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Cognitive impairment and dementia are common non-motor symptoms in Parkinson’s disease (PD). To elucidate the potentially typical progression of cognitive decline in PD and its variation, we retrospectively surveyed neuropsychological data obtained at the Parkinson-Klinik Ortenau, Germany in the years 1996–2015. Many of the patients in the surveyed period were repeatedly admitted to our clinic and we were thus able to compile neuropsychological re-test data for 252 patients obtained at varying time intervals. Neuropsychological testing was conducted with the NAI (Nurnberger Alters-Inventar). This battery provides sub-tests that examine cognitive processing speed, executive function, working memory, and verbal/visual memory functions. The re-test time span varied across patients from below 1 year up to about 12 years. Most patients were seen twice, but some patients were tested up to eight times. The steepest rates of cognitive decline were observed for the NAI sub-tests Trail-Making, Maze Test, and Stroop-Word Reading/Color Naming. Intermediate rates of decline were found for Digit Span, Word List—Immediate Recall, and Picture Test. Stroop Test—Interference, Word List—Delayed Recognition, and Figure Test exhibited the slowest decline rates. We did not observe a significant effect of age at diagnosis or gender on the rate of decline. In sum, this study retrospectively evaluated cognitive decline in a sample of patients with PD. Our data suggest a broad cognitive decline that particularly affects the cognitive capacities for processing speed, executive functions, and immediate memory functions.

Background We previously reported that increasing severity of watershed (WS) injury in neonatal magnetic resonance imaging (MRI) is associated with worse language outcomes in early childhood. In the present study, we investigated the relationship between neonatal injury patterns and cognitive profile in adolescents with neonatal encephalopathy. Methods Term neonates with encephalopathy were prospectively enrolled and imaged using brain MRI from 1999 to 2008. Neonatal brain injury was scored according to the degree of injury in WS and basal ganglia/thalamus (BG/T) areas. The children underwent a neurocognitive assessment and follow-up brain MRI at the age of 10–16 years. The relationship between neonatal brain injury patterns and adolescent cognitive outcomes was assessed. Results In a cohort of 16 children, neonatal MRI showed WS injury in 7, BG/T injury in 2, and normal imaging in 7. Children with WS injury had lower estimated overall cognitive ability than those with normal imaging. Increasing WS injury score was associated with decreasing estimated overall cognitive ability, Perceptual Reasoning Index, and digit span score. Conclusions Children with the WS injury are at an increased risk of having problems in long-term intellectual ability. These cognitive outcomes may underlie early language difficulties seen in children with neonatal WS injury. Impact Adolescents with a history of neonatal encephalopathy and watershed pattern of injury on neonatal brain magnetic resonance imaging (MRI) had lower overall cognitive ability, perceptual reasoning skills, and auditory working memory than those with normal neonatal imaging. Children with post-neonatal epilepsy and cerebral palsy had the worst cognitive outcomes. Watershed pattern of injury confers high long-term differences in intellectual ability.

Background : Minor physical anomalies (MPAs) are established markers of abnormal neurodevelopment that also has been postulated to lead to attentional impairments. Both these variables are studied and found in schizophrenia. We aimed to compare the neuropsychological domain of attention in patients with schizophrenia and healthy controls and correlated the findings with number of MPAs. Methods : Thirty patients with early onset schizophrenia (in remission) and thirty healthy controls were recruited. While attention was assessed using the Digit span, the Digit vigilance and the Trail Making Tests, MPAs were comprehensively assessed using the 55 item Extended Waldrop Scale. Study variables were analysed using non-parametric measures. Results : Schizophrenia patients were found to have significantly higher cranio facial and total MPAs. Attentional impairment in patients was significantly impaired as compared to controls. There was no significant correlation between MPA scores and attentional measures. Conclusions : This study supports the finding that total and specific cranio-facial MPA scores and, impaired attention are indeed illness markers in schizophrenia patients. No distinguishable association, however, was found between MPAs and attentional measures. We suggest heterogeneity in brain morphogenesis, disease and treatment influences as possible hindrances. Keywords : Schizophrenia; Neurodevelopment; Neuropsychology; Minor physical anomalies; attention.

AIM To evaluate the cognitive function in dialysis patients over 60 years old and identify the contributing factors. METHODS A group of elderly dialysis patients in the Department of Nephrology, Pan'an People's Hospital between March 2015 and June 2018 were chosen as the subjects for this study. Patients were divided into two groups, those with cognitive impairment and those with normal cognitive function. Results of their Montreal Cognitive Assessment (MoCA) scores, Controlled Oral Word Association Test (COWAT), Wechsler Adult Intelligence Scale Digit Span subtest (WDMS), and Stanford Diagnostic Math Test (SDMT) were reviewed and analyzed. RESULTS Among the 110 elderly dialysis patients, 75 patients (68.18%) showed different levels of damage to their cognitive function. Their assessment scores on MoCA (total), MoCA subtests: visuospatial/executive, naming, attention, language, delayed recall, abstraction and orientation, COWAT (total), COWAT1, COWAT2, COWAT3, WMDS-Backward, and SDMT are significantly lower than patients with normal cognitive abilities (p

Aims: To identify cognitive tests that best differentiate between Posterior Cortical Atrophy (PCA) and typical Alzheimer's Disease (tAD), as well as PCA and healthy control (HC) participants. Method: Medline, PsycInfo and Web of Science were systematically searched using terms related to PCA, tAD, and cognitive testing. Seventeen studies were identified, including 441 PCA, 391 tAD, and 284 HC participants. Standardised effect sizes of mean scores were calculated to measure performance differences on cognitive tests for PCA versus tAD and PCA versus HC groups. Meta-analyses used a random effects model. Results: The most discriminating cognitive tests for PCA and tAD presentations were measures of visuospatial function and verbal memory. Large, significant effect sizes were produced for all measures of visuospatial function, most notably for Rey-Osterrieth Copy (Hedges' g =-2.79), VOSP Fragmented letters (Hedges' g =-1.73), VOSP Dot Counting (Hedges' g =-1.74), and VOSP Cube Analysis (Hedges' g =-1.98). For measures of verbal memory, the RAVLT delay and Digit Span Backwards produced significant medium effects (Hedges' g = .62 and-.56, respectively). Conclusion: Establishing a common framework for testing individuals with PCA has important implications for diagnosis and treatment, and forms a practical objective for future research. Findings from this meta-analysis suggest that measures of visuospatial function and verbal memory would form an important part of this framework. Crown Copyright (c) 2021 Published by Elsevier Ltd. All rights reserved.

Cheng Chen,1,2,&ast; Xin Dong,1,&ast; Ping Gu,1 Keyan Chen,1 Qi Wan,1 Haiyue Xie,3 Zhaochun Shi,1 Teng Wang1 1Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China; 2Department of Neurology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, People’s Republic of China; 3The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Teng Wang; Zhaochun ShiDepartment of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of ChinaTel +86 256 830 6050; +86 256 830 3613Fax +86 258 371 8836Email tengwnjmu@163.com; 290694748@qq.comBackground and Purpose: Migraine suffering is more than the onset of head pain. The broad non-painful clinical symptoms associated with migraine are not well recognized. Recent researches support that migraineurs suffer attention deficits, but these findings are not conclusive. The purpose of our study was to assess whether patients with migraine without aura (MwoA) during the interictal period have attention impairment and to identify the migraine characteristics related to attention deficits.Methods: We enrolled subjects with MwoA during the interictal period and healthy controls matched for age, gender, and education level in this cross-sectional study. The attention network test (ANT) and a battery of neuropsychological tests, including the trail-making test (TMT), the digit span test (DST), and the Stroop test, were administered to the participants during the headache-free period.Results: Forty-four subjects with MwoA (4 males, 40 females) and 20 controls matched for age, gender, and literacy education were included. Patients in MwoA were more anxious (P = 0.007) and depressed (P = 0.001) than healthy subjects. Significant differences between the two groups were detected in the executive network (P = 0.006) but not in the alerting and orienting networks of ANT. Mean reaction time of ANT in the MwoA group was significantly longer than that in the control group (P = 0.028). Patients showed worse performance on DST-forward (P < 0.001), DST-backward (P < 0.001), DS Total (P < 0.001), TMT-A (P < 0.001), TMT-B (P < 0.001) and TMT-d (P = 0.002). Differences found in executive functions between the two groups were unrelated to gender, age, literacy, anxiety, and depression. Multiple regression analysis revealed no relation between clinical characteristics of headache and scores on the executive function with MwoA.Conclusion: Our study suggested that patients in MwoA present worse performances on the executive control of attention networks during the headache-free period, which appear not be associated with measures of migraine severity. Although more studies are needed in this area, our results could be useful to find specific neuropsychological biomarker for migraine pathophysiology.Keywords: migraine without aura, attention, attention network test, executive function, reaction time

BACKGROUND: The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE: The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephone. METHOD: Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS: Consistent with research employing traditional face-to-face neuropsychological evaluations, both PVTs maintained adequate specificity (i.e., > 90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS

OBJECTIVE Using embedded performance validity (PVT) comparisons, Erdodi et al. suggested that Grooved Pegboard (GPB) T-score cutoffs for either hand (≤ 29) or both hands (≤ 31) could be used as additional embedded PVTs. The current study evaluated the relationship between these proposed cutoff scores and established PVTs (Medical Symptom Validity Test [MSVT]; Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). METHOD Participants (N = 178) were predominately Caucasian (84%) males (79%) with a mean age and education of 41 (SD = 11.7) and 15.8 years (SD = 2.3), respectively. Participants were stratified as "passing" or "failing" the GPBviaErdodi's proposed criteria. "Failures" on the MSVT, NV-MSVT, and RDS were based on conventional recommendations. RESULTS Moderate correlations between GPB classification and a condition of interest (COI; i.e. at least two failures on reference PVTs) were observed for dominant (χ2 (1, n = 178) = 34.72, ϕ = .44, p < .001), non-dominant (χ2 (1, n = 178) = 16.46, ϕ = .30, p = .001), and both hand conditions (χ2 (1, n = 178) = 32.48, ϕ = .43, p < .001). Sensitivity, specificity, and predictive power were generally higher than Erdodi et al.'s initial findings. CONCLUSION These findingsprovide supportfor the clinical utility of the GPB as an additional embedded PVT. More specifically, dominant and both hand cutoffs were found to be more robust measures ofnon-genuine performance in those without motor deficits. While promising, sensitivity continues to be low; therefore, it is ill-advised to use the GPB as a sole measure of -performance validity.

Aims of the study: We aimed to define the cognitive burden of the largest pseudotumor cerebri syndrome (PTCS) population to date, compare objective to subjective cognitive dysfunction, and determine clinical predictors of cognitive dysfunction amongst an array of previously unstudied factors. Clinical rationale: Patients with PTCS commonly report cognitive dysfunction, a factor associated with poor quality of life. It is not definitively known whether cognitive impairment is present in these patients, and what features of the syndrome predict impairment. Materials and methods: We administered a cognitive battery consisting of the National Adult Reading Test, Mini-Mental Status Exam, Digit Span, Boston Naming Test, Rey Auditory Verbal Learning Test, Clock Drawing, Trail Making Test, Controlled Oral Word Association, and Category Fluency. Cognitive impairment was defined as mild-single domain with one test score, and mild-multiple domain with two scores, more than two standard deviations below the mean for age-, gender-, and education-adjusted norms. Results: One-hundred and one prospectively recruited PTCS patients were enrolled. The objective testing showed 30 patients had mild-single domain impairment, and 25 had mild-multi domain impairment. More patients without objective cognitive impairment had transverse venous sinus stenosis, but otherwise the groups did not differ. Two measures of headache severity, the Headache Impact Test and pain on the Numeric Rating Scale, were negatively associated with the composite cognitive score, as was ocular pain, vision-related disability, and mental health. Opening pressure and visual function were not associated with objective cognitive impairment. We found no association between subjective and objective cognitive impairment. Conclusions and clinical implications: Patients with PTCS may be cognitively impaired, and this correlates with measures of headache burden. Studies evaluating cognitive impairment before and after remission of the headache disorder would have to be performed to investigate this relationship further. Patients with self-perception of cognitive burden are no more likely to be cognitively impaired.

Background Associations have been found between single nucleotide polymorphisms (SNPs) in the MTHFR gene and cognitive outcomes in cancer survivors. Prior research has demonstrated that the presence of MTHFR SNPs (rs1801131 and rs1801133) in survivors of acute lymphoblastic leukemia (ALL) corresponds to impairments in attention and executive functioning. The current study examines the associations between rs1801131 and/or rs1801133 SNPs and cognitive performance in long-term survivors of medulloblastoma. Procedure: Eighteen pediatric medulloblastoma survivors, on average 12.42 years post-diagnosis, completed the Digit Span Forward, Digit Span Backward, California Verbal Learning Test Trial 1, and Auditory Consonant Trigrams tests. MTHFR SNPs were detected using whole genome sequencing data and custom scripts within R software. Results: Survivors with a rs1801131 SNP performed significantly worse on Digit Span Backward than survivors without this SNP exhibiting a large effect (p = 0.049; d = 0.95). Survivors with a rs1801131 SNP performed worse on Digit Span Forward (d = 0.478) and the CVLT Trial 1 (d = 0.417) with medium effect sizes. In contrast to rs1801131, relationships were not identified between a rs1801133 SNP and these performance measures. Conclusions Our findings demonstrate the potential links between MTHFR SNPs and cognitive outcomes following treatment in brain tumor survivors. The current findings establish a novel relationship between rs1801131 and working memory in medulloblastoma. Increases in homocysteine levels and oxidative damage from radiation may lead to adverse long-term outcomes. This establishes the need to look beyond leukemia and methotrexate treatment to consider the risk of MTHFR SNPs for medulloblastoma survivors.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms and motor complications of Parkinson’s disease (PD). The intervention is expected to result in some cognitive changes, the nature of which is not uniform across the studies which have reported them. PD itself is associated with progressive cognitive decline and hence longitudinal follow-up studies with medically managed control group of patients are needed to explore the cognitive deficits attributable to DBS. We conducted a prospective comparative observational study to assess the effects of bilateral STN DBS on cognition. Cognitive functions were assessed at baseline and after a minimum of two years after surgery, and compared with baseline and follow-up assessments in patients on medical management alone. Thirty-four patients with PD who underwent bilateral STN DBS and thirty-four medically managed patients participated in the study. At a mean follow-up of around 33 months, we found a significant decline in verbal fluency scores in the DBS group compared to those on medical management alone (1.15 ± 1.23 vs 0.59 ± 0.93, p = 0.034) and a trend for decline was noted in digit span test. There was no difference in the performance in tests addressing other cognitive domains, or tests of global cognitive function. No patient developed dementia. Motor functions and activities of daily living (ADL) were significantly better in the surgical group. STN DBS results in minor deficits in executive functions, particularly verbal fluency. These may be inconsequential, considering the marked improvement in motor functions and ADL.

OBJECTIVE We intend to evaluate the change of different cognitive functions after a guard shift in physicians. METHODS A descriptive observational study was performed. The study population included Spanish physicians who were asked to complete before and immediately after their guard shift the following tests: Digit Span, TMT-A, TMT-B, Symbol Digit, Stroop, Free and Cued Selective Reminding, creep and formal fluency, Visual Orientation and Space Perception tests, and the Leeds Sleep Questionnaire. RESULTS Thirty subjects were included in the study among which 43.3% were female. The mean subjective impression of the guard shift was 4.47/10 (2.57) and was correlated with the number of sleep hours during the guard shift (r = 0.72, p

Jihui Yue,1,2,&ast; Shuming Zhong,1,&ast; Aimin Luo,3 Shunkai Lai,1 Tingting He,4 Yuchong Luo,2 Ying Wang,5 Yiliang Zhang,1 Shiyi Shen,4 Hui Huang,4 Shenglin Wen,2 Yanbin Jia1 1Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People’s Republic of China; 2Department of Psychiatry, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People’s Republic of China; 3Department of Psychology, Guangdong Sanjiu Brain Hospital, Guangzhou, Guangdong Province, People’s Republic of China; 4School of Management, Jinan University, Guangzhou, Guangdong Province, People’s Republic of China; 5Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanbin JiaDepartment of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of ChinaTel +86 13392489168Fax +86 020-38688888Email Yanbinjia2006@163.comPurpose: This study aimed to investigate the mechanism of working memory (WM) impairment in drug-naive obsessive-compulsive disorder (OCD) by using neuropsychological tests and proton magnetic resonance spectroscopy (1H-MRS).Patients and Methods: A total of 55 patients with drug-naive OCD and 55 healthy controls (HCs) were recruited for this study. The working memory (WM) was evaluated using the digit span test (DST), visual space memory test (VSMT), and the 2-back task and stroop color word test (SCWT). The bilateral metabolite levels of the prefrontal cortex (PFC) were evaluated by 1H-MRS, then determined the ratios of N-acetyl aspartate (NAA), choline-containing compounds (Cho), and myo-inositol (MI) to creatine (Cr). The independent sample t-test was used to analyse the differences in WM performance and neurometabolite ratios. Multivariate linear regression analysis was performed to screen the influential factors of WM, with an introduction level of 0.05 and a rejection level of 0.10.Results: 1) Patients with OCD performed significantly worse on DST (score), VSMT (score), 2-back task (accuracy rate), SCWT (execution time) when compared with HCs. 2) NAA/Cr and Cho/Cr in the left PFC (lPFC) and MI/Cr ratios in the bilateral PFC of OCD patients were significantly lower when compared to HCs. 3) For OCD patients, the NAA/Cr ratio in the lPFC was negatively correlated with the score of DST (forwards), the Cho/Cr ratio in the lPFC was positively correlated with the accuracy rate of 2-back task, and the MI/Cr ratio in the right PFC (rPFC) was positively correlated with the score of DST (forwards) and the accuracy rate of VSMT. We also found that the compulsive symptoms showed a positive correlation with MI/Cr ratio of the rPFC.Conclusion: Drug-naive OCD patients have demonstrated WM impairments, including phonological loop, visual-spatial sketchpad and central executive system, and the WM impairments might be associated with hypometabolism in the PFC, especially the lPFC.Keywords: obsessive compulsive disorder, prefrontal cortex, working memory, neurometabolites, proton magnetic resonance spectroscopy

Background Although NKX 2.1 related chorea has been considered benign due to the favourable course of motor phenotype during life, the neurological condition is not limited to chorea, including non-motor symptoms in the developmental, cognitive and psychiatric domain. Aim of our study was to test working memory, attention and planning abilities of a cohort of NKX2.1 choreic patients compared to healthy controls. Methods patients and healthy controls were assessed for working memory (Visual Digit Span test), response inhibition and sustained attention (Cued Go/No-Go test), and spatial problem-solving and planning task (Tower of London test). For experimental protocol, we used a computer based tool for neuropsychological experiments, Inquisit 5.0 software (Millisecond Software®). Non-parametric tests were performed for statistical analysis. Results six patients and fifteen healthy paediatric controls were recruited. In the Digit Span test, both in forward and backward recall, patients showed statistically significant lower scores than controls. In the Cued Go/No-Go test as well as in the Tower of London, NKX 2.1 patients showed similar scores in the error rate and total score respectively, whereas in both tests they appeared to be slower than controls suggesting a poor performance in the execution of the tests. Conclusions our findings demonstrate that patients with NKX2.1-related chorea show a selective impairment in working memory with increased latencies in both planning and attention. A developmental alteration of the cholinergic neurotransmission in the basal forebrain and the disruption of striatal networks could explain, at least in part, this neuropsychological profile.

[Background] Gliomas are typically considered to cause relatively few neurological impairments. However, cognitive difficulties can arise, for example during treatment, with potential detrimental effects on quality of life. Accurate, reproducible, and accessible cognitive assessment is therefore vital in understanding the effects of both tumor and treatments. Our aim is to compare traditional neuropsychological assessment with an app-based cognitive screening tool in patients with glioma before and after surgical resection. Our hypotheses were that cognitive impairments would be apparent, even in a young and high functioning cohort, and that app-based cognitive screening would complement traditional neuropsychological assessment., [Methods] Seventeen patients with diffuse gliomas completed a traditional neuropsychological assessment and an app-based touchscreen tablet assessment pre- and post-operatively. The app assessment was also conducted at 3- and 12-month follow-up. Impairment rates, mean performance, and pre- and post-operative changes were compared using standardized Z-scores., [Results] Approximately 2–3 h of traditional assessment indicated an average of 2.88 cognitive impairments per patient, while the 30-min screen indicated 1.18. As might be expected, traditional assessment using multiple items across the difficulty range proved more sensitive than brief screening measures in areas such as memory and attention. However, the capacity of the screening app to capture reaction times enhanced its sensitivity, relative to traditional assessment, in the area of non-verbal function. Where there was overlap between the two assessments, for example digit span tasks, the results were broadly equivalent., [Conclusions] Cognitive impairments were common in this sample and app-based screening complemented traditional neuropsychological assessment. Implications for clinical assessment and follow-up are discussed., RRG is funded by a Guarantors of Brain Post-Doctoral Fellowship award, by a Cancer Research UK Cambridge Centre RG86786 (CRUK grant ref: A25117) grant, and by the EMERGIA Junta de Andalucía program. Y. E. is funded by a Royal Society Dorothy Hodgkin Research Fellowship. M. A. is funded by the Cambridge Trust–Yousef Jameel Scholarship. S. J. P. is supported by the National Institute for Health Career Development Fellowship (CDF-2018-11-ST2-003). This report is an independent research supported by the National Institute of Research (NIHR Career Development Fellowship, Mr. Stephen Price, CDF-2018-11-ST2-003). M. G. H. received an award from The Brain Tumour Charity (ref: RG86218) to fund this work.

BACKGROUND Cosmos caudatus (CC) is traditional Asian vegetable, commonly consumed among the Southeast Asian population. It has been reported to be high in flavonoids and might potentially improve brain activity among older adults with mild cognitive impairment (MCI). The effect of CC in brain activation improvement using neuroimaging is yet to be discovered. PURPOSE To investigate the effects of CC supplement on brain activity using functional magnetic resonance imaging (fMRI) among older adults with MCI. STUDY TYPE Prospective, randomized, double-blind, placebo-controlled trial. POPULATION/SUBJECTS Twenty older adults with mild cognitive impairment (60-75 years old), 14 of them (70%) were female subjects. FIELD STRENGTH/SEQUENCE A 3.0-T, T1-weighted anatomical images, T2*-weighted imaging data, A single shot, gradient echo-echo planar imaging (EPI) sequence. ASSESSMENT All subjects were asked to consume two 500 mg capsules of either CC supplement or placebo (maltodextrin) daily for 12 weeks. Cognitive function was measured using validated neuropsychological tests (i.e. Mini-mental State Examination and Digit Span) and task-based fMRI (N-back and Stroop Color Word Test) at baseline and 12th week. Brodmann's area 9, 46 and anterior cingulate cortex were selected as the regions of interest to define dorsolateral prefrontal cortex (DLPFC) in fMRI analysis. STATISTICAL TESTS Normality test was performed with the Shapiro-Wilk test. Two-way repeated ANOVA determined the intervention effects of the CC supplementation on brain activity after adjustments for covariates. Significance level at P

Background: Children with Down Syndrome commonly suffer from phonological and other language disorders which have been partly attributed to underlying deficit in phonological short term memory. Its evaluation was previously confined to non word repetition and/or forward digit span tasks. Aim of Study: To assess phonological short term memory in children with Down Syndrome with mild degree of intel-lectual disability in comparison with non syndromic children with mild degree of intellectual disability to find out any possible correlation between Down Syndrome and phonolog-ical short term memory deficits through comprehensive eval-uation. Subjects and Methods: This case control study has been conducted on 40 children (20 Down Syndrome children with mild degree of intellectual disability, 20 non syndromic children with mild degree of intellectual disability with matched mental age). All of them underwent psychometric evaluation, audiological evaluation, language evaluation using Arabic version of Modified Preschool Language Scale-4th edition (PLS-4), and Arabic version of Phonological Short Term Memory Test (PSTM). Results: Down Syndrome group scored significantly lower than non syndromic children with mild degree of intellectual disability in all items of phonological short term memory test; digit span, syllable repetition, non sense word repetition, dissimilar word set recall, similar word set recall, total score (p-value 0.000, 0.001, 0.004, 0.000, 0.000, 0.000 respectively) and language test; expressive abilities was lower in Down syndrome children (p-value 0.002) but both groups were equal in their receptive abilities (p-value 0.054). Conclusion: Children with Down Syndrome scored below expected for phonological short term memory and their pho-nological store was extensively impaired.

Objective This study examined the degree to which verbal and visuospatial memory abilities influence performance validity test (PVT) performance in a mixed clinical pediatric sample. Method Data from 252 consecutive clinical pediatric cases (Mage=11.23 years, SD=4.02; 61.9% male) seen for outpatient neuropsychological assessment were collected. Measures of learning and memory (e.g., The California Verbal Learning Test-Children’s Version; Child and Adolescent Memory Profile [ChAMP]), performance validity (Test of Memory Malingering Trial 1 [TOMM T1]; Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition Digit Span indices; ChAMP Overall Validity Index), and intellectual abilities (e.g., WISC-V) were included. Results Learning/memory abilities were not significantly correlated with TOMM T1 and accounted for relatively little variance in overall TOMM T1 performance (i.e., ≤6%). Conversely, ChAMP Validity Index scores were significantly correlated with verbal and visual learning/memory abilities, and learning/memory accounted for significant variance in PVT performance (12%–26%). Verbal learning/memory performance accounted for 5%–16% of the variance across the Digit Span PVTs. No significant differences in TOMM T1 and Digit Span PVT scores emerged between verbal/visual learning/memory impairment groups. ChAMP validity scores were lower for the visual learning/memory impairment group relative to the nonimpaired group. Conclusions Findings highlight the utility of including PVTs as standard practice for pediatric populations, particularly when memory is a concern. Consistent with the adult literature, TOMM T1 outperformed other PVTs in its utility even among the diverse clinical sample with/without learning/memory impairment. In contrast, use of Digit Span indices appear to be best suited in the presence of visuospatial (but not verbal) learning/memory concerns. Finally, the ChAMP’s embedded validity measure was most strongly impacted by learning/memory performance.

Objective: Attention is the cardinal feature of delirium, but attentional domains may also be affected by dementia and its severity. It is, therefore, of interest to study the correlation between the severity of cognitive impairment in non-delirious patients and different measurements of attentional performance, to identify attention subdomains less affected by severity of cognitive impairment. Methods: Neuropsychological data from non-delirious outpatients (age ≥ 65 years), presenting at two memory clinics were analysed retrospectively. Scores for selective, divided, and sustained attention were correlated with cognitive impairment as defined by the score of the Mini-Mental State Examination. Results: A total of 1658 outpatients were included. The mean age was 77.15 (± 8.17) years, with a mean MMSE score of 22.67 (± 4.91). Compared to the type of attention, the tests that are less influenced by the severity of cognitive impairment are those of selective attention, in particular the Digit Span Forward (DSF). Conclusions: This is the first study to correlate deficits in attention subdomains with the degree of cognitive impairment in non-delirious patients. The results suggest that measurements of selective attention (i.e. DSF) might be better suited to discriminate delirium from dementia. Indeed, a lower score on these tests might be indicative of an acute change and worsening of the baseline inattention and a longitudinal monitoring of these changes might be used to determine the delirium resolution.

Objective: The addition of Sequencing to WAIS-IV Digit Span (DS) brought about new Reliable Digit Span (RDS) indices and an Age-Corrected Scaled Score that includes Sequencing trials. Reports have indicated that these new performance validity tests (PVTs) are superior to the traditional RDS; however, comparisons in the context of known neurocognitive impairment are sparse. This study compared DS-derived PVT classification accuracies in a design that included adults with verified TBI. Methods: Participants included 64 adults with moderate-to-severe TBI (TBI), 51 healthy adults coached to simulate TBI (SIM), and 78 healthy comparisons (HC). Participants completed the WAIS-IV DS subtest in the context of a larger test battery. Results: Kruskal-Wallis tests indicated that all DS indices differed significantly across groups. Post hoc contrasts revealed that only RDS Forward and the traditional RDS differed significantly between SIM and TBI. ROC analyses indicated that RDS variables were comparable predictors of SIM vs. HC; however, the traditional RDS showed the highest sensitivity when approximating 90% specificity for SIM vs. TBI. A greater percentage of TBI scored RDS Sequencing < 1 compared to SIM and HC. Conclusion: In the context of moderate-to-severe TBI, the DS-derived PVTs showed comparable discriminability. However, the Greiffenstein et al. traditional RDS demonstrated the best classification accuracy with respect to specificity/sensitivity balance. This relative superiority may reflect that individuals with verified TBI are more likely to perseverate on prior instructions during DS Sequencing. Findings highlight the importance of including individuals with verified TBI when evaluating and developing PVTs.

Aim. The aim of our study was to verify the effectiveness of the innovative IntelligenceGym training in improving cognitive abilities in the elderly.Material and methods. We developed an original training method that requires interaction between motor and cognitive functions. In our study 123 women and 89 men, aged 68–76 were examined. The inclusion criteria were Mini-Mental State Examination (MMSE) scores of 23 to 25 at inclusion, autonomy in walking, medical certification to participate in light physical activity. We have proposed to the participants to attend IntelligenceGym training one hour twice a week for 24 weeks. Cognitive performance was assessed before and after intervention included MMSE, Forward and Backward Digit Span Test, Rey’s Auditory Verbal Learning test (RAVLT), TMT-A, TMT-B. Moreover, motor performance was tested by using the Time Up and Go (TUG) test.Results.The cognitive assessment after IntelligenceGym training showed statistically significant improvement in all the scores tested (t-test performed). The results showed that participants of the IntelligenceGym training had particularly improved performance in Digit Span, MMSE and TMT-B tests and also improvements in motor TUG test.Conclusion. These findings indicate that the IntelligenceGym training is an efficient tool to improve cognitive performance in older adults with borderline or mild cognitive deficiency.

Background: Tau neurofibrillary tangle burden increases with Alzheimer’s disease (AD) stage and correlates with degree of cognitive impairment. Tau PET imaging could facilitate understanding the relationship between tau pathology and cognitive impairment. Objective: Evaluate the relationship between 18F flortaucipir uptake patterns and cognition across multiple cognitive domains. Methods: We acquired flortaucipir PET scans in 84 amyloid-positive control, mild cognitive impairment (MCI), and AD subjects. Flortaucipir standardized uptake value ratio (SUVr) values were obtained from a neocortical volume of interest (VOI), a precuneus VOI, and VOIs defined by the correlation between flortaucipir SUVr images and domain-specific cognitive tests. Cognitive assessments included Mini-Mental State Exam (MMSE), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog), and a neuropsychological test battery (i.e., Wechsler Memory Scale-Revised Logical Memory (WMS-R), Trail Making Test, Boston Naming Test, Digit Symbol Substitution Test, Animal List Generation, WMS-R Digit Span, American National Adult Reading Test, Clock Drawing Test, Judgment of Line Orientation, and WMS-R Logical Memory II (Delayed Recall)) and the Functional Activities Questionnaire (FAQ). Correlation analyses compared regional and voxel-wise VOIs to cognitive scores. Results: Subjects included 5 controls, 47 MCI, and 32 AD subjects. Significant correlations were seen between both flortaucipir and florbetapir SUVrs and MMSE, ADAS-Cog, and FAQ. Cognitive impairment was associated with increased flortaucipir uptake in regionally specific patterns consistent with the neuroanatomy underlying specific cognitive tests. Conclusion: Flortaucipir SUVr values demonstrated significant inverse correlations with cognitive scores in domain-specific patterns. Findings support the hypothesis that PET imaging of neuropathologic tau deposits may reflect underlying neurodegeneration in AD.

Pharmacological treatments for mild cognitive impairment (MCI), are lacking, and alternative approaches have been implemented, including cognitive training (CT). Objective: To determine the impact of CT on cognitive and quality of life measures in patients with Parkinson’s disease (PD) who were seen a hospital neurorehabilitation program. Methods: Thirty-nine individuals with MCI-PD, according to the Movement Disorder Society, were randomly distributed into two groups: experimental and control group, matched for demographic and clinical characteristics. Both groups were assessed for cognition and quality of life at the beginning of the study and at the end of the intervention protocol. The following instruments were used to assess cognition and quality of life: Addenbrooke’s Cognitive Examination III, Digit Span, Trail Making Test (TMT, A and B) and Parkinson disease quality of life questionnaire. The experimental group (EG) engaged in CT, whereas the control group (CG) underwent activities of the general rehabilitation program. Results: No baseline evaluation differences were found. Intergroup analysis showed differences in measures, such as total score (1.977, p=0.0480) and visuospatial domain (-2.636, p=0.0084) of the ACE-III, with the EG performing better, in addition to better performance in TMT-B mistakes (-1.928, p=0.0439). Intragroup analysis revealed that the EG showed significant improvement in almost all the cognitive variables, well as in self-reported quality of life (total score and mobility, activities of daily living, body discomfort dimensions). Conclusions: Engagement in cognitive activities was associated with better cognitive abilities in PD-MCI. Future studies should consider the long-term effect of this type of intervention and impact on functional activities. RESUMO. A falta de evidência de tratamentos farmacológicos, especificamente para pacientes com comprometimento cognitivo leve na doença de Parkinson (CCL-DP), leva à implementação de abordagens alternativas, incluindo a reabilitação cognitiva. Objetivo: Determinar o impacto do treino cognitivo (TC) em medidas cognitivas e da qualidade de vida em pacientes com DP, que participavam de um programa de reabilitação neurológica hospitalar. Métodos: Total de 39 indivíduos com CCL-DP, de acordo com a Sociedade de Distúrbios do Movimento, foram distribuídos aleatoriamente em dois grupos: experimental e controle, pareados por características demográficas e clínicas. Ambos os grupos foram avaliados quanto à cognição e qualidade de vida no início do estudo e ao final do protocolo de intervenção. Os seguintes instrumentos foram utilizados para avaliar a cognição e a qualidade de vida: Exame Cognitivo III de Addenbrooke, teste de dígitos, TMT (A e B) e questionário de qualidade de vida da doença de Parkinson. O grupo experimental foi submetido ao treino cognitivo, ao passo que o grupo controle passou por atividades do programa de reabilitação. Resultados: Não foram encontradas diferenças na avaliação basal. A análise intergrupo mostrou diferenças em medidas, como escore total (1,977, p=0,0480) e domínio visuoespacial (-2,636, p=0,0084) da ACE-III, tendo o grupo experimental melhor desempenho, além de desempenho superior em TMT-B erros (-1,928, p=0,0439). A análise intragrupo revelou que o grupo experimental mostrou melhora significativa em quase todas as variáveis cognitivas, assim como na percepção de qualidade de vida (escore total e dimensões de mobilidade, atividades da vida diária e desconforto corporal). Conclusões: O envolvimento em atividades cognitivas foi associado a melhores habilidades cognitivas em pacientes com CCL-DP. Estudos futuros devem considerar o efeito a longo prazo desse tipo de intervenção e o impacto nas atividades funcionais.

We sought to establish norms and correlates for the Musical Ear Test (MET), an objective test of musical ability. A large sample of undergraduates at a Canadian university (N > 500) took the 20-min test, which provided a Total score as well as separate scores for its Melody and Rhythm subtests. On each trial, listeners judged whether standard and comparison auditory sequences were the same or different. Norms were derived as percentiles, Z-scores, and T-scores. The distribution of scores was approximately normal without floor or ceiling effects. There were no gender differences on either subtest or the total score. As expected, scores on both subtests were correlated with performance on a test of immediate recall for nonmusical auditory stimuli (Digit Span Forward). Moreover, as duration of music training increased, so did performance on both subtests, but starting lessons at a younger age was not predictive of better musical abilities. Listeners who spoke a tone language exhibited enhanced performance on the Melody subtest but not on the Rhythm subtest. The MET appears to have adequate psychometric characteristics that make it suitable for researchers who seek to measure musical abilities objectively.

Background: Myelin damage is a salient feature in cerebral small vessel disease (cSVD). Of note, myelin damage extends into the normal appearing white matter (NAWM). Currently, the specific role of myelin content in cognition is poorly understood. Objective: The objective of this exploratory study was to investigate the association between NAWM myelin and cognitive function in older adults with cSVD. Methods: This exploratory study included 55 participants with cSVD. NAWM myelin was measured using myelin water imaging and was quantified as myelin water fraction (MWF). Assessment of cognitive function included processing speed (Trail Making Test Part A), set shifting (Trail Making Test Part B minus A), working memory (Verbal Digit Span Backwards Test), and inhibition (Stroop Test). Multiple linear regression analyses assessed the contribution of NAWM MWF on cognitive outcomes controlling for age, education, and total white matter hyperintensity volume. The overall alpha was set at ≤0.05. Results: After accounting for age, education, and total white matter hyperintensity volume, lower NAWM MWF was significantly associated with slower processing speed (β = –0.29, p = 0.037) and poorer working memory (β= 0.30, p = 0.048). NAWM MWF was not significantly associated with set shifting or inhibitory control (p > 0.132). Conclusion: Myelin loss in NAWM may play a role in the evolution of impaired processing speed and working memory in people with cSVD. Future studies, with a longitudinal design and larger sample sizes, are needed to fully elucidate the role of myelin as a potential biomarker for cognitive function.

BACKGROUND: The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders. OBJECTIVE: To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals. METHODS: Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session. RESULTS: Thirty participants completed the protocol, ten per arm [14 women; mean age = 55.9; mean time post-stroke = 66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained. CONCLUSIONS: The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.

BACKGROUND Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group. METHODS This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered. RESULTS The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P

Background Despite pharmacological treatment, many individuals with multiple sclerosis (MS) continue to experience symptoms and medication side effects. Exercise holds promise for MS, but changes in brain structure following exercise have not been thoroughly investigated, and important cognitive and psychosocial variables are rarely primary outcomes. The aim of this pilot study was to investigate whether a 12-week exercise intervention would improve white matter integrity in the brain, or cognition, symptoms of fatigue, and depressed mood for individuals with relapsing-remitting MS (RRMS). Method Thirteen participants completed 12 weeks of speeded walking. Baseline and post-intervention testing included 3T diffusion tensor imaging (DTI) to assess white matter and neuropsychological testing to assess cognition, fatigue, and mood. Image pre-processing and analyses were performed in functional magnetic resonance imaging of the Brain Software Library. Results Post-intervention, there were no significant changes in white matter compared to baseline. Post-intervention, individuals with RRMS performed significantly better on the Symbol Digit Modalities Test (SDMT), reported fewer perceived memory problems, and endorsed less fatigue. Performance was not significantly different on Trails or Digit Span, and there were no significant changes in reports of mood. Conclusion Although 12 weeks of speeded walking did not improve white matter integrity, exercise may hold promise for managing some symptoms of RRMS in the context of this study population.

Cross-sectional studies show an association of decline in mental flexibility and inhibitory control with reduced gait speed and falls, as well as divided attention deficit and difficulty in initiating gait. Objective: To investigate the relationships between cognitive function and gait performance in patients with Parkinson’s disease (PD) who participated in a hospital neurorehabilitation program. Methods: A total of 107 patients (79 males, 28 females; mean age 61.00±8.2 years; mean schooling 11.7±4.1 years) with idiopathic PD (mean disease duration 5.5±4.1 years) were recruited for this study. Among them, 78.50% were in stages I and II of the Hoehn & Yahr Scale. Cognitive functions were evaluated through the Digit Span test, Trail Making Test, and Addenbrooke’s Cognitive Examination III. Motor function was assessed with the 10-Meter Walk Test, the short version of the Balance Evaluation Systems Test (Mini-BESTest), and the Timed Up and Go Test. Results: Balance skills were significantly correlated with global cognition and specific domains, including divided attention, verbal fluency, and visuospatial function. Functional mobility showed a significant association with all cognitive tests, except for the number of errors on TMT-A. Gait speed presented a significant correlation with global cognition scores, memory, and attention, including divided attention. Conclusions: These findings might help early identification of cognitive deficits or motor dysfunctions in PD patients who may benefit from rehabilitation strategies, as well as facilitate fall risk assessments and strategies to prevent falls. Future prospective studies are needed to investigate the effects of cognitive training on motor performance, since the difficulty in motor rehabilitation may be more related to cognitive loss than to motor damage. RESUMO. Estudos transversais mostram associação entre declínio da flexibilidade mental e controle inibitório com redução da velocidade de marcha e quedas, assim como déficit de atenção dividida e dificuldade para iniciar a marcha. Objetivo: Investigar as relações entre a função cognitiva e o desempenho da marcha em pacientes com Doença de Parkinson (DP) que participaram de um programa de reabilitação hospitalar. Métodos: Um total de 107 pacientes (79 homens, 28 mulheres; idade média de 61,00±8,2 anos, média de escolaridade 11,7±4,1) apresentando DP idiopática (duração média da doença: 5,5±4,1 anos) foram recrutados para o estudo. Desses, 78,50% estavam nos estágios I e II da Hoehn e Yahr. As funções cognitivas foram avaliadas por meio do teste de Dígitos Spam, Teste de Trilhas e Exame Cognitivo de Addenbrooke (terceira versão). A função motora foi examinada por meio do teste de caminhada de 10 metros, Mini BESTest e teste Timed Up and Go. Resultados: As análises de correlação mostraram que as habilidades de equilíbrio estavam significativamente correlacionadas com a cognição global e com domínios específicos, incluindo atenção dividida, fluência verbal e função visuoespacial. Além disso, a mobilidade funcional apresentou correlação significativa com todos os testes cognitivos, exceto TMT-A (erro). A velocidade da marcha mostrou correlação significativa com escores globais de cognição, memória e atenção, incluindo atenção dividida. Conclusões: Esses achados podem ajudar na identificação precoce de déficits cognitivos ou disfunções motoras em pacientes com DP que podem se beneficiar de estratégias de reabilitação, facilitar avaliações de risco de queda e estratégias de prevenção de queda. Estudos prospectivos futuros são necessários para investigar os efeitos do treino cognitivo no desempenho motor, uma vez que a dificuldade na reabilitação motora pode estar mais relacionada à perda cognitiva do que aos prejuízos motores.

Background Head injury is an important public health problem nowadays. Traumatic brain injury (TBI) results from external force that leads to damage to brain tissue. Main causes of TBI are motor vehicle collisions and fall from height. One of the primary symptoms after TBI is impaired word retrieval. Therefore, this study was undertaken to assess memory impairment in TBI patients following treatment to asses a residual memory status to declare them apt for official works if improved enough. Objectives The purpose of this study was to assess memory impairment in TBI patients to assess the residual memory status following treatment. Materials and Methods The study was conducted in Outpatient Department (OPD) of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh. The TBI patients were assessed by predesigned memory assessment questionnaire during their follow-up following discharge from hospital. Results A total of 65 patients with TBI were assessed, of which 21 (32.3%) cases had frontal lobe injuries with 9 of 21 having memory loss (42.9% cases). The temporoparietal lobe was affected in 10 (15.4%) cases out of which 5 developed memory loss, that is, 50% cases. The multiple lobes were involved in 24 (36.9%) cases, out of which memory impairment occurred in 9 cases, that is, 37.5%. Four of total five cases (80%) of diffuse axonal injury had memory loss. Further, 16.9% (n = 11) TBI patients were unable to perform digit span test (immediate memory test), 44.6% (n = 29) cases could not perform three-word recall at 5 minutes (short-term memory test), and 15.4% (n = 10) cases could not perform (long-term memory test). Conclusion The study showed that memory assessment is required in TBI patients for instituting proper rehabilitation measures and to allow them for sensitive memory-related work following discharge from hospital.

ObjectiveTo determine whether patients with Lewy body dementia (LBD) with likely Alzheimer disease (AD)–type copathology are more impaired on confrontation naming than those without likely AD-type copathology.MethodsWe selected 57 patients with LBD (dementia with Lewy bodies [DLB], n = 38; Parkinson disease dementia [PDD], n = 19) with available AD CSF biomarkers and neuropsychological data. CSF β-amyloid1-42 (Aβ42), phosphorylated-tau (p-tau), and total-tau (t-tau) concentrations were measured. We used an autopsy-validated CSF cut point (t-tau:Aβ42 ratio > 0.3, n = 43), or autopsy data when available (n = 14), to categorize patients as having LBD with (LBD + AD, n = 26) and without (LBD − AD, n = 31) likely AD-type copathology. Analysis of covariance tested between-group comparisons across biologically defined groups (LBD + AD, LBD − AD) and clinical phenotypes (DLB, PDD) on confrontation naming (30-item Boston Naming Test [BNT]), executive abilities (letter fluency [LF], reverse digit span [RDS]), and global cognition (Mini-Mental State Examination [MMSE]), with adjustment for age at dementia onset, time from dementia onset to test date, and time from CSF to test date. Spearman correlation related cognitive performance to CSF analytes.ResultsPatients with LBD + AD performed worse on BNT than patients with LBD − AD (F = 4.80, p = 0.03); both groups performed similarly on LF, RDS, and MMSE (all p > 0.1). Clinically defined PDD and DLB groups did not differ in performance on any of these measures (all p > 0.05). A correlation across all patients showed that BNT score was negatively associated with CSF t-tau (ρ = −0.28, p < 0.05) and p-tau (ρ = −0.26, p = 0.05) but not Aβ42 (p > 0.1).ConclusionMarkers of AD-type copathology are implicated in impaired language performance in LBD. Biologically based classification of LBD may be advantageous over clinically defined syndromes to elucidate clinical heterogeneity.

In this pilot study, the authors developed and evaluated a working memory intervention (WMI) using a combination of mobile phone-based application and an activity booklet, among children with idiopathic generalized epilepsy. Pre- and post-intervention cognitive evaluation at 8 wk included: subtests comprising working memory index from Wechsler Intelligence Scale-IV, color cancellation task for sustained attention, and parent’s rating from the Conners’ ADHD/DSM-IV Scales of the Conners’ Rating Scales-Revised. Fourteen children completed the intervention; one was lost to follow-up. Significant improvement in most working memory parameters occurred at 8 wk: digit span [scaled scores: median 7 (IQR 4–9) to 12 (IQR 9–14.25); p = 0.001]; letter-number sequencing [scaled scores: median 9 (IQR 5–10) to 11.5 (IQR 6.75–13); p = 0.03]; WMI [median 14 (IQR 9–18) to 22 (IQR 16.75–27); p = 0.001] and sustained attention [time for cancellation test improved from 95 (72–117) to 85 (63–98) s; p = 0.001]. This indigenous WMI was feasible and efficacious in improving working memory deficits in CWE in low-resource settings.

Introduction: Although working memory (WM) dysfunction has been proposed as a schizophrenia (SZ) endophenotype, the specific impaired component (encoding or maintenance) in patients and unaffected relatives remains inconclusive. We compared auditory-verbal and visuospatial WM in patients with SZ, unaffected siblings (USs), and healthy controls under 2 response conditions: immediate (encoding condition) and delayed (maintenance condition). Methods: We included 22 participants per group, similar in age and gender. Three WM tests (Spatial Span, Backward Digit Span, and Letter-Number Span) were administered under both conditions in a counterbalanced manner to all participants. Results: Poorer performance was found in the SZ group for all tests (p < 0.001). USs showed a better performance than patients, but worse than controls (p < 0.05), except for the Backward Digit Span test, in which their performance was similar to that of the SZ group. The effect of the delayed response in all tasks was not significant in any group. Conclusion: Our results indicate that WM impairment, including auditory-verbal and visuospatial modalities, corresponds to a stable feature of the disease as it is present in USs, thus confirming its potential endophenotypic property in SZ patients. No effect of the delayed response was observed, suggesting failures in encoding in both patients and USs.

Objectives Reduction in cognitive function of college students affects their academic recitation. Acupuncture is widely practiced for health promotion. Objective of this study was to evaluate the effect of acupuncture on cognitive task performance in college students. Methods Sixty students aged 18–25 years were randomly allocated into acupuncture group (AG) (n=30) and control group (CG) (n=30). The AG underwent 20 min of acupuncture/day, while the CG underwent their normal routine for 10 days. Assessments were performed before and after the intervention. Results Between-group analysis showed a significant increase in the six-letter cancellation test (SLCT) score in AG compared with CG. Within-group analysis showed a significant increase in the scores of all tests (i.e. SLCT, forward and backward Digit span test [DST]) in AG, while a significant increase in backward DST was observed in CG. Conclusion Acupuncture has a beneficial effect on improving the cognitive function of college students.

The overarching role of working memory, its characteristics, and functions in our cognitive system is conspicuous. Nevertheless, sex differences in digit span as an index of the phonological loop - one of the main components of the working memory system - remain puzzling. In spite of numerous attempts, the previous studies yielded inconsistent results. The focus of this article was to study potential sex differences in verbal forward digit span. To this end, a sample of 120 young adults ranging from 16 to 25 years old from Persian population was measured and the memory span scores were analyzed using the classical method of comparing the mean score as well as the relatively new method of comparing the frequency of extreme performances. Similar to some previous studies, no significant difference was observed between males and females’ mean score. However, analyzing the frequency of extreme scores revealed that females were slightly overrepresented in the lower tail of the score distribution. Considering the evidence observed in the present study and other similar works, it is very likely that sex differences in performing memory strategies, but not in the true size of short term memory, are the underlying reasons of the observed differences. The theoretical implications and practical importance of these findings are broadly discussed.

Introduction: Optimal cognitive performance is the essence of effective execution of a flying mission. Effects of two commonly encountered aviation stressors, hypoxia and noise, on performance have been studied. However, studies on effects of concurrent dual effects of both these stressors on key cognitive parameters are sparse; hence, the objective was to examine these effects. Material and Methods: Cognitive performances were assessed among 30 healthy volunteers (28 males and 2 females) sequentially in four different conditions – baseline (without stressors), 85 dB(A) noise, 14,000 ft altitude, and concurrent exposure to 85 dB(A) noise at 14,000 ft altitude. White noise was simulated through software, altitude in the hypobaric chamber and cognitive performance was assessed with tests from Psychology Experiment Building Language (PEBL) test battery. Data were analyzed using descriptive statistics and repeated measures ANOVA. Results: The study revealed statistically significant direct detrimental effect of altitude and noise on implicit reaction time independently as well as concurrently. However, there was insignificant interaction effect between the dual stressors on implicit reaction time. There were no statistically significant effects of dual stressors on implicit correctness, visuospatial working memory, and selective attention. Although statistically not significant, noise enhanced the performance level in the form of increased Corsi block memory span and Corsi block total score. Conclusion: No significant effect of the dual stressors was observed on most of the cognitive parameters. However, implicit reaction time, a measure of pilot’s risk-taking behavior, was found to be significantly affected by the dual stressors. Further research with a larger sample of aircrew population who differ in age, experience, and other potentially influencing factors is recommended.

Background: Cognitive decline in older adults is a serious public health problem today. Association between vitamin D supplementation and cognition remains controversial. Objective: To determine whether a 12-month vitamin D supplementation improves cognitive function in elderly subjects with mild cognitive impairment (MCI), and whether it is mediated through the mechanism in which telomere length (TL) regulate oxidative stress. Methods: This was a double-blind, randomized, placebo-controlled trial in Tianjin, China. Participants were all native Chinese speakers aged 65 years and older with MCI. 183 subjects were randomized to an intervention group (vitamin D 800 IU/day, n = 93) or a placebo group (the matching starch granules, n = 90), and followed up for 12 months. Tests of cognitive function and mechanism-related biomarkers were evaluated at baseline, 6 months, and 12 months. Results: Repeated-measures ANOVA showed substantial improvements in the full scale intelligence quotient (FSIQ), information, digit span, vocabulary, block design, and picture arrangement scores in the vitamin D group over the placebo group (p

الملخص: أهداف البحث: تهدف هذه الدراسة للتحقق من قدرة البوابات الحسية السمعية لدى الحفاظ باستخدام فحص استجابة جذع الدماغ السمعي مع أو بدون المهام النفسية. طرق البحث: تم اشراك ٢٣ مشاركا في هذه الدراسة. منهم ١١ من الحفاظ الذين يحفظون ٣٠ جزءا من القرآن الكريم و١٢ من غير الحفاظ كمجموعة التحكم. كان لجميع المشاركين إدراك سمع طبيعي وتم إخضاعهم لفحص استجابة جذع الدماغ السمعي مع أو بدون المهام النفسية. تمت استجابة جذع الدماغ السمعي عند ٧٠ ديسيبل باستخدام ٣٠٠٠ هرتز نغمة تحفيز اندفاعية مع ٢-٠-٢ دورة بمعدل تكرار للتحفيز ٤٠ هرتز. كما تم قياس إشارة استجابة جذع الدماغ السمعي سعة ٥ واختفائها ومقارنتها إحصائيا. تم عمل اختبار المدى الرقمي الأمامي لتحديد سعة الذاكرة العاملة للمشاركين. النتائج: لم يوجد اختلاف كبير في إشارة استجابة جذع الدماغ السمعي سعة ٥ واختفائها بين الحفاظ وغير الحفاظ في استجابة جذع الدماغ السمعي مع أو بدون المهام النفسية. لم يكن هناك أيضا فرق كبير في إشارة استجابة جذع الدماغ السمعي سعة ٥ واختفائها عند المجموعتين مع أو بدون المهام النفسية. بالإضافة لذلك، لم يلاحظ هناك اختلاف كبير في المدى الرقمي لدرجة الذاكرة العاملة بين المجموعتين. الاستنتاجات: في هذه الدراسة، اعتمادا على نتائج استجابة جذع الدماغ السمعي، أظهر الحفاظ نفس سعة البوابات الحسية السمعية مثل مجموعة غير الحفاظ. وكانت نتائج استجابة جذع الدماغ السمعي متسقة مع المدى الرقمي لدرجة اختبار الذاكرة العاملة. يعني هذا أن لدى المجموعتين أداء ذاكرة عمل متماثلة. ومع ذلك، النتائج محدودة فقط لطرق التقييم المحددة المستخدمة في هذه الدراسة. Abstract: Objective: This study aims to investigate the auditory sensory gating capacity in Huffaz using an auditory brainstem response (ABR) test with and without psychological tasks. Methods: Twenty-three participants were recruited for this study. The participants were comprised of 11 Huffaz who memorized 30 chapters of the Islamic Scripture (from the Quran) and 12 non-Huffaz as the control group. All participants had normal hearing perception and underwent an ABR test with and without psychological tasks. The ABR was elicited at 70 dB nHL using a 3000 Hz tone burst stimulus with a 2-0-2 cycle at a stimulus repetition rate of 40 Hz. The ABR wave V amplitude and latencies were measured and statistically compared. A forward digit span test was also conducted to determine participants’ working memory capacity. Results: There were no significant differences in the ABR wave V amplitudes and latencies between Huffaz and non-Huffaz in ABR with and without psychological tasks. There were also no significant differences in the ABR wave V amplitudes and latencies in both groups of ABR with and without psychological tasks. In addition, no significant differences were identified in the digit span working memory score between both groups. Conclusions: In this study, based on the ABR findings, Huffaz showed the same auditory sensory gating capacity as the non-Huffaz group. The ABR result was consistent with the digit span working memory test score. This finding implies that both groups have similar working memory performance. However, the conclusion is limited to the specific assessment method that we used in this study.

Purpose Patients with temporal lobe epilepsy (TLE) are at high risk of cognitive impairment. In addition to persistent seizures and antiepileptic drugs (AEDs), genetic factors also play an important role in the progression of cognitive deficits in TLE patients. Defining a cognitive endophenotype for TLE can provide information on the risk of cognitive impairment in patients. This study investigated the cognitive endophenotype of TLE by comparing neuropsychological function between patients with TLE, their unaffected siblings, and healthy control subjects. Patients and Methods A total of 46 patients with TLE, 26 siblings, and 33 control subjects were recruited. Cognitive function (ie, general cognition, short- and long-term memory, attention, visuospatial and executive functions, and working memory) was assessed with a battery of neuropsychological tests. Differences between groups were evaluated by analysis of covariance, with age and years of education as covariates. The Kruskal-Wallis test was used to evaluate data that did not satisfy the homogeneity of variance assumption. Pairwise comparisons were adjusted by Bonferroni correction, with a significance threshold of P

Dementia causes disorders in multiple higher cortical functions. Visual impairment could further impact cognition in those with dementia. This study reports the results of a computerized attention training program in a patient with dementia and visual impairment. The case involves a 98-year-old woman with bilateral maculopathy and moderate dementia. The program consisted of pre- and post-assessments and training sessions. Assessments included the Cantonese version of the Mini-Mental State Examination, the digit span forward test, the Chinese version of the Verbal Learning Test (CVVLT), and the Test of Attentional Performance (TAP). Training sessions were conducted once to twice a week for a total of 8 45-minute sessions. The participant showed a decrease in the CVVLT score and improvements in TAP parameters. The results indicated that, in visually impaired older adults with dementia, attention and processing speed (measured by a sensitive test such as TAP) could potentially be improved with appropriate computerized training.

Objectives Extensive analysis of the associations between socioeconomic status and cognition has been conducted among older adults. However, it is not clear whether associations in high-income countries are similar in low-and middle-income countries. This research aims to investigate the association between the socioeconomic status of older adults in Ghana and their cognitive function by using a sample of older adults that is nationally representative. Methods Data were obtained from a sample of older Ghanaian adults (50+) from the Study of Global AGEing and Adult Health Wave 1 (n = 3710) of the World Health Organization. Objectively, cognition was measured by verbal recall, verbal fluency, forward digit span, and backward digit span, while variations in cognition overall were evaluated against socioeconomic factors using linear regression. Results Older age, older women, rural life, increasing memory difficulty, and being diagnosed with stroke were the most significant determinants of impaired cognitive function. Higher education and higher income were significantly associated with a better cognitive function than those with no formal education and low income. Conclusions These results provide new evidence for public health programs in Ghana and other low-and middle-income countries to tackle cognitive impairments in growing populations.

The catechol-O-methyltransferase (COMT) Val158Met polymorphism has been associated with working memory (WM) in many studies, but the results have not been consistent. One plausible explanation is sex-specific effects of this polymorphism as reported in several studies. The current study aimed to explore the sex-specific effects of the COMT Val158Met polymorphism on WM-related brain function in an elderly sample. We found that Val homozygotes outperformed Met allele carriers on the backward digit span subtest for both males and females. The triangular part of the left inferior frontal gyrus and the left inferior temporal gyrus exhibited higher activation in Met allele carriers compared with Val homozygotes during the n-back task, while the background functional connectivity (bFC) between the left angular gyrus (ANG) and the right ANG was enhanced in Val homozygotes as compared to Met allele carriers. Finally, the associations between brain activation, bFC (among various regions), and WM performance were identified only in specific genotype groups of the female participants. These findings provide new insights into the role of COMT Val158Met gene polymorphism in brain function, particularly its female-specific nature.

Background. Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that affects cognitive performance and leads to depression and decreased quality of life (QOL). The current study aims to assess the effects of cognitive rehabilitation versus donepezil therapy on memory, attention, depression, and QOL in MS patients compared to placebo and control groups. Methods. Eighty MS patients were randomly selected from parallel randomized trials and divided into four groups: A: cognitive rehabilitation (10 sessions of 120 minutes), B: control (no intervention), C: donepezil (10 mg daily), and D: placebo. Patients received the intervention for three months. They were assessed for cognitive status, depression, and QOL prior to the intervention and immediately after that using abbreviated mental test (AMT), prospective and retrospective memory questionnaire (PRMQ), everyday memory questionnaire (EMQ), digit span, MSQOL-54, and second edition Beck depression inventory (BDI). We compared scores between groups after the intervention, as well as the progression of scores in every single group. Results. The cognitive rehabilitation group showed improvement in EMQ, RPMQ, digit span, physical and mental health subscales of MSQOL54, and depression P < 0.05 . We observed the same effect for donepezil except for the digit span test P = 0.15 . Intergroup comparison of scores showed the superiority of cognitive rehabilitation over donepezil in digit span, depression, and mental health scores. Conclusion. Both donepezil and cognitive rehabilitation effectively improve memory performance, attention, depression, and QOL in MS patients. Cognitive rehabilitation is superior altogether. This study is registered with the Iranian registry of clinical trials http://clinicaltrials.gov/ct2/show/IRCT2016042227522N1.

Background: Extra virgin olive oil (EVOO) constitutes a natural compound with high protection over cognitive function. Objective: To investigate for the first time the effect of Greek High Phenolic Early Harvest Extra Virgin Olive Oil (HP-EH-EVOO) versus Moderate Phenolic (MP-EVOO) and Mediterranean Diet (MeDi) in people with mild cognitive impairment (MCI). Methods: We conducted a randomized prospective study so as to examine the HP-EH-EVOO and MP-EVOO versus MeDi in MCI. Genetic predisposition (APOE ɛ4) to Alzheimer’s disease (AD) was tested and an extensive neuropsychological battery was administered at baseline and after 12 months. Each participant was randomized and assigned one of three groups: 1) Group 1 received the HP-EH-EVOO (50 mL/day); 2) Group 2 received the MP-EVOO (50 mL/day), and 3) Group 3 received only the MeDi instructions. Results: Better follow-up performance was found in Group 1 compared to Group 2 and Group 3 in the almost all cognitive domains. Moreover, Group 2 showed also significant improvement compared to Group 3 in ADAS-cog (p = 0.001) and MMSE (p = 0.05), whereas Group 3 exhibited worse or similar to baseline performance in almost all domains. In particular, Group 1 and Group 2 had better outcomes with regards to ADAS-cog (p = 0.003), Digit Span (p = 0.006), and Letter fluency (p = 0.003). Moreover, there was a significant difference (p = 0.001) in the presence of APOE ɛ4 between the Groups 1 and 2 versus Group 3. Conclusion: Long-term intervention with HP-EH-EVOO or MP-EVOO was associated with significant improvement in cognitive function compared to MeDi, independent of the presence of APOE ɛ4.

The Audio and Visual Whole Body Reaction (WBR) motor function test uses the THP-15 tool, the balance test uses the Balance Error Scoring System (BESS), while the Working Memory (WM) executive function test uses the Forward Digit Span Task and the Inhibitory Control (IC) test using the Animal Stroop Task. The data analysis technique used the Pearson Chi-Square test with Statistical Package for Social Science (SPSS). The results obtained the mean of the visual Whole Body Reaction (WBR) motor function in the EO (0.55±0.21) and EBO (0.52±0.25) groups (p=0.558). The mean WBR Audio in the EO (0.73±0.24) and EBO (0.70±0.29) groups (p=0.918). The average balance in the EO group (1.65±0.54) and EBO (1.58±0.48) (p=0.297). Executive function of Working Memory (WM) in the EO (5.00±0.74) and EBO (5.19±0.74) groups (p=0.636). The mean inhibitory control (IC) in the EO group (4.61±2.09) and the EBO group (3.88±2.86) (p=0.048). Based on the results of the study, it can be concluded that students who take extracurricular sports at school have higher executive inhibitory control function than students who take non-sports extracurricular.

Purpose This study explores the effect of glaucomatous visual field defects on several neuropsychological tests that are often used in research and in clinical settings. Methods Nineteen glaucoma patients and nineteen healthy participants, which are current drivers and older than 65 years old were included. All participants completed the Montreal Cognitive Assessment (MoCA), the Trail Making Test (TMT), the Benton Visual Retention Test (BVRT), the Snellgrove Maze Task (SMT) and the Digit Span Test (DST). All participants were also tested on contrast sensitivity and near and far visual acuity. For the glaucoma patients, visual field tests were downloaded from hospital servers. Results On the MoCA test, glaucoma patients scored lower than the healthy group, but not significantly. On the MoCA-Blind, the difference was statistically significant. Glaucoma patients also had lower percentile scores on the TMT, with a significant difference in the TMT-A, but this difference largely disappeared in the calculated TMT B-A index, which isolates the cognitive component. The BVRT and SMT showed no significant differences between both groups. In the only non-visual test, the DST, glaucoma patients outperformed the healthy group. Glaucoma severity did not influence results, except for the BVRT on which the moderate/severe group has better scores. Conclusion Using visual items might lead to conclusions about cognition when it should be one about vision. Therefore, careful selection of tests is needed when examining cognition in glaucoma patients.

Objective To explore pharmacogenetic relationships of NRG1 genotypes with neurocognitive performance and clinical symptoms after 12 week treatment of risperidone in Chinese Han first-episode schizophrenia. Methods A cohort of 221 patients with schizophrenia were recruited for this research. Finally 177 untreated first-episode patients were clinically evaluated with the Positive and Negative Syndrome Scale (PANSS), Raven's Standard Progressive Matrices (RSPM), Digit Vigilance Test (DVT), Digit Span (DS), underwent genotyping for five polymorphisms of NRG1, and completed a 12-week prospective study of risperidone monotherapy. Results 1. After risperidone treatment of 12 weeks, the total scores, positive score, negative score and general score of PANSS decreased significantly; the scores of RSPM, DVT and DS increased significantly. 2. No significant association with PANSS scores at baseline or change in scores after 12 weeks'treatment was found with any of the five SNPs. There was also neither significant association of DVT, DS or RSPM at baseline with any of the five SNPs. 3. After risperidone treatment of 12 weeks, rs3924999 and rs35753505 showed significant association with change in DVT and in RSPM in which there were significant differences among different genotype groups. Conclusion This study suggested pharmacogenetic relationships between NRG1 variants and changes in cognition response with exposure to 12 weeks of treatment with risperidone. Two variants, rs3924999 and rs35753505, in the NRG1 gene were associated with the changes in attention and reasoning ability after risperidone treatment of 12 weeks.

Docosahexaenoic acid (DHA) plays an essential role in brain, and its status is dependent on dietary intakes. School-aged children in rural China, who consume diets low in omega-3 polyunsaturated fatty acids, may benefit from DHA supplementation. Therefore, this trial was performed to examine the effect of 6-month DHA supplementation on executive functions (EFs) among healthy school-aged children in rural China. A randomized, double-blind, placebo-controlled trial was conducted among 106 primary school children aged 7–12 years in rural China. Participants were randomized to receive either 300 mg/d DHA or placebo for 6 months. EFs including working memory and cognitive flexibility were evaluated at baseline, at 3 months and at 6 months, using Digit Span Backwards and Wisconsin card sorting test, respectively. Socio-demographic data were collected at baseline, and erythrocyte membrane fatty acids and serum neurotransmitters were measured at baseline and after 6-month intervention. Ninety-four children (88.7%) completed the study according to the protocol. Changes in erythrocyte membrane fatty acids indicated good compliance of the participants. There was no significant intervention effect on serum neurotransmitters. In two-factor ANCOVA, both groups showed a significant improvement in the Digit Span Backwards and the Wisconsin card sorting test from baseline to endpoint. However, no significant intervention effect was found on any EF scores. Linear regression analysis suggested no significant association between changes in erythrocyte DHA level with changes in any EF scores. Supplementation with 300 mg/d DHA for 6 months had no benefit on EFs including working memory and cognitive flexibility among healthy school-aged children. This trial was registered at clinicaltrials.gov as NCT02308930 on December 5, 2014.

Mild cognitive impairment (MCI) is a very common non-motor feature of Parkinson’s disease (PD) and the non-amnestic single-domain is the most frequent subtype. Transcranial random noise stimulation (tRNS) is a non-invasive technique, which is capable of enhancing cortical excitability. As the main contributor to voluntary movement control, the primary motor cortex (M1) has been recently reported to be involved in higher cognitive functioning. The aim of this study is to evaluate the effects of tRNS applied over M1 in PD-MCI patients in cognitive and motor tasks. Ten PD-MCI patients, diagnosed according to the Movement Disorder Society, Level II criteria for MCI, underwent active (real) and placebo (sham) tRNS single sessions, at least 1 week apart. Patients underwent cognitive (Digit Span Forward and Backward, Digit Symbol, Visual Search, Letter Fluency, Stroop Test) and motor assessments (Unified Parkinson’s Disease Rating Scale [UPDRS-ME], specific timed trials for bradykinesia, 10-m walk and Timed up and go tests) before and after each session. A significant improvement in motor ability (UPDRS-ME and lateralized scores, ps from 0.049 to 0.003) was observed after real versus sham tRNS. On the contrary, no significant differences were found in other motor tasks and cognitive assessment both after real and sham stimulations. These results confirm that tRNS is a safe and effective tool for improving motor functioning in PD-MCI. Future studies using a multisession tRNS applied over multitargeted brain areas (i.e., dorsolateral prefrontal cortex and M1) are required to clarify the role of tRNS regarding rehabilitative intervention in PD.

Background The high illiteracy rates in the North African and Middle Eastern region make direct cognitive testing challenging. Validated instruments for dementia in Arabic language are lacking specially those targeting low-educated subjects. Objectives The aim of this study was to develop a cognitive evaluation battery suitable for both educated and illiterate Egyptian elderly people. Design A cross-sectional study was conducted. Setting: Ain-Shams University geriatric and ophthalmology wards, geriatrics outpatient clinic, and geriatric clubs. Participants: 159 male and female participants aged ≥ 60 years were recruited. Measurements Cut-off points were determined according to DSM-IV criteria for dementia and MMSE scores which divided the participants into 3 quadrants as normal, having mild cognitive impairment and having dementia then application of the new battery test was done. Results Test re-test reliability ranged from adequate to high in most of its tests with r ≥ 0.7. There was a statistical significance between all battery tests when divided into normal and dementia according to DSM IV criteria except in digit span forward length, digit span backward length, stimulus cue of confrontation naming and judgment. Means and standard deviations were calculated for each battery subset, for the whole sample, for low-educated group and group with > 9 years education according to three quadrants of MMSE. Conclusion A new valid and reliable neurocognitive evaluation battery that can differentiate between normal, mild cognitive impairment, and dementia in both educated and illiterate subjects under the name of Ain Shams Cognitive Assessment (ASCA) scale is now available.