Agreement between Computerized and Human Assessment of Performance on the Ruff Figural Fluency Test

The Ruff Figural Fluency Test (RFFT) is a sensitive test for nonverbal fluency suitable for all age groups. However, assessment of performance on the RFFT is time-consuming and may be affected by interrater differences. Therefore, we developed computer software specifically designed to analyze performance on the RFFT by automated pattern recognition. The aim of this study was to compare assessment by the new software with conventional assessment by human raters. The software was developed using data from the Lifelines Cohort Study and validated in an independent cohort of the Prevention of Renal and Vascular End Stage Disease (PREVEND) study. The total study population included 1,761 persons: 54% men; mean age (SD), 58 (10) years. All RFFT protocols were assessed by the new software and two independent human raters (criterion standard). The mean number of unique designs (SD) was 81 (29) and the median number of perseverative errors (interquartile range) was 9 (4 to 16). The intraclass correlation coefficient (ICC) between the computerized and human assessment was 0.994 (95%CI, 0.988 to 0.996; p<0.001) and 0.991 (95%CI, 0.990 to 0.991; p<0.001) for the number of unique designs and perseverative errors, respectively. The mean difference (SD) between the computerized and human assessment was -1.42 (2.78) and +0.02 (1.94) points for the number of unique designs and perseverative errors, respectively. This was comparable to the agreement between two independent human assessments: ICC, 0.995 (0.994 to 0.995; p<0.001) and 0.985 (0.982 to 0.988; p<0.001), and mean difference (SD), -0.44 (2.98) and +0.56 (2.36) points for the number of unique designs and perseverative errors, respectively. We conclude that the agreement between the computerized and human assessment was very high and comparable to the agreement between two independent human assessments. Therefore, the software is an accurate tool for the assessment of performance on the RFFT

Does playing chess make children smart?

Schaken is een van oudsher klassiek bordspel waarbij veel cognitieve vaardigheden nodig zijn, zoals concentratie, planning en inhibitie. Daarom zijn het vaak de slimme kinderen die kiezen voor schaakles of zelfs eerder toegang krijgen tot het volgen van schaakles, binnen en buiten school. Maar zijn het de slimme kinderen die schaaklessen gaan volgen of worden kinderen ook slimmer van schaken? Om slimmer te worden van schaakles zou ‘far transfer’ van leren moeten optreden. Dit is overdracht van vaardigheden tussen minder sterk gerelateerde domeinen, zoals lijkt te gebeuren bij schaken en rekenvaardigheid, omdat beide domeinen kenmerken delen (numerieke en ruimtelijke vaardigheden). Daarnaast zijn er prille aanwijzingen dat schaken een positieve invloed heeft op het executief functioneren van kinderen, zoals cognitieve flexibiliteit, planning en inhibitie. Omdat betere executieve functies zijn gerelateerd aan betere schoolvaardigheden hypothetiseren wij een mediërende rol voor executieve functies in de relatie tussen schaakles en schoolvaardigheden. Schaken kan in dit geval gezien worden als een vorm van executieve functietraining, waarbij de principes van dergelijke trainingen gevolgd kunnen worden om cognitieve functies bij kinderen te verbeteren (zoals het uitdagend maken van de training). Deze training kan onder andere ingezet worden bij achterblijvende schoolprestaties en cognitieve ontwikkeling. Schaken is dus niet alleen voor slimme kinderen. Voor ieder niveau zijn er varianten op het klassieke schaakspel, waardoor iedereen, ook jonge kinderen, op een speelse en ontdekkende manier met schaken in aanraking kunnen komen

Cognitive functioning in patients treated for nonfunctioning pituitary macroadenoma and the effects of pituitary radiotherapy

Context and objective Cognitive deterioration is reported in patients with a nonfunctioning pituitary macroadenoma (NFA) and after pituitary radiotherapy. However, reported results are inconsistent and are potentially confounded by different underlying pituitary disorders. The aim of this study was to examine cognitive functions in patients previously treated for NFA with or without radiotherapy. Design Verbal memory was assessed with the Dutch equivalent to the Rey Auditory Verbal Learning Test (15 Words Test, 15 WT). Executive functioning was examined using the Ruff Figural Fluency Test (RFFT). We compared our patient cohort with large reference populations representative of the Dutch population. Patients Eighty-four patients (62 +/- 10 years) who underwent transsphenoidal surgery 8.6 +/- 6.3 years earlier participated. Patients who underwent radiotherapy (n = 39) were compared to those who received surgery alone (n = 45). All patients were on stable hormonal replacement therapy. Results The total patient group scored significantly below the reference sample on all 15 WT z-scores (95%CI): short-term memory, -0.3 (-0.5 to -0.1); total memory, -0.8 (-1.1 to -0.5); learning score, -0.3 (-0.5 to -0.1); delayed memory, -0.8 (-1.1 to -0.5), all P <0.01. The total patient group scored significantly below the reference sample on RFFT z-scores (95%CI): unique designs, -0.7 (-0.9 to -0.5) and perseverative errors, -0.5 (-0.8 to -0.2), both P <0.001. Patients who underwent radiotherapy showed no significant differences on cognition when compared to those who received surgery alone. Conclusion Patients with NFA score significantly worse on cognition compared to reference populations. Radiotherapy does not appear to have a major influence on cognition

Cognitive performance after postoperative pituitary radiotherapy: a dosimetric study of the hippocampus and the prefrontal cortex

Objective: The hippocampus and prefrontal cortex (PFC) are important for memory and executive functioning and are known to be sensitive to radiotherapy (RT). Radiation dosimetry relates radiation exposure to specific brain areas. The effects of various pituitary RT techniques were studied by relating detailed dosimetry of the hippocampus and PFC to cognitive performance. Methods: In this cross-sectional design, 75 non-functioning pituitary macroadenoma (NFA) patients (61+/-10 years) participated and were divided into irradiated (RT+, n=30) and non-irradiated (RT-, n=45) groups. The RT+ group (who all received 25 fractions of 1.8 Gy; total dose: 45 Gy) consisted of three RT technique groups: three-field technique, n=10; four-field technique, n=15; and five-field technique, n=5. Memory and executive functioning were assessed by standardized neuropsychological tests. A reconstruction of the dose distributions for the three RT techniques was made. The RT doses on 30, 50, and 70% of the volume of the left and right hippocampus and PFC were calculated. Results: Cognitive test performance was not different between the four groups, despite differences in radiation doses applied to the hippocampi and PFC. Age at RT, time since RT, and the use of thyroid hormone varied significantly between the groups; however, they were not related to cognitive performance. Conclusion: This study showed that there were no significant differences on cognitive performance between the three-, four-, and five-field RT groups and the non-irradiated patient group. A doseresponse relationship could not be established, even with a radiation dose that was higher on most of the volume of the hippocampus and PFC in case of a four-field RT technique compared with the three-and five-field RT techniques

No Effect of the Thr92Ala Polymorphism of Deiodinase-2 on Thyroid Hormone Parameters, Health-Related Quality of Life, and Cognitive Functioning in a Large Population-Based Cohort Study

Introduction: The presence of the Thr92Ala polymorphism of deiodinase-2 (D2) has been thought to have several effects. It may influence its enzymatic function, is associated with increased expression of genes involved in oxidative stress in brain tissue, and may predict favorable response to combination levothyroxine (LT4) plus triiodothyronine (T3) therapy. It was hypothesized that homozygous carriers of the D2-92Ala allele have different thyroid hormone parameters, and reduced health-related quality of life (HRQoL) and cognitive functioning. Methods: In 12,625 participants from the LifeLines cohort study with genome-wide genetic data available, the effects of the Thr92Ala polymorphism (rs225014) were evaluated in the general population and in 364 people treated with thyroid hormone replacement therapy, the latter mainly because of primary hypothyroidism. In addition to evaluating anthropometric data, medication use, and existence of metabolic syndrome, HRQoL was assessed with the RAND 36-Item Health Survey, and the Ruff Figural Fluency Test was used as a sensitive test for executive functioning. Data on thyrotropin, free thyroxine (fT4), and free T3 (fT3) levels were available in a subset of 4479 participants. Results: The mean age (-standard deviation) was 53 +/- 12 years and the body mass index was 27.0 +/- 4.5 kg/m(2) in the LT4 users compared with 48 +/- 11 years and 26.2 +/- 4.1 kg/m(2) in participants from the general population. The Ala/Ala genotype of the D2-Thr92Ala polymorphism was present in 11.3% of LT4 users and in 10.7% of the general population. In total, 3742/4479 subjects with thyroid hormone data available had normal TSH (0.4-4.0 mIU/L), and 88% of LT4 users were females. LT4 users had higher fT4, lower fT3, and a lower fT3/fT4 ratio, and female patients had lower scores on the HRQoL domains of physical functioning, vitality, mental health, social functioning, bodily pain, and general health compared with those not using LT4 (p <0.005). Executive functioning scores, as part of cognitive functioning, were comparable between female LT4 users and the general population. In both groups, the D2-Thr92Ala polymorphism was not associated with differences in TSH, fT4, fT3, the fT3/fT4 ratio, presence of metabolic syndrome or other comorbidities, use of medication, HRQoL, and cognitive functioning. Conclusion: The Thr92Ala polymorphism of D2 was not associated with thyroid parameters, HRQoL, and cognitive functioning in the general population and in participants on thyroid hormone replacement therapy

Cognition and brain abnormalities on MRI in pituitary patients

Purpose: The extent to which cognitive dysfunction is related to specific brain abnormalities in patients treated for pituitary macroadenoma is unclear. Therefore, we compared brain abnormalities seen on Magnetic Resonance Imaging (MRI) in patients treated for nonfunctioning pituitary macroadenoma (NFA) with or without impairments in cognitive functioning. Methods: In this cross-sectional design, a cohort of 43 NFA patients was studied at the University Medical Center Groningen. White matter lesions (WMLs), cerebral atrophy, (silent) brain infarcts and abnormalities of the temporal lobes and hippocampi were assessed on pre-treatment and post-treatment MRI scans. Post-treatment cognitive examinations were performed using a verbal memory and executive functioning test. We compared our patient cohort with large reference populations representative of the Dutch population. Results: One or more impairments on both cognitive tests were frequently observed in treated NFA patients. No treatment effects were found with regard to the comparison between patients with and without impairments in executive functioning. Interestingly, in patients with one or more impairments on verbal memory function, treatment with radiotherapy had been given more frequently (74% in the impaired group versus 40% in the unimpaired group, P = 0.025). Patients with or without any brain abnormality on MRI did not differ in verbal memory or executive functioning. Conclusions: Brain abnormalities on MRI are not observed more frequently in treated NFA patients with impairments compared to NFA patients without impairments in verbal memory or executive functioning. Conversely, the absence of brain abnormalities on MRI does not exclude impairments in cognition. (C) 2014 Elsevier Ireland Ltd. All rights reserved

Bland-Altman plot of computerized and human assessment of the number of unique designs.

<p>Left: human vs. human assessment (independent raters); right: computerized vs. human assessment.</p

Bland-Altman plot of computerized and human assessment of the number of perseverative errors.

<p>Left: human vs. human assessment (independent raters); right: computerized vs. human assessment.</p

Comparison of computerized and human assessment of the number of unique designs.

<p>Left: human vs. human assessment (independent raters); right: computerized vs. human assessment. Broken lines represent lines of identity. Abbreviations: ICC, intraclass correlation coefficient; Lin’s concordance, Lin’s concordance correlation coefficient.</p

Five-dot patterns in parts 1 to 5 of the Ruff Figural Fluency Test.

<p>Each part consists of 35 identical five-dot patterns [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0163286#pone.0163286.ref004" target="_blank">4</a>]. See also reference 6.</p