is not yet well studied, but neuropsychologists will undoubtedly play an important role in the years to come.
Objectives: Both depression and apathy, alone and in combination, have been shown to negatively affect cognition in patients with Parkinson’s disease (PD). However, the influence of specific symptom dimensions of depression and apathy on cognition is not well understood. The current study investigated the relationship between symptom dimensions of depression and apathy, based on factors identified in Kirsch-Darrow et al. (2011), and memory and executive function in PD. Methods: A sample of 138 non-demented individuals with PD (mean age=64.51±7.43 years) underwent neuropsychological testing and completed the Beck Depression Inventory, 2nd Edition, and Apathy Scale. Separate hierarchical regression models examined the relationship between symptom dimensions of depression and apathy (“pure” depressive symptoms, “pure” apathy, loss of interest/pleasure [anhedonia], and somatic symptoms) and three cognitive domain composites: immediate verbal memory, delayed verbal memory, and executive function. Results: After adjusting for general cognitive status and the influence of the other symptom dimensions, “pure” depressive symptoms were negatively associated with the delayed verbal memory composite (p<.034) and somatic symptoms were positively associated with the executive function composite (p<.026). No symptom dimensions were significantly related to the immediate verbal memory composite. Conclusions: Findings suggest that specific mood symptoms are associated with delayed verbal memory and executive function performance in non-demented patients with PD. Further research is needed to better understand possible mechanisms through which specific symptom dimensions of depression and apathy are associated with cognition in PD. (JINS, 2018, 24, 269–282)
Objectives: This study examined whether individuals with Parkinson’s disease (PD) are at increased vulnerability for vascular-related cognitive impairment relative to controls. The underlying assumption behind this hypothesis relates to brain reserve and that both PD and vascular risk factors impair similar fronto-executive cognitive systems. Methods: The sample included 67 PD patients and 61 older controls (total N=128). Participants completed neuropsychological measures of executive functioning, processing speed, verbal delayed recall/memory, language, and auditory attention. Cardiovascular risk was assessed with the Framingham Cardiovascular Risk index. Participants underwent brain imaging (T1 and T2 FLAIR). Trained raters measured total and regional leukoaraiosis (periventricular, deep subcortical, and infracortical). Results: Hierarchical regressions revealed that more severe cardiovascular risk was related to worse executive functioning, processing speed, and delayed verbal recall in both Parkinson patients and controls. More severe cardiovascular risk was related to worse language functioning in the PD group, but not controls. In contrast, leukoaraiosis related to both cardiovascular risk and executive functioning for controls, but not the PD group. Conclusions: Overall, results revealed that PD and cardiovascular risk factors are independent risk factors for cognitive impairment. Generally, the influence of cardiovascular risk factors on cognition is similar in PD patients and controls. (JINS, 2017, 23, 322–331)
Objectives: Parkinson’s disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. Methods: This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. Results: Depressive symptoms increased only in the control group (p<.02). Executive function improved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (p<.02). Conclusions: Aerobic exercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878–889)
The objective of this study was to test the hypothesis that apathy and depression are dissociable in Parkinson disease (PD) by conducting a confirmatory factor analysis (CFA) of items from two commonly used mood scales. A total of 161 non-demented PD patients (age = 64.1; ± 8.4 years) were administered the Apathy Scale and the Beck Depression Inventory-II. Items were hypothesized to load onto four factors: (1) an apathy factor representing loss of motivation, (2) dysphoric mood factor representing sadness and negativity, (3) loss of interest/pleasure factor representing the features common to both apathy and depression, and (4) a somatic factor representing bodily complaints. Results indicated a good fit for the overall CFA model, χ2 (128, N = 146) = 194.9; p<.01. RMSEA was .060 (p = .16). The four-factor model was significantly better than all alternative nested models at p < .001, including an overarching single factor model, representing “depression.” Results support the concept that apathy and depression are discrete constructs. We suggest a “factor based” scoring of the Apathy Scale and Beck Depression Inventory-II that disentangles symptoms related to apathy, depression, overlapping symptoms, and somatic complaints. Such scoring may be important in providing useful information regarding differential treatment options. (JINS, 2011, 17, 1058–1066)
In humans, the neural circuitry underlying facial expressions differs,
depending on whether facial expressions are spontaneously (i.e., limbic,
subcortical) or voluntarily initiated (i.e., frontal cortex). Previous
investigators have suggested that the “masked face” of
Parkinson's disease involves spontaneous, but not intentional, facial
expressions. In contrast, we hypothesized that intentional facial
expressions may be slowed (bradykinetic) and involve less movement, in
much the same way that other intentional movements are affected by
Parkinson's disease. To test this hypothesis, we used sophisticated
computer imaging techniques to quantify dynamic facial movement. Relative
to controls, Parkinson patients had reduced facial movement (entropy) and
were significantly slowed in reaching a peak expression (i.e.,
bradykinesia). These findings are consistent with the view that the basal
ganglia play a role in affecting intentional facial movements. This
possibly occurs because of diminished efficiency and/or activation of
face representation areas in the frontal cortical regions (i.e., motor,
premotor, and supplementary motor area) or because of movement-based
suppression secondary to dopaminergic reduction in frontostriatal
pathways. Taken together, the characterization of Parkinson's disease
as a model system for the neuroanatomic dissociation between voluntary and
spontaneous expressions may be unjustified. (JINS, 2006,
Covariance structure analyses of a core neuropsychological test
battery consisting of the Wechsler Adult Intelligence Scale–Revised,
Wechsler Memory Scale–Revised, and Auditory Verbal Learning Test
have previously identified a 5-factor model in a sample of cognitively
normal White volunteers from Mayo's Older Americans Normative Studies
(MOANS). The present study sought to replicate this factor structure in a
sample of 289 cognitively normal, community-dwelling African American
elders from Mayo's Older African Americans Normative Studies
(MOAANS). The original 5-factor model was tested against 2 alternative
4-factor models and a 6-factor model generated on a substantive basis.
Confirmatory factor analysis supported the construct validity of this core
battery in older African Americans by replicating the original 5-factor
model of Verbal Comprehension, Perceptual Organization,
Attention/Concentration, Learning, and Retention as viable in the
present sample. (JINS, 2005, 11, 184–191.)
Multiple studies have explored the relationship between MRI-based
volumetric measurements of the hippocampus and amygdala, the degree of
volumetric asymmetry of these structures, and symptom manifestation.
However, considerable variability exists with regard to the reported
volumetric values of these structures. The present study employed
meta-analytic procedures to provide a systematic analysis of the normal
population parameters of hippocampal and amygdala volumetric asymmetry
as well as the absolute intrahemispheric volumes of these structures in
normal adults. A literature review of studies published between 1990
and 2002 resulted in a representative sample of 82 studies (N
= 3,564 participants) providing volumetric information of the
hippocampus and 51 studies (N = 2,000 participants) providing
volumetric information of the amygdala. Results revealed that both the
hippocampus and the amygdala are reliably asymmetrical structures in
normal adults, with larger right hippocampal (D = 0.21,
p < .001) and right amygdala (D = 0.09, p
< .01) volumes. Additional analyses indicated that differences in
MRI magnet field strength and slice thickness values might
differentially contribute to volumetric asymmetry estimates. These
results expand on previous volumetric normative studies and may be
relevant to investigators studying the clinical correlates of
hippocampal and amygdala volumes. (JINS, 2004, 10,
Deficits in visual-spatial ability can be associated with
Parkinson's disease (PD), and there are several possible reasons
for these deficits. Dysfunction in frontal–striatal and/or
frontal–parietal systems, associated with dopamine deficiency,
might disrupt cognitive processes either supporting (e.g., working
memory) or subserving visual-spatial computations. The goal of this
study was to assess visual–spatial orientation ability in
individuals with PD using the Mental Rotations Test (MRT), along with
other measures of cognitive function. Non-demented men with PD were
significantly less accurate on this test than matched control men. In
contrast, women with PD performed similarly to matched control women,
but both groups of women did not perform much better than chance.
Further, mental rotation accuracy in men correlated with their
executive skills involving mental processing and psychomotor speed. In
women with PD, however, mental rotation accuracy correlated negatively
with verbal memory, indicating that higher mental rotation performance
was associated with lower ability in verbal memory. These results
indicate that PD is associated with visual–spatial orientation
deficits in men. Women with PD and control women both performed poorly
on the MRT, possibly reflecting a floor effect. Although men and women
with PD appear to engage different cognitive processes in this task,
the reason for the sex difference remains to be elucidated.
(JINS, 2003, 9, 1078–1087.)
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