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European Journal of Neurology Jul 2024Cognitive complaints are common in functional neurological disorder (FND), but it is unclear whether objective neurocognitive deficits are present. This systematic... (Review)
Review
BACKGROUND AND PURPOSE
Cognitive complaints are common in functional neurological disorder (FND), but it is unclear whether objective neurocognitive deficits are present. This systematic review summarized validated/standardized cognitive test performance in FND samples across cognitive domains.
METHODS
Embase, PsycInfo and MEDLINE were searched from inception to 15 May 2023, combining terms for FND and cognitive domains (e.g., attention, memory, executive functioning). Studies included a range of FND phenotypes (seizures, motor, cognitive disorder, mixed), compared to healthy or clinical controls. Risk of bias was assessed with the modified Newcastle-Ottawa Scale and a qualitative synthesis/narrative review of cognitive performance in FND was conducted. Test performance scores were extracted, and random effects meta-analyses were run where appropriate. This review was registered on PROSPERO, CRD42023423139.
RESULTS
Fifty-six studies including 2260 individuals with FND were eligible. Although evidence for some impairments emerged across domains of executive functioning, attention, memory and psychomotor/processing speed, this was inconsistent across studies and FND phenotypes. Common confounds included group differences in demographics, medication and intellectual functioning. Only 24% of studies objectively assessed performance validity. Meta-analyses revealed higher scores on tests of naming (g = 0.67, 95% confidence interval [CI] 0.50, 0.84) and long-term memory (g = 0.43, 95% CI 0.13, 0.74) in functional seizures versus epilepsy, but no significant differences in working (g = -0.08, 95% CI -0.44, 0.29) or immediate (g = 0.25, 95% CI -0.02, 0.53) memory and cognitive flexibility (g = -0.01, 95% CI -0.29, 0.28).
CONCLUSIONS
There is mixed evidence for objective cognitive deficits in FND. Future research should control for confounds, include tests of performance validity, and assess relationships between objective and subjective neurocognitive functioning.
PubMed: 38953473
DOI: 10.1111/ene.16386 -
International Journal of Developmental... Jul 2024Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a diverse profile of cognitive functions. Heterogeneity is observed among both baseline and comorbid... (Review)
Review
OBJECTIVES
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a diverse profile of cognitive functions. Heterogeneity is observed among both baseline and comorbid features concerning the diversity of neuropathology in autism. Symptoms vary depending on the developmental stage, level of severity, or comorbidity with other medical or psychiatric diagnoses such as intellectual disability, epilepsy, and anxiety disorders.
METHOD
The neurodiversity movement does not face variations in neurological and cognitive development in ASD as deficits but as normal non-pathological human variations. Thus, ASD is not identified as a neurocognitive pathological disorder that deviates from the typical, but as a neuro-individuality, a normal manifestation of a neurobiological variation within the population.
RESULTS
In this light, neurodiversity is described as equivalent to any other human variation, such as ethnicity, gender, or sexual orientation. This review will provide insights about the neurodiversity approach in children and adults with ASD. Using a neurodiversity approach can be helpful when working with children who have autism spectrum disorder (ASD).
DISCUSSION
This method acknowledges and values the various ways that people with ASD interact with one another and experience the world in order to embrace the neurodiversity approach when working with children with ASD.
PubMed: 38953464
DOI: 10.1002/jdn.10356 -
American Journal of Hematology Jul 2024Central nervous system (CNS) injury is common in sickle cell disease (SCD) and occurs early in life. Hydroxyurea is safe and efficacious for treatment of SCD, but...
Central nervous system (CNS) injury is common in sickle cell disease (SCD) and occurs early in life. Hydroxyurea is safe and efficacious for treatment of SCD, but high-quality evidence from randomized trials to estimate its neuroprotective effect is scant. HU Prevent was a randomized (1:1), double-blind, phase II feasibility/pilot trial of dose-escalated hydroxyurea vs. placebo for the primary prevention of CNS injury in children with HbSS or HbS-β-thalassemia subtypes of SCD age 12-48 months with normal neurological examination, MRI of the brain, and cerebral blood flow velocity. We hypothesized that hydroxyurea would reduce by 50% the incidence of CNS injury. Two outcomes were compared: primary-a composite of silent cerebral infarction, elevated cerebral blood flow velocity, transient ischemic attack, or stroke; secondary-a weighted score estimating the risk of suffering the consequences of stroke (the Stroke Consequences Risk Score-SCRS), based on the same outcome events. Six participants were randomized to each group. One participant in the hydroxyurea group had a primary outcome vs. four in the placebo group (incidence rate ratio [90% CI] 0.216 [0.009, 1.66], p = .2914) (~80% reduction in the hydroxyurea group). The mean SCRS score was 0.078 (SD 0.174) in the hydroxyurea group, 0.312 (SD 0.174) in the placebo group, p = .072, below the p-value of .10 often used to justify subsequent phase III investigations. Serious adverse events related to study procedures occurred in 3/41 MRIs performed, all related to sedation. These results suggest that hydroxyurea may have profound neuroprotective effect in children with SCD and support a definitive phase III study to encourage the early use of hydroxyurea in all infants with SCD.
PubMed: 38953438
DOI: 10.1002/ajh.27423 -
Minerva Surgery Jul 2024
PubMed: 38953422
DOI: 10.23736/S2724-5691.24.10396-6 -
British Journal of Clinical Pharmacology Jul 2024Cerebral hypometabolism occurs years prior to a diagnosis of neurodegenerative diseases and coincides with reduced cerebral perfusion and declining noradrenergic...
Effects on cerebral blood flow after single doses of the β agonist, clenbuterol, in healthy volunteers and patients with mild cognitive impairment or Parkinson's disease.
AIMS
Cerebral hypometabolism occurs years prior to a diagnosis of neurodegenerative diseases and coincides with reduced cerebral perfusion and declining noradrenergic transmission from the locus coeruleus. In pre-clinical models, β-adrenoceptor (β-AR) agonists increase cerebrocortical glucose metabolism, and may have therapeutic potential for neurodegenerative diseases. This study investigated the safety and effects on regional cerebral blood flow (rCBF) of the oral, brain-penetrant β-AR agonist, clenbuterol, in healthy volunteers (HV) and patients with mild cognitive impairment (MCI) or Parkinson's disease (PD).
METHODS
This study evaluated the safety and effects on cerebral activity of the oral, brain-penetrant, β-AR agonist clenbuterol (20-160 μg) in healthy volunteers and patients with MCI or PD. Regional CBF, which is tightly coupled to glucose metabolism, was measured by arterial spin labelling MRI in 32 subjects (25 HV and 8 MCI or PD) across five cohorts. In some cohorts, low doses of nadolol (1-5 mg), a β-AR antagonist with minimal brain penetration, were administered with clenbuterol to control peripheral β-AR responses.
RESULTS
Significant, dose-dependent increases in rCBF were seen in multiple brain regions, including hippocampus, amygdala and thalamus, following the administration of clenbuterol to HVs (mean changes from baseline in hippocampal rCBF of -1.7%, 7.3%, 22.9%, 28.4% 3 h after 20, 40, 80 and 160 μg clenbuterol, respectively). In patients with MCI or PD, increases in rCBF following 80 μg clenbuterol were observed both without and with 5 mg nadolol (in hippocampus, 18.6%/13.7% without/with nadolol). Clenbuterol was safe and well-tolerated in all subjects; known side effects of β-agonists, including increased heart rate and tremor, were mild in intensity and were blocked by low-dose nadolol.
CONCLUSIONS
The effects of clenbuterol on rCBF were evident both in the absence and presence of low-dose nadolol, suggesting central nervous system (CNS) involvement. Concomitant inhibition of the peripheral effects of clenbuterol by nadolol confirms that meaningful β-AR antagonism in the periphery was achieved without interrupting the central effects of clenbuterol on rCBF.
PubMed: 38953404
DOI: 10.1111/bcp.16160 -
Cognition & Emotion Jul 2024Previous research on emotion-induced blindness (EIB) argues emotional distractors capture attention in a bottom-up manner due to their physical and emotional salience....
Previous research on emotion-induced blindness (EIB) argues emotional distractors capture attention in a bottom-up manner due to their physical and emotional salience. However, recent research has shown it is controversial whether EIB will be modulated by top-down factors. The present study further investigated whether the magnitude of EIB would be modulated by top-down factors, specifically the emotional relevance between tasks and distractors. Participants were divided into two groups having the same targets except for different task instructions. The orientation judgment group was asked to judge the orientation of the target (an emotionally irrelevant task), and the emotion judgment group was required to judge the emotional valence of the target (an emotionally relevant task). It was found the emotional relevance between tasks and distractors has no modulation on the magnitudes of EIB in two groups when targets and distractors are from different categories (Experiment 1), but a modulation when they are from the same category (Experiment 2). Consequently, we contend top-down task relevance modulates the EIB effect and distractors' priority is regulated by the emotional relevance between tasks and distractors. The current study holds attentional capture by stimulus-driven is unconditional in EIB, while attentional capture by goal-driven requires certain conditions.
PubMed: 38953391
DOI: 10.1080/02699931.2024.2369894 -
Cognition & Emotion Jul 2024Western society generally highly values happiness. As a result, people sometimes experience pressure not to feel negative emotions. In this study, we comprehensively...
Western society generally highly values happiness. As a result, people sometimes experience pressure not to feel negative emotions. In this study, we comprehensively investigated this pressure, and how it manifests itself, in adult romantic relationships. Specifically, we first examined when, how often and how intensely people experience pressure not to feel bad from their romantic partners (94 different-sex couples). Additionally, we investigated (both between- and within-person) how this pressure is related to context (presence of, contact and or conflict with a partner), emotional processes (i.e. experienced sadness and anxiety, emotion suppression, and how their partner perceived their affect), and relationship well-being. Using experience sampling methodology data (6/14 reports per day over one week) we found that although participants generally did not experience strong pressure from their partner, they experienced some feelings of pressure about 50% of the time. Furthermore, within-person predictors associated with negative processes/emotions (i.e. negative emotions, conflict, emotion suppression) were related to the momentary frequency (odds) and/or intensity of perceived pressure not to feel bad. At the between-person level, individuals who experience more sadness, anxiety and reported suppressing their emotions more often tended to experience more and/or stronger pressure. Only weak associations with relationship well-being were found.
PubMed: 38953390
DOI: 10.1080/02699931.2024.2371094 -
The International Journal of Eating... Jul 2024Adults with binge-eating disorder (BED), compared with those without BED, demonstrate higher blood-oxygen-level-dependent (BOLD) response to food cues in reward-related...
OBJECTIVE
Adults with binge-eating disorder (BED), compared with those without BED, demonstrate higher blood-oxygen-level-dependent (BOLD) response to food cues in reward-related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge-eating cues following CBT versus wait-list control (WLC).
METHOD
Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (fMRI) to measure BOLD response while listening to personalized scripts of binge-eating and neutral-relaxing cues. Data were analyzed using general linear models with mixed effects.
RESULTS
Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge-eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge-eating stimuli during the fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward-based eating drive, disinhibition, and hunger as assessed by questionnaires (ps < 0.05).
DISCUSSION
CBT was effective in reducing binge eating, but, contrary to our hypothesis, CBT did not improve BOLD response to auditory binge-eating stimuli in reward regions of the brain. Further studies are needed to assess mechanisms underlying improvements with CBT for BED.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT03604172.
PubMed: 38953334
DOI: 10.1002/eat.24244 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Objective To assess the influences of self-and interviewer-administered methods on the scores of anxiety and depression questionnaires among the patients with sports...
Objective To assess the influences of self-and interviewer-administered methods on the scores of anxiety and depression questionnaires among the patients with sports injuries.Methods A total of 532 participants with sports injuries treated in the Sports Medicine Center of West China Hospital,Sichuan University from November 2022 to May 2023 were included.They were randomly assigned to either the interviewer-administered group (=270) or the self-administered group (=262) to complete the generalized anxiety disorder (GAD-7) and the patient health questionnaire (PHQ-9) scales.The total scores and prevalence rates of anxiety and depression were compared between the two groups.Results There was no statistically significant difference in gender,occupation,or surgical site between the two groups (all >0.05).The self-administered group had higher scores of GAD-7 and PHQ-9 scales than the interviewer-administered group (<0.001,<0.001).A greater proportion of participants in the self-administered group than in the interview-administered group met the criteria for mild to moderate anxiety and depression (<0.001,=0.002).The prevalence rates of moderate to severe anxiety (GAD-7≥10) and depression (PHQ-9≥10) showed no statistically significant difference between the two groups (=0.761,=0.086).Conclusion This study demonstrates that the participants in the self-administered group are more likely to report mild to moderate symptoms of anxiety and depression than those in the interviewer-administered group.
Topics: Humans; Surveys and Questionnaires; Depression; Female; Anxiety; Male; Adult; Athletic Injuries; China; Middle Aged; Young Adult
PubMed: 38953255
DOI: 10.3881/j.issn.1000-503X.15839 -
The Gerontologist Jul 2024Previous research has tended to prioritize the condition of dementia when investigating positive lived experiences, while there is no evidence that well-being becomes...
BACKGROUND AND OBJECTIVES
Previous research has tended to prioritize the condition of dementia when investigating positive lived experiences, while there is no evidence that well-being becomes fundamentally different when living with dementia. The current exploratory qualitative study examined how people living with dementia describe how they realize their well-being, without treating dementia as a central concern, and specifically addressed people who are successful in maintaining their well-being.
RESEARCH DESIGN AND METHODS
Semi-structured face-to-face interviews (n=16) and two focus groups (n=13) were conducted with community-dwelling older people living with dementia, aged 65-93 years (68% male). Conversations covered contributors to experienced life satisfaction, and life enjoyment, and were analyzed using inductive thematic analysis.
RESULTS
Two main themes described how people realize well-being. (1) To live a fulfilling life, participants engaged in activities in order to feel useful and relaxed, and they engaged with others, by interacting and sharing with others, and relying on others. (2) To have a positive attitude towards life, participants appreciated the good things in their current life, their lived life, and about their own person, and positively coped with difficulties by accepting them as part of life, not dwelling on the negative, and actively addressing difficulties.
DISCUSSION AND IMPLICATIONS
The results appear to reflect universal ways of realizing well-being, justifying the use of universal models of well-being for people living with dementia. We can learn from people living with dementia that living a fulfilling life and having a positive attitude towards life are key to realizing their well-being.
PubMed: 38953169
DOI: 10.1093/geront/gnae077