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Cognitive symptoms are associated with return to work, healthcare use and quality of life after mild traumatic brain injury (mTBI). Additionally, while overall ‘post-concussion’ symptoms are often present at similar levels in mTBI and control groups, cognitive complaints may be specifically elevated in mTBI. A systematic review and meta-analysis was conducted to investigate the frequency and extent of cognitive complaints following adult civilian mTBI, and compare it to the frequency and extent of complaints in control populations (PROSPERO: CRD42020151284).
This review included studies published up to March 2022. Thirteen studies were included in the systematic review, and six were included in the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers.
Cognitive complaints are common after mTBI, although reported rates differed greatly across studies. Results suggested that mTBI groups report cognitive complaints to a significantly greater extent than control groups (Hedges’ g = 0.85, 95% CI 0.31–1.40, p = .0102). Heterogeneity between studies was high (τ2 = 0.20, 95% CI 0.04–1.58; I2 = 75.0%, 95% CI 43.4%–89.0%). Between-group differences in symptom reporting were most often found when healthy rather than injured controls were employed.
Cognitive complaints are consistently reported after mTBI, and are present at greater levels in mTBI patients than in controls. Despite the importance of these complaints, including in regards to return to work, healthcare use and quality of life, there has been limited research in this area, and heterogeneity in research methodology is common.
Autobiographical memory (ABM), personal semantic memory (PSM), and autonoetic consciousness are affected in individuals with mild cognitive impairment (MCI) but their relationship with Alzheimer's disease (AD) biomarkers are unclear.
Forty-five participants (healthy controls (HC) = 31, MCI = 14) completed the Episodic ABM Interview and a battery of memory tests. Thirty-one (HC = 22, MCI = 9) underwent β-amyloid positron emission tomography (PET) and magnetic resonance (MR) imaging. Fourteen participants (HC = 9, MCI = 5) underwent one imaging modality.
Unlike PSM, ABM differentiated between diagnostic categories but did not relate to AD biomarkers. Personal semantic memory was related to neocortical β-amyloid burden after adjusting for age and apolipoprotein E (APOE) ɛ4. Autonoetic consciousness was not associated with AD biomarkers, and was not impaired in MCI.
Autobiographical memory was impaired in MCI participants but was not related to neocortical amyloid burden, suggesting that personal memory systems are impacted by differing disease mechanisms, rather than being uniformly underpinned by β-amyloid. Episodic and semantic ABM impairment represent an important AD prodrome.
The anterior cingulate cortex is frequently implicated in the pathophysiology of bipolar disorder, but magnetic resonance imaging (MRI) studies have reported variable findings owing to a reliance on patient samples with chronic illness and to limited appreciation of the region's heterogeneity.
To characterise anterior cingulate cortex abnormalities in patients with bipolar disorder experiencing their first episode of psychosis while accounting for regional anatomical variability.
Grey matter volume, surface area and cortical thickness were measured in six anterior cingulate cortex subregions per hemisphere using MRI scans acquired from 26 patients with bipolar I disorder experiencing first-episode psychosis and 26 healthy controls matched for age, gender and regional morphological variability.
Relative to controls, male patients displayed increased thickness in the right subcallosal limbic anterior cingulate cortex. No significant differences were identified in females for grey matter volume or surface area measures. The findings were not attributable to medication effects.
These data suggest that first-episode psychosis in bipolar disorder is associated with a gender-specific, right-lateralised thickness increase in anterior cingulate cortex subregions known to play a role in regulating physiological stress responses.
Introduction: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity for such use. We have evaluated their validity in detecting cognitive impairment not dementia (CIND) and dementia in a community-based sample of first-ever stroke patients.
Methods: The standardized MMSE (S-MMSE) and the 16-item IQCODE were administered to 79 patients 1 year after a first-ever stroke. CIND and dementia were diagnosed independently using a comprehensive cognitive battery. The performances of the two tests were evaluated using receiver operating characteristic (ROC) analyses. Combined performance was evaluated when their scores were used in parallel (the “or rule”), in series (the “and rule”) or as a weighted sum (the “weighted sum rule”).
Results: Both tests were extremely poor at detecting CIND individually and in combination. For dementia, at traditional cut-points, the S-MMSE (≤23) was insensitive (0.50, 95% CI 0.16–0.84) and the IQCODE (≥3.30) nonspecific (0.63, 95% CI 0.51–0.75). An acceptable balance between sensitivity and specificity was achieved for dementia using the “or rule” combination, but with only modest positive predictive value.
Conclusions: The S-MMSE and the IQCODE were individually poor at detecting CIND and dementia after a nonaphasic first-ever stroke. The combination was useful in detecting dementia but it does not replace the need for detailed neuropsychological tests.
Subjects underwent longitudinal neuropsychological assessment
in order to retrospectively determine which measures of cognitive
function best predicted later development of dementia of the
Alzheimer type (DAT). Three groups of subjects were studied:
normal controls, patients with early DAT, and questionable dementia
subjects (QD). All subjects were assessed using a battery of
standard neuropsychological measures and two subtests from the
Cambridge Neuropsychological Test Automated Battery (CANTAB),
paired associate learning and delayed matching to sample. A
structured interview was also used to elicit a profile of the
subject's daily functioning. Subjects were assessed every
6 months for 2 years. At the 6 month assessment, almost half
of the QD group exhibited significant deterioration in scores
on the computerized paired associate learning subtest, while
maintaining their scores on standard measures. At the conclusion
of the study, all of this QD subgroup fulfilled the
NINCDS–ADRDA criteria for probable DAT pertaining to
significant cognitive and functional deterioration. Performance
on the CANTAB paired associate learning subtest identified the
onset of progressive memory deterioration in a subgroup of QD
subjects. In almost all cases this was well before significant
deterioration was noted on standard neuropsychological measures.
Paired associate learning performance may therefore be a valuable
tool for the early, preclinical detection and assessment of
DAT. (JINS, 2002, 8, 58–71.)
We studied a group of 31 temporal lobe epilepsy
patients (25 left, 6 right) with unilateral hippocampal
sclerosis evident on magnetic resonance imaging. Single
slice T2 relaxation times were acquired for the left and
right hippocampi. Principal components analysis of preoperative
memory data resulted in two factors that reflect a distinction
between arbitrary and semantic forms of verbal recall.
The former component correlated with left hippocampal T2
relaxation time, while the latter component did not. This
study suggests that variation in left hippocampal integrity
is more related to the acquisition of arbitrary associates
than semantically structured material, and reinforces the
possibility that the left temporal lobe is functionally
heterogeneous with respect to memory. (JINS, 2000,
This book is monumental in every sense of the word.
Before he had the opportunity to complete and publish his
project, the final stages of which had occupied him for
the past decade, Pierre Gloor suffered a stroke in 1994
that rendered him aphasic. In what was undoubtedly a magnificent
act of tribute, an editorial committee of his colleagues
prepared the vast manuscript for publication.
Left-to-right reorganization of verbal memory following
early left hemisphere damage has been reported in patients
whose expressive language is governed by the right hemisphere.
We present a case in which verbal memory performance was
intact, despite severe left mesial temporal damage, and
despite aphasia on left internal carotid sodium amytal
ablation. The distribution and degree of left mesial temporal
damage was assessed visually and quantitatively on MRI.
These findings raise the possibility that verbal memory
may shift to the language-nondominant hemisphere as a result
of early left mesial temporal damage. (JINS, 1999,
This longitudinal study examines the sensitivity
of 2 computerized neuropsychological tests, delayed matching
to sample and paired associate learning, to early dementia
of the Alzheimer type (DAT). Normal controls, patients
in the early stages of DAT, and individuals with questionable
dementia (QD) were studied. At 6 and 12 months after initial
presentation, almost half of the QD group exhibited lower
scores on the computerized subtests, maintaining their
scores on standard testing. Over the same period NC subjects
maintained their performance levels, while DAT patients
continued to deteriorate. Linear discriminant function
analyses of the computerized subtests at 6 and 12 months
correctly classified 100% of the early DAT patients. Eighty-four
and 79 percent of normal controls were correctly classified
at 6 and 12 months respectively. Further development of
these subtests for the detection of early dementia and
the documentation of ongoing change in DAT is warranted.
The findings are discussed in terms of the special sensitivity
of these tests to the neuropathology of Alzheimer's
Disease. (JINS, 1997, 3, 139–146.)