Cognition in children and young adults with myoclonus dystonia - A case control study

INTRODUCTION: In adult patients with myoclonus dystonia (MD), cognitive deficits regarding information processing speed and executive functioning have been demonstrated, but it is unclear whether cognition is also affected in young MD patients. The present study investigates cognition in young MD patients and the role of an SGCE mutation. METHODS: In this case control study 20 young MD patients (9 children (5.75-12.58 years) and 11 adolescents/young adults (13.5-25.42 years)) were included and compared to an age-, IQ- and gender-matched healthy control group (n = 40). Within the patient group, we compared patients with (n = 12) and without (n = 8) an SGCE mutation (SGCE+/-). All participants completed neuropsychological tests for memory, attention/processing speed, executive functioning, social cognition and language. RESULTS: Overall, patients performed in the (low) average range, comparable to healthy controls. Only on a semantic fluency test, patients scored significantly lower. SGCE + patients had lower emotion recognition scores (a social cognition test) compared to SGCE-patients. CONCLUSION: We could not demonstrate cognitive deficits as found in adult MD patients in our younger group. Patients performed on the same level as healthy controls, with only a small difference in semantic fluency. We did not find executive deficits that were manifest in adult SGCE + patients, but we did find an association of an SGCE mutation and lower scores on a social cognition test. Similar to executive functioning, social cognition is a prefrontally regulated function, but had not been tested in adult MD. Hence, social cognition may precede executive problems in adulthood, suggesting growing into deficit

Participation after traumatic brain injury:the surplus value of social cognition tests beyond measures for executive functioning and dysexecutive behavior in a statistical prediction model

Objective: This study evaluates the contribution of measures for social cognition (SC), executive functioning (EF) and dysexecutive behavior to the statistical prediction of social and vocational participation in patients with traumatic brain injury (TBI), taking into account age and injury severity. Method: A total of 63 patients with moderate to severe TBI participated. They were administered a semi-structured Role Resumption List for social (RRL-SR) and vocational participation (RRL-RTW). EF was measured with planning- and switching tasks. Assessment of SC included tests for facial affect recognition and Theory of Mind (ToM). Dysexecutive behavior was proxy-rated with a questionnaire. Additionally, healthy controls were assessed with the same protocol. Results: Patients with TBI performed significantly worse on tests and had significantly more behavioral problems compared to healthy controls. Hierarchical multiple regression analyses for the TBI group revealed that SC accounted for 22% extra variance in RRL-RTW and 10% extra variance in RRL-SR, which was significant over and above the amounts of variance explained by EF, dysexecutive behavior, age and injury severity. Conclusions: Our findings underline the added value of measures of SC and dysexecutive behavior in the prediction of social and vocational participation post-TBI. In particular, impairments in ToM, and dysexecutive behavior were related to a lower participation making them important targets for rehabilitation

The efficacy of anti-inflammatory medication in postoperative cognitive decline: A meta-analysis

Objective: Post-operative cognitive decline is a surgical complication involving chronic impairments in different cognitive domains. Although the exact mechanisms behind postoperative cognitive decline are still unknown, there is increasing evidence for a key role of neuroinflammation. This meta-analysis aims to investigate the efficacy of anti-inflammatory treatment on postoperative cognitive decline. Participants and Methods: An electronic search was performed using PubMed, Psychinfo, EmBase, Cochrane Database of Systematic Reviews and clinicaltrial.gov (until November 2019). No year or language restrictions were applied. Only randomized, double-blind, placebocontrolled studies that investigated clinical outcome in adult patients who underwent surgery under general anaesthesia (except brain surgery) were included. The search yielded 574 papers, of which nineteen fulfilled the inclusion criteria. Results: The current meta-analysis found a significant effect of different anti-inflammatory agents on the incidence of POCD (OR=0.67, p=0.010). Administration of COX-2 inhibitors (OR=0.31, p<0.0001), ketamine (OR=0.44, p=0.38) and lidocaine (OR=0.79, p=0.33) showed better results than placebo in a meta-analysis of at least two studies. Erythromycin (OR=0.14, p=0.006), erythropoietin (OR=0.15, p=0.07) and dexmedetomidine (OR=0.58, p=0.03) were significant in single studies. No beneficial effects on cognition were found for magnesium, 17βestradiol, dexamethasone and melatonin. Conclusion: The results of this meta-analysis provide evidence for a potential efficacy of anti-inflammatory agents on POCD, but further research is necessary to determine which agents are most appropriate for clinical application

Effectiveness of RESET:a strategic executive treatment for executive dysfunctioning in patients with Parkinson's disease

In this multicentre randomised controlled trial (RCT), 43 patients with Parkinson’s disease (PD) were randomly allocated to either the experimental condition receiving cognitive rehabilitation including strategy training (ReSET; Strategic Executive Treatment, n = 24) or to the control condition receiving computerised repetitive practice training for attention (Cogniplus, n = 16). We expected that strategy training (ReSET) would be more effective than cognitive training (Cogniplus) in improving patients’ everyday life executive functioning. Neuropsychological assessment was administered at baseline, at 2 weeks and 3–5 months post-treatment. Primary outcome measure was the Role Resumption List (RRL). Secondary outcome measures were treatment goal attainment (TGA), Dysexecutive Questionnaire (DEX), Parkinson’s Disease Questionnaire (PDQ-39), Zarit Burden Interview (ZBI) and neuropsychological tests. No effects of treatment were found on the primary outcome measure and on neuropsychological tests, except for one test of attention. At 2 weeks and 3–5 months post-treatment, PD patients in both the ReSET and Cogniplus group reported a significant improvement in everyday life executive functioning, as measured with TGA and the DEX-self, with an advantage for ReSET only shortly after treatment. Given these results and that PD patients were able to adhere to these treatments despite their motor symptoms and fatigue (i.e., the drop-out rate was small), we conclude that both strategy training and cognitive training for impairments in EF might be beneficial and feasible for PD patients