Search

Objective Soroxchi/Acute Mountain Sickness (AMS) is a condition that can result in cerebral and pulmonary hypoxia. Neuropsychological research on AMS is minimal and the long-term effects on cognition and behavior are unclear. AMS is associated with cognitive impairments in processing speed, attention, and executive functions as well as neurobehavioral symptoms. This case study delineates the neuropsychological and neurobehavioral changes secondary to bilateral globus pallidus (GP) lesions associated with AMS. Case Description Patient is a 51-year old, primarily Spanish-speaking, male of Mexican descent with 9 years of education, and who had traveled to La Paz, Bolivia (4,070 MASL) for work. Upon arrival, fatigue and dizziness led to hospitalization to treat acute pulmonary edema and hypoxia. Brain MRI revealed hyperintense bilateral GP lesions. Medical history was notable for hyperlipidemia. Psychiatric history was unremarkable. Neuropsychological assessment 4 months post-AMS revealed impairments in visuo-conceptual and speeded complex visuospatial abilities, executive functions, and confrontation naming. Cognitive improvements were noted in delayed recall of non-contextual verbal information and confrontation naming ten months post-AMS. Significant mood and personality changes were reported; patient endorsed anhedonia, fatigue, alexithymia, avolition, and sleep difficulties. Family described patient as depressed, apathetic, and socially withdrawn. Pharmacological and psychotherapy treatments were recommended and initiated. Diagnostic Impressions and Outcomes Findings were consistent with a diagnosis of Mild Neurocognitive Disorder. His family denied neurobehavioral improvements post interventions. Discussion This case study is the first to characterize the long-term neuropsychological and neurobehavioral changes following bilateral GP lesions secondary to AMS. Declines in visual-conceptual abilities reveal a new finding for this type of cerebral incident. [ABSTRACT FROM AUTHOR]

Objective Fergenbaum et al. 2009 found that obesity was linked to increased cognitive issues in otherwise healthy individuals, while another study found obesity to be neuroprotective in a sample of dementia patients (Fitzpatrick et al. 2009). The present study explores whether obesity is associated with worse cognitive dysfunction in those with Multiple Sclerosis (MS). Method This study examined archival neuropsychological test data of 40 patients diagnosed with MS. Participants were separated into two groups based on their BMI: healthy/overweight individuals and obese/morbidly obese. ANOVA was performed to compare performances between groups on tasks measuring learning and memory, processing speed, and executive functioning; areas commonly affected in MS. Results Significant differences between groups were noted on only portions of two different tests; unstructured verbal learning (p =.003) and mental sequencing (p =.048), but no differences were found in other tasks. Particularly, performance was statistically equal between groups on measures of response inhibition (p =.887), visual processing speed (p =.182), visuospatial learning (p =.118), visuospatial free recall (p =.205), simple auditory attention (p =.630), working memory (p =.223), psychomotor speed (p =.969), and complex divided attention (p =.202). Conclusion Obese patients with MS scored significantly better on the majority of tasks that we reviewed. These results seem to contradict a study that examined healthy subjects but seems to replicate findings in at least one clinical population; those with dementia. It is possible that increased BMI in clinical populations may indicate better overall health leading to better cognition, though if it is actually neuroprotective and only limited to MS and dementia is uncertain. Future research endeavors are discussed. [ABSTRACT FROM AUTHOR]

Objective Despite potential for dependence and adverse neurological effects, long-term benzodiazepine (BDZ) use is common among persons living with HIV (PLWH). As PLWH are at risk for CNS dysfunction, we retrospectively examined the association between BDZ use and HIV-associated neurocognitive disorders (HAND). Methods 306 PLWH (mean age = 45.1 years) underwent comprehensive neurobehavioral evaluations. Current BDZ use (BDZ+) was determined via self-report. Using propensity scores, 153 BDZ- individuals were matched to 153 BDZ+ participants on demographics, HIV disease characteristics, and comorbidities. Multiple regression models examined HAND and demographically-adjusted neurocognitive T-scores as a function of BDZ group, adjusting for estimated premorbid ability, current affective symptoms, and nadir CD4 count. Secondary analyses explored neurocognitive correlates of positive BDZ urine toxicology screens (TOX+). Results Median BDZ use was 24 months. Compared to BDZ-, BDZ+ had higher likelihood of HAND (OR = 2.14; p =.003) and poorer global (d = -0.33, p =.005), processing speed (d = -0.29, p =.013), and motor T-scores (d = -0.35, p = 0.003). Compared to BDZ+/TOX-, BDZ+/TOX+ users exhibited additional decrements in global (p =.033), executive function (p =.019), and delayed recall T-scores (p =.006). Conclusions BDZ use may elevate risk for HAND, potentially through diffuse neurocognitive slowing and acute compromise of recall and higher-order capacities. These effects are robust to psychosocial and HIV-specific factors and occur in comparison to a tightly-matched BDZ- group. Indications for BDZs (e.g. insomnia) may also impact neurocognition and/or manifest from latent neuropathology. Longitudinal studies should evaluate potential causal associations between HAND and BDZs. Given the extent of BDZ use and possibility of neurocognitive recovery post-abstinence, interventional studies should explore treatment alternatives to BDZs in PLWH. [ABSTRACT FROM AUTHOR]

Objective Lesions to the retrosplenial cortex secondary to acute stroke or tumor have been shown to disrupt Papez's circuit due to disconnection between the anterior thalamus and hippocampus, via the posterior cingulate, producing an amnestic syndrome. This case demonstrates how small but strategic lacunes in this region may produce memory deficits. Method The patient is a 52-year-old, right-handed, African-American woman with 18 years of education who reported memory changes over the last 8 years (e.g. misplacing items, forgetting details of conversations). Her medical history was notable for BMI of 31 and borderline diabetes. She completed structural magnetic resonance imaging 6 years prior to, and concordant with, her neuropsychological evaluation. Both scans showed two small (2-3 mm) right-sided retrosplenial lacunes, without evidence of hippocampal or global volume loss over the 6-year span. Results Her neurocognitive profile was characterized by impairments in both verbal (stories, word-list) and figural memory, with relative strengths in attention, processing speed, and executive functioning. Across memory measures, she performed in the low average-to-mildly impaired range on immediate recall, mildly-to-severely impaired range on delayed recall, and did not benefit from yes-no recognition format. She demonstrated additional features of an amnestic profile, including flat learning slope, recency effect, elevated cued recall intrusion errors, and very elevated false positive errors on recognition. Conclusions Findings expand upon the existing literature to show that chronic, small retrosplenial lacunes can disrupt the connection between the anterior thalamus and hippocampus, resulting in a clinical presentation of circumscribed memory impairment that persists years beyond acute vascular changes. [ABSTRACT FROM AUTHOR]

Objective Poorer sleep quality is related to worse cognitive functioning in the general population and people living with HIV; however, many studies use self-report sleep questionnaires that rely on retrospective recall. This study aimed to examine the relationship between objective (wrist actigraphy) and subjective sleep quality with neurocognitive functioning. Method Eighty-five adults aged 50-74 years with and without HIV (HIV+ n = 53, HIV- n = 32) were recruited from the community and ongoing studies at UC San Diego. Participants completed comprehensive neuropsychological testing assessing global and domain-specific cognition. Participants wore actigraphy watches for 14 nights after neuropsychological testing to objectively assess sleep quality (i.e. total sleep time (TST), efficiency, wake after sleep onset, and sleep fragmentation). The Pittsburgh Sleep Quality Index assessed subjective sleep quality. Results After adjusting for demographic variables and use of sleep medications, there were no differences in any sleep quality measures by HIV status (p's>0.05). In separate adjusted linear regression models, lower sleep efficiency (p = 0.02; 95% CI: -9.5, -1.1) and greater sleep fragmentation (p = 0.02; 95% CI: -0.82, -0.09) were associated with worse learning. Less TST was associated with worse working memory (p = 0.02; 95% CI: -9.2, -0.8). In contrast, worse subjective sleep quality was associated with worse executive function (p < 0.01; 95% CI: -1.18, -0.23) and working memory (p = 0.03; 95% CI: -1.22, -0.07). Conclusion Both objective and subjective sleep quality were associated with cognition in both persons with and without HIV; however, subjective and objective sleep quality were associated with different cognitive domains. Therefore, both objective and subjective sleep quality are important health behaviors to assess. [ABSTRACT FROM AUTHOR]

There is a high rate of medical and psychiatric comorbidities in the HIV population (Kilbourne et al, 2001), many of which complicate the clinical picture, especially with respect to cognitive functioning (Milanini & Valcour, 2017). It is important to be aware of the impact multiple disorders can have on formulating impressions and treatment planning. We reviewed the records of 35 consecutive patients with HIV seen in our neuropsychology clinic in a county hospital. The 30 men and 5 women had a mean age of 49 (SD = 13.7), with mean education of 13.5 years (SD = 2.0). Average age of HIV diagnosis was 33 (SD = 9.3). Patients had an average of eight major comorbid medical and psychiatric diagnoses, including ADHD (45%), mood disorders (62%), developmental disorders (11%), substance abuse or dependence (45%), sleep apnea (11%), TBI (31%), stroke (14%), cardiovascular disease (51%), and hepatitis (20%). Neuropsychological data were available for 33 patients. Performance on CVLT Trial 5 and Delayed Recall, Rey-Ostereith Copy, WAIS-IV Information and Digit Span, as well as Trail Making A and B were used to measure memory and executive functioning. 21% of the sample obtained one score that was >2 SD below the normative means, and 45% obtained 2 or more scores >2 SD below the mean.In this clinical sample referred for evaluation of cognitive functioning, there was a high rate of comorbid diagnoses. This review highlights the point that comorbid diagnoses are a common presentation and must be considered when discussing etiology of cognitive impairment and treatment planning. [ABSTRACT FROM AUTHOR]