• 【青少年神经性厌食症的增强认知行为疗法: 家庭疗法的替代方法?】 复制标题 收藏 收藏
    DOI:10.1016/j.brat.2012.09.008 复制DOI
    作者列表:Dalle Grave R,Calugi S,Doll HA,Fairburn CG
    BACKGROUND & AIMS: :A specific form of family therapy (family-based treatment) is the leading treatment for adolescents with anorexia nervosa. As this treatment has certain limitations, alternative approaches are needed. "Enhanced" cognitive behaviour therapy (CBT-E) is a potential candidate given its utility as a treatment for adults with eating disorder psychopathology. The aim of the present study was to establish, in a representative cohort of patients with marked anorexia nervosa, the immediate and longer term outcome following CBT-E. Forty-nine adolescent patients were recruited from consecutive referrals to a community-based eating disorder clinic. Each was offered 40 sessions of CBT-E over 40 weeks from a single therapist. Two-thirds completed the full treatment with no additional input. In these patients there was a substantial increase in weight together with a marked decrease in eating disorder psychopathology. Over the 60-week post-treatment follow-up period there was little change despite minimal subsequent treatment. These findings suggest that CBT-E may prove to be a cost-effective alternative to family-based treatment.
    背景与目标: : 一种特殊形式的家庭治疗 (基于家庭的治疗) 是青少年神经性厌食症的主要治疗方法。由于这种治疗有一定的局限性,因此需要其他方法。“增强” 认知行为疗法 (cbt-e) 是一种潜在的候选药物,因为它可用于饮食失调精神病理学的成年人。本研究的目的是在具有明显神经性厌食症的代表性队列中,建立cbt-e后的近期和长期结果。从连续转诊到社区饮食失调诊所招募了49名青少年患者。每位治疗师在40周内接受了40次cbt-e治疗。三分之二的人完成了完整的治疗,没有额外的投入。在这些患者中,体重显着增加,进食障碍心理病理学显着减少。在治疗后60周的随访期内,尽管后续治疗很少,但变化不大。这些发现表明,cbt-e可能被证明是基于家庭的治疗的一种经济有效的替代方法。
  • 2 Changes in cognition following mild stroke. 复制标题 收藏 收藏

    【轻度卒中后认知的变化。】 复制标题 收藏 收藏
    DOI:10.1080/09602011.2012.748672 复制DOI
    作者列表:Wolf TJ,Rognstad MC
    BACKGROUND & AIMS: :The objective of the study was to determine how performance on cognitive assessments administered in the subacute phase of mild stroke change or remain stable over time. A prospective longitudinal cohort pilot study was used to assess the cognitive status of participants with mild stroke (n = 20) at two time points: (1) within 3 weeks post-discharge from the acute care setting following mild stroke, and (2) approximately 6 months post-mild stroke. Participants were given a battery of cognitive assessments at both time points that included the following measures: (1) Short Blessed Test, (2) California Verbal Learning Test (CVLT), (3) Connor's Continuous Performance Task (CPT), and (4) The Delis-Kaplan Executive Function System (DKEFS) Trail Making subtest. The only significant differences between the test administrations was on the CVLT Short Delay Free Recall (p = .027) and Long Delay Free Recall (p = .002) which was likely due to practice effects associated with this measure. The results of the study show that performance on standardised cognitive testing in the early phases of mild stroke remained stable over a 6 month period. These results help justify the necessity and ability to assess cognition immediately post-mild stroke in order to make accurate and appropriate rehabilitation recommendations.
    背景与目标: : 该研究的目的是确定在轻度中风的亚急性阶段进行的认知评估的表现如何随时间变化或保持稳定。前瞻性纵向队列试验用于评估轻度卒中参与者 (n = 20) 在两个时间点的认知状况 :( 1) 轻度卒中后出院后3周内,以及 (2) 轻度卒中后约6个月。参与者在两个时间点都接受了一系列认知评估,包括以下措施 :( 1) 简短的祝福测试,(2) 加州语言学习测试 (CVLT),(3) 康纳的持续表现任务 (CPT),(4) Delis-Kaplan执行功能系统 (DKEFS) 跟踪子测试。测试管理之间的唯一显着差异是CVLT短延迟免费召回 (p =  .027) 和长延迟免费召回 (p =  .002),这可能是由于与该措施相关的实践效果。研究结果表明,在轻度中风的早期阶段,标准化认知测试的表现在6个月内保持稳定。这些结果有助于证明轻度卒中后立即评估认知的必要性和能力,以便提出准确和适当的康复建议。
  • 【在美国军人中,轻度TBI后,脑震荡后的可变,并非总是持续的症状: 一项为期五年的横断面结局研究。】 复制标题 收藏 收藏
    DOI:10.1089/neu.2012.2743 复制DOI
    作者列表:Lange RT,Brickell TA,Ivins B,Vanderploeg RD,French LM
    BACKGROUND & AIMS: :This study examined postconcussion symptom reporting within the first 5 years after mild traumatic brain injury (mTBI). Participants were 167 U.S. military service members (mean age, 27.6 years; 74.3% blast; 96.4% male) who were evaluated subsequent to injuries sustained in theater during Operations Iraqi and Enduring Freedom (92.8%) or from other combat-related operations. Participants completed the Neurobehavioral Symptom Inventory and Post-Traumatic Stress Disorder Checklist within 3 months of injury and at least one follow-up telephone interview at 6 (n = 46), 12 (n = 89), 24 (n = 54), 36 (n = 42), 48 (n = 30), and/or 60 months (n = 25) postinjury. Approximately half of the sample (49.7%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptom criteria for postconcussion disorder (PCD) at baseline. At all six follow-ups, 46.1-72.0% met DSM-IV criteria for PCD. However, only 20.4-48.0% reported persistent PCD from baseline to follow-up. A substantial minority had also improved (4.0-24.1%) or "developed" new symptoms (16.9-27.8%). Using regression analyses, baseline symptoms were somewhat predictive of PCD symptom reporting at follow-up, though this was not always reliable. Follow-up for all service members who sustain a combat-related mTBI in the context of polytrauma, regardless of the presence or absence of symptom reporting in the acute recovery stage, should be considered the rule, not the exception.
    背景与目标: : 这项研究检查了轻度创伤性脑损伤 (mTBI) 后头5年内的脑震荡后症状报告。参与者是167名美国军人 (平均年龄,27.6岁; 74.3% 爆炸; 96.4% 男性),他们在伊拉克和持久自由行动 (92.8%) 或其他与战斗有关的行动中在战区受伤后接受了评估。参与者在受伤后3个月内完成了神经行为症状清单和创伤后应激障碍清单,并在6 (n = 46),12 (n = 89),24 (n = 54),36 (n = 42),受伤后48 (n = 30) 和/或60个月 (n = 25)。大约一半的样本 (49.7%) 在基线时符合精神疾病诊断和统计手册第四版 (dsm-iv) 脑震荡后障碍 (PCD) 的症状标准。在所有六次随访中,46.1-72.0% 符合dsm-iv PCD标准。然而,从基线到随访,只有20.4-48.0% 报告了持续的PCD。相当一部分也改善了 (4.0-24.1%) 或 “发展” 新症状 (16.9-27.8%)。使用回归分析,基线症状在一定程度上可以预测随访时的PCD症状报告,尽管这并不总是可靠的。对于在多发伤情况下维持与战斗相关的mTBI的所有服务人员,无论在急性恢复阶段是否存在症状报告,都应视为规则,而不是例外。
  • 【社会天真的自我评估调节了精神分裂症的认知洞察力与阳性症状之间的关系。】 复制标题 收藏 收藏
    DOI:10.1016/j.schres.2012.10.037 复制DOI
    作者列表:Guerrero AG,Lysaker PH
    BACKGROUND & AIMS: :Cognitive insight refers to awareness of one's own thinking. Research has found deficits in cognitive insight in schizophrenia but studies of its links with positive symptoms and delusions have been equivocal. One possibility is that the association of cognitive insight with positive symptoms and delusions is moderated by other factors. To explore this issue this study examined whether level of socially naive self-appraisal moderated the relationship of two forms of cognitive insight, self-reflectivity and self-certainty with delusions and positive symptoms. Participants were 92 adults, with diagnoses of schizophrenia or schizoaffective disorder, who were administered the Positive and Negative Syndrome Scale, self-deceptive subscale from the Marlowe-Crowne Social Desirability Scale and the Beck Cognitive Insight Scale. Stepwise multiple regressions with the interaction term of the predictive and moderator variables suggested that social naiveté moderates the relationship between self-reflectivity and self-certainty with positive symptoms in general. Moreover, association between self-certainty and delusions was also moderated by social naiveté self-appraisal. All models were significant after controlling for willful impression management as well as a measure of executive function. Results suggest that higher levels of self-certainty are a risk factor for having greater positive symptoms including more severe levels of delusions, when one has a view of oneself that is not tempered by the perceptions of others. Concerning lower levels of self-reflectivity it may be that this combined with a socially naïve view of oneself leaves persons less inhibited when they are tempted to accept unusual thoughts and perceptions as accurate. Implications for treatment are discussed.
    背景与目标: : 认知洞察力是指对自己思维的认识。研究发现精神分裂症的认知能力不足,但对其与阳性症状和妄想的联系的研究却模棱两可。一种可能性是,认知洞察力与积极症状和妄想的关联受到其他因素的调节。为了探讨这个问题,本研究检查了社交天真的自我评估水平是否调节了两种认知洞察力,自我反射和自我确定性与妄想和积极症状之间的关系。参与者为92名诊断为精神分裂症或分裂情感障碍的成年人,他们接受了阳性和阴性综合征量表,Marlowe-Crowne社会期望量表和Beck认知洞察力量表的自我欺骗性量表。具有预测变量和调节变量相互作用项的逐步多元回归表明,社会天真通常会缓和自我反射性和自我确定性与积极症状之间的关系。此外,社会天真的自我评估也减轻了自我确定性和妄想之间的联系。在控制了故意的印象管理以及执行功能的度量之后,所有模型都很重要。结果表明,当一个人对自己的看法不受他人的看法影响时,较高的自我确定性水平是出现更大积极症状 (包括更严重的妄想) 的危险因素。关于较低的自我反射率,这可能与对自己的社会天真的看法相结合,使人们在试图接受不寻常的想法和看法准确时受到的抑制较小。讨论了对治疗的影响。
  • 【有或没有先兆的偏头痛的色觉障碍。】 复制标题 收藏 收藏
    DOI:10.1111/j.1526-4610.2007.00774.x 复制DOI
    作者列表:De Marinis M,Rinalduzzi S,Accornero N
    BACKGROUND & AIMS: OBJECTIVE:To assess visual perception in 40 patients suffering from migraine with aura (MA), 40 patients suffering from migraine without aura (MO), and 40 controls. BACKGROUND:Visual perception abnormalities are a common feature in both MA and MO. METHODS:We performed luminance and color central perimetry. Black and white pattern reversal visual-evoked potentials were also assessed. RESULTS:Luminance perimetry was similar in patients and controls. Color perimetry instead revealed an impairment in the perception of red ("quantitative perception index") in migraine patients; this impairment was more pronounced in patients with MA (P < .001) than in those with MO (P < .05) and was related to the degree of photophobia recorded before testing. A subgroup of MO patients who had a migraine attack shortly after being tested also displayed a marked impairment in the perception of blue. This subgroup of patients had a statistically significant (P < .001) lower perception of blue than the rest of the MO patients, who had a migraine attack later; they also had a high degree of unpleasant perceptions after testing. Black and white visual evoked potentials were similar in patients and controls. CONCLUSION:The impairment in visual perception of red, which was more marked in MA than in MO patients, may be related to the degree of photophobia recorded before testing. The reduced perception of blue, which only occurred in a subgroup of MO patients in the premonitory phase of the migraine attack, probably occurs through mechanisms that involve dopaminergic function. We cannot exclude the possibility that the visual stimulations induced the migraine attack in this subgroup of MO patients shortly after they were tested.
    背景与目标:
  • 【焦虑症成人认知行为治疗结果的荟萃分析综述。】 复制标题 收藏 收藏
    DOI:10.1097/01.nmd.0000253843.70149.9a 复制DOI
    作者列表:Norton PJ,Price EC
    BACKGROUND & AIMS: :The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.
    背景与目标: : 认知行为治疗 (CBT) 对成年人焦虑的功效已得到多项荟萃分析的支持。然而,大多数只关注1个诊断,因此不允许进行诊断比较。这项研究检查了CBT在焦虑症中的功效。针对焦虑症的CBT试验达到了研究标准。单独使用认知疗法和暴露疗法,或与放松训练相结合,在焦虑症中是有效的,对于任何特定诊断的任何治疗成分都没有不同的功效。然而,当比较各种诊断时,广泛焦虑症和创伤后应激障碍的结果优于社交焦虑症,但没有其他差异。CBT效果优于无治疗和预期对照治疗,尽管初步证据表明CBT与仅松弛治疗相比具有相同的效果。
  • 【重度抑郁症治疗后复发与认知反应性的关系。】 复制标题 收藏 收藏
    DOI:10.1037/0022-006X.75.3.447 复制DOI
    作者列表:Fresco DM,Segal ZV,Buis T,Kennedy S
    BACKGROUND & AIMS: :Z. V. Segal et al. (2006) demonstrated that depressed patients treated to remission through either antidepressant medication (ADM) or cognitive-behavioral therapy (CBT), but who evidenced mood-linked increases in dysfunctional thinking, showed elevated rates of relapse over 18 months. The current study sought to evaluate whether treatment response was associated with gains in decentering-the ability to observe one's thoughts and feelings as temporary, objective events in the mind-and whether these gains moderated the relationship between mood-linked cognitive reactivity and relapse of major depression. Findings revealed that CBT responders exhibited significantly greater gains in decentering compared with ADM responders. In addition, high post acute treatment levels of decentering and low cognitive reactivity were associated with the lowest rates of relapse in the 18-month follow-up period.
    背景与目标: : Z。五.Segal等人 (2006) 证明,抑郁症患者通过抗抑郁药物 (ADM) 或认知行为疗法 (CBT) 治疗缓解,但证明了功能障碍思维的情绪相关增加,显示出超过18个月的复发率升高。当前的研究试图评估治疗反应是否与偏心的增加有关-观察一个人的思想和感觉作为暂时的,客观的心理事件的能力-以及这些增加是否缓解了与情绪相关的认知反应与重抑郁症复发之间的关系。调查结果显示,与ADM响应者相比,CBT响应者在偏心方面表现出更大的收益。此外,在18个月的随访期内,急性治疗后高水平的偏心和低认知反应性与最低的复发率相关。
  • 【情绪识别障碍是早期存在的,并且在精神分裂症的整个过程中是稳定的。】 复制标题 收藏 收藏
    DOI:10.1016/j.schres.2012.11.005 复制DOI
    作者列表:Comparelli A,Corigliano V,De Carolis A,Mancinelli I,Trovini G,Ottavi G,Dehning J,Tatarelli R,Brugnoli R,Girardi P
    BACKGROUND & AIMS: :Individuals with schizophrenia experience problems in the perception of emotion throughout the course of the disorder. Few studies have addressed the progression of the deficit over time. The present investigation explores face emotion recognition (FER) performance throughout the course of schizophrenia. The aim of the study was to test the hypotheses that: 1) FER impairment was present in ultra high-risk (putatively prodromal) individuals, and that 2) impairment was stable across the course of the illness. Forty-three individuals with a putative prodromal syndrome, 50 patients with first episode of schizophrenia, 44 patients with multi-episode schizophrenia and 86 unaffected healthy control subjects were assessed to examine emotion recognition ability. ANCOVA analysis adjusted for possible confounder factors and subsequent planned contrasts with healthy controls was undertaken. The results revealed deficits in recognition of sadness and disgust in prodromal individuals, and of all negative emotions in both first-episode and multi-episode patients. Furthermore, there were no significant differences between clinical groups. Within the framework of the neurodevelopmental model of schizophrenia, our results suggest the presence of emotional recognition impairment before the onset of full-blown psychosis. Moreover, the deficit remains stable over the course of illness, fitting the pattern of a vulnerability indicator in contrast to an indicator of chronicity or severity.
    背景与目标: : 精神分裂症患者在整个疾病过程中都会遇到情绪感知问题。很少有研究解决赤字随时间推移的进展。本研究探讨了精神分裂症整个过程中的面部情感识别 (FER) 表现。该研究的目的是检验以下假设: 1) 在超高危 (假定为前驱) 个体中存在FER损伤,并且2) 损伤在整个病程中是稳定的。评估了43例假定的前驱综合征患者,50例首发精神分裂症患者,44例多发作精神分裂症患者和86例未受影响的健康对照受试者,以检查情绪识别能力。进行了ANCOVA分析,以调整可能的混杂因素,并随后与健康对照进行了计划对比。结果显示,前驱个体对悲伤和厌恶的认识不足,以及首发和多发作患者对所有负面情绪的认识不足。此外,临床组之间没有显着差异。在精神分裂症的神经发育模型的框架内,我们的结果表明在全面精神病发作之前存在情绪识别障碍。此外,赤字在疾病过程中保持稳定,符合脆弱性指标的模式,而不是慢性或严重程度的指标。
  • 【评估多奈哌齐改善精神分裂症患者认知障碍的前景。】 复制标题 收藏 收藏
    DOI:10.1517/13543784.2013.750650 复制DOI
    作者列表:Thakurathi N,Vincenzi B,Henderson DC
    BACKGROUND & AIMS: INTRODUCTION:Even though cognitive impairment is manifested in almost all patients with schizophrenia, the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) study showed no significant difference between first- and second-generation psychotropic drugs in improving cognitive abilities. Discovering new drugs that can improve impaired cognition, thus, is an attractive treatment target for patients with schizophrenia. AREAS COVERED:This article briefly reviews about donepezil, a highly selective (IC(50) = 6.7 nM) centrally acting reversible acetylcholinesterase inhibitor that has been approved by FDA for treating cognitive deficit states such as in Alzheimer's disease and its uses in clinical trials for the treatment of schizophrenia. The literature search included PubMed and Cochrane library with the following words: donepezil, schizophrenia and cognitive impairments. EXPERT OPINION:The results of several clinical trials utilizing donepezil as an adjunct to second-generation antipsychotic drugs targeting cognitive deficits in schizophrenia subjects have been disappointing and would not lead clinicians to consider this as a potential treatment option. While longer randomized controlled trials, increase dosage and selected groups of patients at different stage of cognitive impairment may provide a better understanding of the potential for this drug in addressing cognitive deficits, results to date have not been encouraging.
    背景与目标:
  • 【MELAS的神经心理缺陷: 全球损伤的证据。】 复制标题 收藏 收藏
    DOI:10.1097/WNN.0b013e3180335faf 复制DOI
    作者列表:Neargarder SA,Murtagh MP,Wong B,Hill EK
    BACKGROUND & AIMS: OBJECTIVE:To examine the neuropsychologic profile of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes) and relate it to neuropathologic findings. BACKGROUND:MELAS is one of over 40 mitochondrial disorders. Symptoms include seizures, strokelike episodes, headaches, memory impairment, hemianopsia, hearing loss, short stature, diffuse limb weakness, exercise intolerance, nausea, and vomiting. Age of onset ranges from 2 to 40 years. A hallmark of MELAS is normal development until the first symptoms appear. METHOD:Because information regarding the neuropsychologic functioning of these individuals is sparse, we report findings from detailed neuropsychologic evaluations for a 13-year-old white male and a 33-year-old African-American male with MELAS. RESULTS:Results revealed global patterns of deterioration in executive function, attention, language, memory, visuospatial, and motor functioning. In both patients, brain scans revealed posterior pathology in the absence of frontal pathology. CONCLUSIONS:We compared our findings with other documented cases and concluded that MELAS is characterized by a pattern of global deterioration. This pattern differs from that observed in other mitochondrial disorders. The absence of identifiable frontal lobe pathology despite the presence of deficits in executive functioning may be related to the distribution patterns of deficient mitochondria and neuronal projection patterns.
    背景与目标:
  • 【社交焦虑症的认知疗法: “自我关注的注意和安全行为实验” 对治疗过程的影响。】 复制标题 收藏 收藏
    DOI:10.1017/S1352465813000672 复制DOI
    作者列表:Schreiber F,Heimlich C,Schweitzer C,Stangier U
    BACKGROUND & AIMS: BACKGROUND AND AIMS:Several studies have shown that cognitive therapy is an effective treatment for social anxiety disorder (SAD). However, it remains unclear which of the complex interventions are associated with an anxiety reduction during the course of treatment. The aim of this study was to examine the impact of the intervention referred to as the "self-focused attention and safety behaviours experiment" on treatment outcome. METHOD:This study was part of a randomized controlled trial including 16 sessions of either individual cognitive therapy (CT) or interpersonal therapy (IPT) for SAD. Of particular importance, a concomitant time-series analysis was used to investigate the impact of the self-focused attention and safety behaviours experiment on subsequent social anxiety (1, 2, 3, and 4 weeks after the intervention) in 32 patients with SAD, who are receiving cognitive treatment. RESULTS:The results revealed a significant reduction of social anxiety after the self-focused attention and safety behaviours experiment during the subsequent month of treatment. CONCLUSION:The findings of the current study confirm current cognitive theories of SAD and demonstrate the importance of interventions that target self-focused attention and safety behaviour in cognitive therapy for SAD.
    背景与目标:
  • 【多发性精神分裂症患者功能能力的认知筛查和行为观察: 一项探索性研究。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2016-014783 复制DOI
    作者列表:Norlin Bagge E,Esbjörnsson E,Sunnerhagen KS
    BACKGROUND & AIMS: OBJECTIVES:To evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care needs, who frequently refuse to participate in cognitive testing or performance-based functional measurement. SETTING:One psychiatric unit specialised in severe mental illness at the Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS:Patients were included consecutively from date of admission to the unit. INCLUSION CRITERIA:age 18-65 years, International Classification of Diseases 10 diagnoses F20.0-F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorder) since at least 5 years. EXCLUSION CRITERIA:acute serious psychotic episodes or physical illness, alcohol or drug abuse during the year before the study, diagnosed cerebral disorder at admission to the unit, and insufficient ability to speak Swedish. 64 patients filled the criteria and 19 accepted participation: 14 males, 5 females, median age 56 years. OUTCOME MEASURES:Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) scores, measured by a psychologist; Frontal Systems Behaviour Scale (FrSBe) Family Version and Functional Independence Measure (FIM) V.4.0 scores, measured by nursing staff. Non-parametric statistics were consistently applied to process the data. RESULTS:Failure analysis showed differences regarding gender and subdiagnoses between participants and non-participants. All participants had BNIS scores indicating cognitive dysfunction. FrSBe group medians showed apathy and executive problems, indicating possible frontal lobe disturbance. FIM showed dependency on others for linguistic and social communication, everyday problem solving, and remembering persons and daily routines. Correlations between FrSBe and FIM (p≤0.01) suggested executive dysfunction being crucial to explain difficulties in performing activities of daily functioning. CONCLUSIONS:Indications of considerable cognitive and functional difficulties found among the participants suggestedthat the instruments are clinically applicable for tentative assessment of cognitive and functional ability among patients with multiepisode schizophrenia and considerable care needs.
    背景与目标:
  • 【社区老年人的脑白质道完整性和认知能力: 洛锡安出生队列,1936。】 复制标题 收藏 收藏
    DOI:10.1037/a0033354 复制DOI
    作者列表:Booth T,Bastin ME,Penke L,Maniega SM,Murray C,Royle NA,Gow AJ,Corley J,Henderson RD,Hernández Mdel C,Starr JM,Wardlaw JM,Deary IJ
    BACKGROUND & AIMS: OBJECTIVE:The present study investigates associations between brain white matter tract integrity and cognitive abilities in community-dwelling older people (N = 655). We explored two potential confounds of white matter tract-cognition associations in later life: (a) whether the associations between tracts and specific cognitive abilities are accounted for by general cognitive ability (g); and (b) how the presence of atrophy and white matter lesions affect these associations. METHOD:Tract integrity was determined using quantitative diffusion magnetic resonance imaging tractography (tract-averaged fractional anisotropy [FA]). Using confirmatory factor analysis, we compared first-order and bifactor models to investigate whether specific tract-ability associations were accounted for by g. RESULTS:Significant associations were found between g and FA in bilateral anterior thalamic radiations (r range: .16-.18, p < .01), uncinate (r range: .19-.26, p < .001), arcuate fasciculi (r range: .11-.12, p < .05), and the splenium of corpus callosum (r = .14, p < .01). After controlling for g within the bifactor model, some significant specific cognitive domain associations remained. Results also suggest that the primary effects of controlling for whole brain integrity were on g associations, not specific abilities. CONCLUSION:Results suggest that g accounts for most of, but not all, the tract-cognition associations in the current data. When controlling for age-related overall brain structural changes, only minor attenuations of the tract-cognition associations were found, and these were primarily with g. In totality, the results highlight the importance of controlling for g when investigating associations between specific cognitive abilities and neuropsychology variables.
    背景与目标:
  • 【认知能力与非痴呆的帕金森氏症患者纹状体相关部分的多巴胺能变性程度相关。】 复制标题 收藏 收藏
    DOI:10.1007/s00702-017-1747-2 复制DOI
    作者列表:Kübler D,Schroll H,Buchert R,Kühn AA
    BACKGROUND & AIMS: :Parkinson's disease (PD) patients show cognitive deficits that are relevant in terms of prognosis and quality of life. Degeneration of striatal dopaminergic afferents proceeds from dorsal/caudal to anterior/ventral and is discussed to account for some of these symptoms. Treatment with dopamine (DA) has differential effects on cognitive dysfunctions, improving some and worsening others. We hypothesized that cognitive performance during the dopaminergic OFF state correlates with DAT availability in the associative striatum. 16 PD patients underwent motor and cognitive examination ON and OFF DA. Global cognition was measured using the Montréal Cognitive Assessment (MoCA) test and executive functioning using a Stroop test. Nigrostriatal dopaminergic innervation was characterized with [123I]FP-CIT SPECT. A connectivity atlas of the striatum was used to assess DAT availability in functionally defined striatal subregions. Correlations between imaging data and behavioral data OFF medication were calculated. Correlations between DAT availability and MoCA performance in the dopaminergic OFF state was strongest in the associative part of the striatum (r = 0.674, p = 0.004). MoCA test performance did not differ between the ON and the OFF state. There was no correlation of DAT availability with Stroop performance in the OFF state but performance was significantly better during the ON state. Not only motor but also cognitive dysfunctions in PD are associated with striatal dopaminergic depletion. Cognitive decline in non-demented PD patients goes along with nigrostriatal degeneration, most pronounced in the associative subdivision of the striatum. In addition, the present findings suggest that executive dysfunctions are ameliorated by DA whereas global cognition is not improved by dopaminergic medication.
    背景与目标: : 帕金森氏病 (PD) 患者表现出与预后和生活质量相关的认知缺陷。纹状体多巴胺能传入的变性从背侧/尾部到前/腹侧进行,并讨论了其中一些症状。多巴胺 (DA) 治疗对认知功能障碍有不同的影响,改善了一些,恶化了另一些。我们假设多巴胺能关闭状态下的认知表现与联想纹状体中的DAT可用性相关。16例PD患者在DA和DA上进行了运动和认知检查。使用蒙特利尔认知评估 (MoCA) 测试测量全球认知,并使用Stroop测试测量执行功能。黑质纹状体多巴胺能神经支配的特征是用 [123I]FP-CIT SPECT。纹状体的连通性图谱用于评估功能定义的纹状体子区域中的DAT可用性。计算药物外的成像数据和行为数据之间的相关性。多巴胺能关闭状态下DAT可用性和MoCA性能之间的相关性最强纹状体的关联部分 (r = 0.674,p = 0.004)。MoCA测试性能在开启和关闭状态之间没有差异。在关闭状态下,DAT可用性与Stroop性能没有相关性,但在开启状态下,性能明显更好。PD不仅运动功能障碍,而且认知功能障碍与纹状体多巴胺能耗竭有关。非痴呆性PD患者的下降伴随着黑质纹状体变性,在纹状体的关联细分中最明显。此外,目前的发现表明,DA可以改善执行功能障碍,而多巴胺能药物不能改善整体认知。
  • 【脑血管病和淀粉样 β 负荷对皮质下血管性认知障碍受试者认知的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.neurobiolaging.2013.06.026 复制DOI
    作者列表:Park JH,Seo SW,Kim C,Kim SH,Kim GH,Kim ST,Jeon S,Lee JM,Oh SJ,Kim JS,Choe YS,Lee KH,Shin JS,Kim CH,Noh Y,Cho H,Yoon CW,Kim HJ,Ye BS,Ewers M,Weiner MW,Lee JH,Werring DJ,Na DL
    BACKGROUND & AIMS: :Cerebrovascular disease (CVD) and amyloid burden are the most frequent pathologies in subjects with cognitive impairment. However, the relationship between CVD, amyloid burden, and cognition are largely unknown. We aimed to evaluate whether CVD (lacunes, white matter hyperintensities, and microbleeds) and amyloid burden (Pittsburgh compound B [PiB] retention ratio) contribute to cognitive impairment independently or interactively. We recruited 136 patients with subcortical vascular cognitive impairment who underwent magnetic resonance imaging, PiB-positron emission tomography, and neuropsychological testing. The number of lacunes was associated with memory, frontal dysfunctions, and disease severity. The volume of white matter hyperintensities and the PiB retention ratio were associated only with memory dysfunction. There was no direct correlation between CVD markers and PiB retention ratio except that the number of lacunes was negatively correlated with the PiB retention ratio. In addition, there were no interactive effects of CVD and PiB retention ratio on cognition. Our findings suggest that CVD and amyloid burden contribute independently and not interactively to specific patterns of cognitive dysfunction in patients with subcortical vascular cognitive impairment.
    背景与目标: : 脑血管疾病 (CVD) 和淀粉样蛋白负担是认知障碍患者最常见的病理。然而,CVD,淀粉样蛋白负担和认知之间的关系在很大程度上尚不清楚。我们旨在评估CVD (腔隙,白质高信号和微出血) 和淀粉样蛋白负荷 (匹兹堡化合物B [PiB] 保留比) 是否独立或交互地导致认知障碍。我们招募了136名皮质下血管性认知障碍患者,他们接受了磁共振成像,PiB-正电子发射断层扫描和神经心理学测试。腔隙的数量与记忆,额叶功能障碍和疾病严重程度有关。白质高信号的体积和PiB保留率仅与记忆功能障碍有关。CVD标记与PiB保留率之间没有直接相关性,只是腔隙数与PiB保留率呈负相关。此外,CVD和PiB保留率对认知没有交互作用。我们的发现表明,在皮质下血管性认知障碍患者中,CVD和淀粉样蛋白负担独立且非交互作用地促进了认知功能障碍的特定模式。

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