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The Brief Cognitive Status Exam (BCSE) is a new, optional subtest of the Wechsler Memory Scale-IV (WMS-IV) developed for rapid detection of cognitive deficits. We examined the clinical validation of the Dutch version of the BCSE in older adults with mild cognitive impairment (MCI) or dementia, comparing it to the Mini-Mental State Examination (MMSE).
BCSE and MMSE were administered in 39 older adults with MCI, 51 with dementia and 96 matched healthy controls.
Our results show that the BCSE is a valid screening instrument, with psychometric properties similar to the widely used MMSE. High correlations were found between the BCSE and MMSE (r = 0.79, n = 183, p < 0.001). Furthermore, a BCSE cut-off score ≤ 42 revealed a sensitivity of 96% a specificity of 92%, a positive predictive value of 86% and a negative predictive value of 97%, whereas the MMSE cut-off score of ≤ 24 showed values of 84%, 96%, 91%, and 92%, respectively. Sensitivity, specificity, positive and negative predictive values to detect MCI compared to controls was 81%, 80%, 61%, and 92%, respectively, on the BCSE, with a cut-off score of ≤ 46, and 84%, 76%, 57%, and 92%, respectively, on the MMSE, with a cut-off score of ≤ 27.
The Dutch version of the BCSE is a clinically valid screening instrument for the detection of cognitive impairment in patients with dementia. Nevertheless, for distinguishing older adults with MCI from healthy controls both the BCSE and MMSE have limitations.
Emotion perception may be impaired after stroke. No study on emotion perception after stroke has taken the influence of post-stroke depressive symptoms into account, although depressive symptoms themselves may hamper emotion perception.
To compare the perception of emotional facial expressions in stroke patients with and without depressive symptoms.
Twenty-two stroke patients participated whose depressive symptoms were classified using the Montgomery-Åsberg Depression Rating Scale (cutoff = 10) and who were compared with healthy controls. Emotion recognition was measured using morphed images of facial expressions.
Patients with depressive symptoms performed worse than controls on all emotions; patients without depressive symptoms performed at control level. Patients with depressive symptoms were less sensitive to the emotions anger, happiness and sadness compared with patients without depressive symptoms.
Post-stroke depressive symptoms impair emotion perception. This extends findings in bipolar disorder indicating that emotion perception deficits are strongly related to the level of depression.
Oosterman JM, de Goede M, Wester AJ, van Zandvoort MJE, Kessels RPC. Perspective taking in Korsakoff's syndrome: the role of executive functioning and task complexity.
Objective: The ability to make inferences about knowledge, thoughts and feelings of others, i.e. perspective taking, is a key element of social cognition. Clinical observations indicate that Korsakoff patients may have impairments in social cognition, but studies are scarce. Also, executive dysfunction is present in Korsakoff patients, which may hamper perspective taking directly.
Methods: Twenty-three patients with Korsakoff's syndrome and 15 healthy matched controls were examined on a story comprehension task, in which inferences had to be made that either relied on perspective taking or not. The effects of task complexity were taken into account and executive function was assessed using an extensive neuropsychological test battery.
Results: The performance of Korsakoff patients declined with increasing complexity, but the pattern of decline for perspective-taking and non-perspective-taking stories was similar compared to that of the control group. Furthermore, the performance decline with increasing task complexity was directly related to the overall decline in executive functioning.
Conclusion: Executive dysfunction, not deficits in perspective taking per se, appears to underlie difficulties in story comprehension in patients with Korsakoff's syndrome.
Objective: Alexithymia refers to an ineffective regulation and expression of emotions. It constitutes a major risk factor for a range of medical and psychiatric problems, including chronic pain, somatisation, anxiety and depression. Alexithymia is a multi-faceted concept, described in terms of cognitive and affective aspects. From a neuropsychological perspective, alexithymia can be defined as a disturbance in affective information processing and social cognition. As the growing literature on brain structures involved in alexithymia is fragmented and sometimes even contradictory, the aim of this article was to review findings on neural substrates with regard to their convergence.
Methods: A narrative review was performed, including both early neuropsychological and more recent imaging studies, in order to achieve a better understanding of the aetiology of alexithymia.
Results: Corpus callosum, cingulate cortex and insula are clearly involved in alexithymia. The amygdala and the orbitofrontal part of the cortex appear to be implicated as mediators, because of their broader involvement in emotional processing and executive control.
Conclusion: Notwithstanding the diffuse neural representation, the alexithymia construct can be usefully applied in the clinical and empirical studies of social cognition, particularly when adopting a dimensional neuropsychological approach.
Background: White matter hyperintensities (WMH) have frequently been associated with lower executive function performance. Little is known, however, about the effects of hippocampal atrophy on executive control in Alzheimer's disease (AD). The present study focused on the association of hippocampal atrophy with executive function in AD patients and examined whether a threshold effect is present, indicating that a certain amount of brain damage must be present before cognitive function becomes impaired. Finally, we examined the combined effect of hippocampal atrophy and WMH on cognitive task performance.
Methods: We retrospectively collected neuropsychological and neuroimaging data of 94 AD patients. These patients completed tasks of general cognitive function, executive function, memory, and processing speed. With magnetic resonance imaging (MRI), hippocampal atrophy was rated as medial temporal lobe atrophy (MTA) and cerebrovascular disease was rated as WMH using validated visual rating scales.
Results: Medial temporal lobe atrophy (MTA) was associated with lower executive function, general cognitive function, and episodic memory performance. A threshold effect was present, indicating that severe to very severe, but not moderate, MTA was associated with lower executive function. WMH were significantly associated with a single executive test only, whereas the interaction between WMH and MTA was not significantly related to any of the cognitive tasks.
Conclusions: Our findings suggest that AD neuropathology in itself may be responsible for executive dysfunction. Potential explanations for these findings are discussed, focusing on the role of the hippocampus in executive function tests and reduced frontal-posterior connectivity in this patient sample.
Impairments in executive functioning frequently occur after acquired brain damage, in psychiatric disorders, and in relation to aging. The Brixton Spatial Anticipation Test is a relatively new measure for assessing the ability to detect and follow a rule, an important aspect of executive functioning. To date, normative data on this task are limited, particularly concerning the elderly. This study presents age- and education-adjusted regression-based norms obtained in a group of healthy older participants (n = 283; mean age 67.4 ± 8.5 years). The applicability and validity of these norms were further examined in different groups of patients with stroke (n = 106), diabetes mellitus (n = 376), MCI/early dementia (n = 70), psychiatric disorders (n = 63), and Korsakoff’s syndrome (n = 41). The results showed that patients with Korsakoff’s syndrome, stroke, and psychiatric disorders performed significantly worse than healthy controls. Test-retest correlation (n = 83), learning effects, and correlations with other neuropsychological tests were also explored. Based on the present study, the Brixton test appears a useful addition to existing measures of executive functioning. Moreover, the test can be reliably applied in different groups of clinical patients. (JINS, 2009, 15, 695–703.)
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