Arne Gramstad

Cognitive profile in young adults born preterm at very low birthweight

Aim  The aim of this study was to assess cognitive function at the age of 19 years in individuals of very low birthweight (VLBW; ≤1500g) and in term‐born comparison individuals.

Computerized Working Memory Training Improves Function in Adolescents Born at Extremely Low Birth Weight

OBJECTIVE To evaluate the effect of a computerized working memory training program on both trained and non-trained verbal aspects of working memory and executive and memory functions in extremely low birth weight (ELBW; <1000 g) infants. STUDY DESIGN Sixteen ELBW infants and 19 term-born control subjects aged 14 to 15 years participated in the training program, and 11 adolescents were included as a non-intervention group. Extensive neuropsychological assessment was performed before and immediately after training and at a 6-month follow-up examination. Both training groups used the CogMed RM program at home 5 days a week for 5 weeks. RESULTS Both groups improved significantly on trained and non-trained working memory tasks and on other memory tests indicating a generalizing effect. Working memory capacity was improved, and effects were maintained at the 6-month follow-up examination. There was no significant improvement in the non-intervention group at the 6-week follow-up examination. CONCLUSIONS The computerized training program Cogmed RM was an effective intervention tool for improving memory and reducing core learning deficits in adolescents born at ELBW.

The impact of affectivity dispositions, self-efficacy and locus of control on psychosocial adjustment in patients with epilepsy

The main hypothesis of this study was that negative and positive affectivity, self-efficacy and health-related locus of control are important for psychosocial adjustment in patients with epilepsy. These dimensions are rarely examined directly in relation to the psychosocial adjustment in these patients. Correlations between measures of these constructs and measures of psychosocial adjustment in epilepsy were investigated. One hundred and one patients answered the Washington psychosocial seizure inventory (WPSI), the positive and negative affect schedule (PANAS-X), the multidimensional health locus of control scales (MHLC), the generalized self-efficacy scale and a scale measuring self-efficacy in epilepsy. Reliability analyses, correlational analyses and multiple stepwise regression analyses were performed. Negative affectivity (NA), positive affectivity (PA) and generalized self-efficacy showed high correlations with the WPSI scales emotional adjustment, overall psychosocial adjustment and quality of life. The epilepsy self-efficacy measures showed high, but lower correlations with the same WPSI scales. The MHLC scales showed low correlations with the WPSI scales. Multiple regression analyses showed that PA, NA and measures of self-efficacy explained more than 50% of the variances on emotional adjustment, overall psychosocial functioning and quality of life. In conclusion, positive and negative affectivity and self-efficacy are important predictors of perceived emotional adjustment, psychosocial adjustment and quality of life in patients with epilepsy. NA is the best predictor, but PA and self-efficacy measures give unique predictions independent of NA.

Fatigue, pain and muscle weakness are frequent after Guillain-Barré syndrome and poliomyelitis

Guillain- Barré syndrome (GBS) and poliomyelitis may cause life-long health problems. We studied fatigue, pain and muscular weakness in both conditions to define possible interactions between these symptoms and their influence on residual disability and daily functioning. We studied 50 patients with previous GBS, 89 patients with a history of poliomyelitis and a reference group of 81 people with similar sex and age and no history of poliomyelitis or GBS using the Fatigue Severity Scale, self-reported pain and muscular weakness Disability Rating Index, and Positive and Negative Affect Schedule (PANAS-X). We assessed the quality of life using the SF-36 Health Survey. The mean score on the Fatigue Severity Scale was significantly higher in the GBS and poliomyelitis patients than in the reference group. This was true also in the subgroups of mild disease, i. e., nonparalytic polio and initial Hughes score less than 3 in the GBS group. Thirty-four percent of GBS patients and 63 % of poliomyelitis patients reported pain; 13 % of GBS and 36 % of poliomyelitis patients reported residual muscle weakness. Fatigue, pain, and muscle weakness interacted in both diseases. Perceived health problems influenced all aspects of the quality of life except mental health in both diseases. Fatigue, pain, and muscle weakness are common sequelae after GBS and poliomyelitis. The symptoms interact with each other and contribute to long-term disability.ObjectiveGuillain- Barré syndrome (GBS) and poliomyelitis may cause life-long health problems. We studied fatigue, pain and muscular weakness in both conditions to define possible interactions between these symptoms and their influence on residual disability and daily functioning.MethodsWe studied 50 patients with previous GBS, 89 patients with a history of poliomyelitis and a reference group of 81 people with similar sex and age and no history of poliomyelitis or GBS using the Fatigue Severity Scale, self-reported pain and muscular weakness Disability Rating Index, and Positive and Negative Affect Schedule (PANAS-X). We assessed the quality of life using the SF-36 Health Survey.ResultsThe mean score on the Fatigue Severity Scale was significantly higher in the GBS and poliomyelitis patients than in the reference group. This was true also in the subgroups of mild disease, i. e., nonparalytic polio and initial Hughes score less than 3 in the GBS group. Thirty-four percent of GBS patients and 63 % of poliomyelitis patients reported pain; 13 % of GBS and 36 % of poliomyelitis patients reported residual muscle weakness. Fatigue, pain, and muscle weakness interacted in both diseases. Perceived health problems influenced all aspects of the quality of life except mental health in both diseases.ConclusionsFatigue, pain, and muscle weakness are common sequelae after GBS and poliomyelitis. The symptoms interact with each other and contribute to long-term disability.

Adult nonconvulsive status epilepticus in a clinical setting: Semiology, aetiology, treatment and outcome

PURPOSE Our objective was to study the semiology, aetiology, treatment and outcome of nonconvulsive status epilepticus (NCSE) in adults. METHODS All NCSE episodes in an unselected hospital cohort in the period 2004-2009 were identified, and the files reviewed. STESS (Status Epilepticus Severity Scale) was conducted retrospectively and correlated to outcome. Follow-up was undertaken after >2 years. RESULTS 48 NCSEs in 39 patients, 22 men and 17 women, were found. Mean age was 63 years. 23/39 (59%) patients had established epilepsy. The underlying cause of NCSE was cerebrovascular disease in 17/39 (44%). 37/48 (77%) NCSEs were complex focal status epilepticus. 3/48 NCSEs (6.3%) lead to death, whereas 8.5% lead to severe sequelae. Cognitive sequelae were found after 14.9% of NCSEs. The outcome was worst in the group with no prior epilepsy (p=0.013). STESS had a negative predictive value of 96% (cut-off value of 3) for severe sequelae and death combined (p<0.002). CONCLUSIONS NCSE has a potential for severe sequelae and represents an emergency in need of intensive treatment. The major determinant of outcome is the underlying cause. The outcome was worse in patients without epilepsy than in patients with epilepsy. STESS is of value in predicting outcome. Cognitive sequelae following NCSE can occur, but need further investigation with prospective, systematic studies.

Cognitive function and health-related quality of life four years after cardiac arrest

AIM Neuropsychological testing has uncovered cognitive impairment in cardiac arrest survivors with good neurologic outcome according to the cerebral performance categories. We investigated cognitive function and health-related quality of life four years after cardiac arrest. METHODS Thirty cardiac arrest survivors over the age of 18 in cerebral performance category 1 or 2 on hospital discharge completed the EQ-5D-5L and HADS questionnaires prior to cognitive testing using the Cambridge Neuropsychological Test Automated Battery. The results were compared with population norms. RESULTS Twenty-nine per cent of patients were cognitively impaired. The pattern of cognitive impairment reflects dysfunction in the medial temporal lobe, with impaired short-time memory and executive function slightly but distinctly affected. There was a significant reduction in quality of life on the EQ-VAS, but not on the EQ index. CONCLUSION Cognitive impairment four years after cardiac arrest affected more than one quarter of the patients. Short-term memory was predominantly affected.

Cognitive control deficits in adolescents born with very low birth weight (≤ 1500 g): Evidence from dichotic listening

The objective of the paper is to explore bottom-up auditory and top-down cognitive processing abilities as part of long-term outcome assessment of preterm birth. Fifty-five adolescents (age 13-15) born with very low birth weight (VLBW) were compared to 80 matched controls born to term, using three consonant-vowel dichotic listening (DL) instruction conditions (non-forced, forced-right and forced-left). DL scores were correlated with cortical gray matter thickness derived from T1-weighted structural MRI volumes using FreeSurfer to examine group differences also in the neural correlates of higher cognitive processes. While showing normal bottom-up processing, VLBW adolescents displayed impaired top-down controlled conflict processing related to significant cortical thickness differences in left superior temporal gryus and anterior cingulate cortex. Preterm birth with VLBW induces fundamental changes in brain function and structure posing a risk for long-term neurocognitive impairments. Deficits emerge in situations of increasing cognitive conflict and can be related to measures of executive functions as well as morphology.

Frontoparietal activation during delayed visuospatial recall in patients with epilepsy due to hippocampal sclerosis

We hypothesized that brain activation during encoding and retrieval of visual material differed between epilepsy patients with hippocampal sclerosis (HS) and healthy controls. Eleven patients with epilepsy and HS and nine age- and education-matched control subjects were tested during functional MRI recording. A three-block design for visuospatial memory encoding and retrieval and an interference interval longer than 1 minute without memory tasks were used. All subjects revealed parietal, occipital, and prefrontal activation patterns during encoding. Interference revealed parietal more than occipital activation, whereas retrieval revealed asymmetrical frontal and parietal activation. Patients demonstrated a relative increase in occipitoparietal versus frontal cortical activation as compared with controls. Memory performance did not differ between patients and controls. The increased activation in occipitoparietal versus frontal areas in the patients suggests cortical reorganization of visuospatial recognition memory in epilepsy patients with HS. The study is limited by other factors that may contribute to the results, for example, antiepileptic drugs, effects of greater cognitive effort allocated in patients than controls, and possibly subclinical epileptic activity. However, normal visuospatial memory performance in our patients with HS suggests successful network plasticity.

Cognitive profile of elderly patients with mild stroke.

Background: A pattern characterizing cognitive deficits in mild stroke could help in differential diagnosis and rehabilitation planning. Methods: Fifty patients with mild stroke (modified Rankin scale ≤2 at discharge) aged >60 years were given the Mini Mental State Examination (MMSE), the Hopkins Verbal Learning Test-Revised (HVLT-R) and the Stroop test. Results: On HVLT-R, significant impairments were found in learning and recall, but not in delayed recall. The Stroop test revealed significant impairments in reading speed, but not in color-word interference. Using the MMSE, significant deficits were only found in the youngest age group. Conclusion: Elderly patients with mild stroke show deficits in verbal learning/recall and in reading speed, but not in the MMSE, delayed recall or color-word interference. The deficits are consistent with a mild-to-moderate brain dysfunction, with relative sparing of medial brain structures.

Neuropsychological performance in patients with POLG1 mutations and the syndrome of mitochondrial spinocerebellar ataxia and epilepsy

Mutations in the catalytic subunit of polymerase gamma (POLG1) produce a wide variety of neurological disorders including a progressive ataxic syndrome with epilepsy: mitochondrial spinocerebellar ataxia and epilepsy (MSCAE). Our earlier studies of patients with this syndrome raised the possibility of more prominent right than left hemisphere dysfunction. To investigate this in more detail, eight patients (six women, two men; mean age: 22.3 years) were studied. All completed an intelligence test (Wechsler Adult Intelligence Scale; WAIS), and four were also given memory tests and a comprehensive neuropsychological test battery. Patients with MSCAE showed significant cognitive dysfunction. Mean Verbal IQ (84.3) was significantly better than Performance IQ (71.8) (t=5.23, P=0.001), but memory testing and neuropsychological testing failed to detect a consistent unilateral dysfunction. Further studies are needed to define the profile and development of cognitive symptoms in this disorder.