Charissa Andreotti

Neuropsychological assessment of the orbital and ventromedial prefrontal cortex

Assessment of the functions of the orbitofrontal cortex and ventromedial prefrontal cortex has proven to be a unique challenge for neuropsychologists. Orbitomedial damage occurs in a range of disorders including traumatic brain injury, ruptured aneurysms, surgical resection, and frontotemporal dementia. We review the effects of orbitomedial damage on a range of neuropsychological tasks, including tasks measuring object alternation and reversal learning, decision-making (gambling), facial emotion recognition, theory of mind, olfactory recognition, autobiographical memory and behavioral rating measures. At present, there is no singular gold standard measure of orbitomedial dysfunction, and assessment requires an integrative approach that reflects the heterogeneity of the region. The heterogeneous neuropsychological deficits arising from orbitomedial damage are difficult to ascribe to a unitary function or process, but appear to reflect a set of processes necessary for monitoring and adapting to changing reinforcement contingencies.

A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors†‡

Deficits in neurocognitive functioning are an important area of late effects in survivors of pediatric brain tumors, but a quantitative analysis of the magnitude of these deficits has yet to be conducted.

Cognitive reappraisal and secondary control coping: associations with working memory, positive and negative affect, and symptoms of anxiety/depression.

Abstract The current study examined the relations of measures of cognitive reappraisal and secondary control coping with working memory abilities, positive and negative affect, and symptoms of anxiety and depression in young adults (N=124). Results indicate significant relations between working memory abilities and reports of secondary control coping and between reports of secondary control coping and cognitive reappraisal. Associations were also found between measures of secondary control coping and cognitive reappraisal and positive and negative affect and symptoms of depression and anxiety. Further, the findings suggest that reports of cognitive reappraisal may be more strongly predictive of positive affect whereas secondary control coping may be more strongly predictive of negative affect and symptoms of depression and anxiety. Overall, the results suggest that current measures of secondary control coping and cognitive reappraisal capture related but distinct constructs and suggest that the assessment of working memory may be more strongly related to secondary control coping in predicting individual differences in distress.

Prevalence, Severity and Risk Factors for Depressive Symptoms and Insomnia in College Undergraduates

Although the college years represent a high-risk period for depressive symptoms and insomnia, little research has explored their prevalence, comorbidities and risk factors within this developmental period. Two studies were conducted; the first evaluated the prevalence and comorbidity of depressive symptoms and insomnia in 1338 students (ages 18-23 years) from a large Southwestern University. Mild depressive symptoms were endorsed by 19% of students and 14.5% reported moderate to severe symptoms. Forty-seven percent of students reported mild insomnia and 22.5% endorsed moderate to severe insomnia severity. A second study investigated perceived stress as a potential mediator of the relation between self-reported childhood adversity and concurrent depressive symptoms and insomnia. Undergraduates (N = 447) from a Southwestern and Southeastern University reported prior childhood adversity, current perceived stress, insomnia and depressive symptoms. Self-reported childhood adversity predicted higher levels of depressive symptoms and insomnia severity, partially mediated by perceived stress. Results support the high prevalence of depressive symptoms and insomnia among undergraduates. The risk for depressive and insomnia symptoms may be increased among students who experienced greater levels of childhood adversity.

Cancer, coping, and cognition: a model for the role of stress reactivity in cancer-related cognitive decline

Cognitive decline and accompanying neurological changes associated with non‐CNS cancer diagnosis and treatment have been increasingly identified in a subset of patients. Initially believed to be because of neurotoxic effects of chemotherapy exposure, observation of cognitive decline in patients not treated with chemotherapy, cancer‐diagnosed individuals prior to treatment, and patients receiving alternative treatment modalities (surgery, endocrine therapy, and radiation) has led to the investigation of additional potential etiologies and moderating factors. Stressful experiences have long been posited as a contributor to these cognitive changes. Through reciprocal connectivity with peripheral systems, the brain maintains a dynamic circuitry to adapt to stress (allostasis). However, overuse of this system leads to dysregulation and contributes to pathophysiology (allostatic load). At this time, little research has been conducted to systematically examine the role of allostatic load in cancer‐related cognitive dysfunction.

The Association of Cytokine Levels With Cognitive Function in Children With Sickle Cell Disease and Normal MRI Studies of the Brain

Children with sickle cell disease, including those without evidence for cerebral infarcts, are at increased risk for cognitive deficits that can contribute to difficulties in academic and social functioning. Chronic inflammatory processes are endemic to sickle cell disease and are apparent in common comorbidities including asthma. Cytokines mediating inflammatory processes can influence cognition. The authors examined the relationship between plasma levels of cytokines commonly associated with asthma and cognitive functioning using standardized neuropsychological measures in 25 children with sickle cell disease with normal magnetic resonance imaging studies of the brain. Children with sickle cell disease performed significantly below the normative mean on tests of cognitive function. Pearson correlations indicated significant negative relations between cytokines (IL-4, IL-5, IL-8, and IL-13) and standardized tests of executive function (r = –.54 to –.74). Preliminary evidence suggests an association between cytokine levels and executive function in children with sickle cell disease, indicating a potential role for inflammatory processes in cognitive outcomes in these children.

Early Childhood Adversity and its Associations With Anxiety, Depression, and Distress in Women With Breast Cancer

BACKGROUND Certain vulnerability factors have been found to place patients at risk for depression and anxiety, especially within the context of medical illness. OBJECTIVES We sought to describe the relationships among early childhood adversity (ECA) and anxiety, depression and distress in patients with breast cancer. METHODS Patients with breast cancer (stages 0-IV) were assessed for ECA (i.e., the Risky Families Questionnaire subscales include Abuse/Neglect/Chaotic Home Environment), distress (i.e., Distress Thermometer and Problem List), anxiety (Hospital Anxiety and Depression Scale-Anxiety), depression (Hospital Anxiety and Depression Scale-Depression), meeting standardized cut-off thresholds for distress (Distress Thermometer and Problem List ≥4 or ≥7)/anxiety (Hospital Anxiety and Depression Scale-Anxiety ≥8)/depression (Hospital Anxiety and Depression Scale-Depression ≥8) and demographic factors. RESULTS A total of 125 participants completed the study (78% response rate). ECA was associated with depression (p <0.001), anxiety (p = 0.001), and distress (p = 0.006), meeting cut-off threshold criteria for distress (p = 0.024), anxiety (p = 0.048), and depression (p = 0.001). On multivariate analysis, only depression (p = 0.04) and emotional issues (i.e., component of Distress Thermometer and Problem List) (p = 0.001) were associated with ECA. Neglect, but not Abuse and Chaotic Home Environment, was associated with depression (β = 0.442, p < 0.001), anxiety (β = 0.342, p = 0.002), and self-identified problems with family (β = 0.288, p = 0.022), emotion (β = 0.345, p = 0.004), and physical issues (β = 0.408, p < 0.001). CONCLUSION ECA and neglect are associated with multiple psychologic symptoms, but most specifically depression in the setting of breast cancer. ECA contributes to psychologic burden as a vulnerability factor. ECA may help to explain individual patient trajectories and influence the provision of patient-centered care for psychologic symptoms in patients with breast cancer.

The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review.

PurposeThe process of assessing patient symptoms and functionality using patient-reported outcomes (PROs) and functional performance status (FPS) is an essential aspect of patient-centered oncology research and care. However, PRO and FPS measures are often employed separately or inconsistently combined. Thus, the purpose of this study was to conduct a systematic review of the level of association between PRO and FPS measures to determine their differential or combined utility.MethodsA systematic search was conducted using five databases (1966 to February 2014) to identify studies that described an association between PRO and FPS. Studies were excluded if they were non-cancer specific, did not include adults aged 18 or older, or were review articles. Publications were selected for review by consensus among two authors, with a third author arbitrating as needed.ResultsA total of 18 studies met inclusion criteria. FPS was primarily assessed by clinicians using the ECOG Performance Status or Karnofsky Performance Status measures. PROs were captured using a variety of measures, with numerous domains assessed (e.g., pain, fatigue, and general health status). Concordance between PROs and FPS measures was widely variable, falling in the low to moderate range (0.09–0.72).ConclusionsDespite consistency in the method of capture of PROs or FPS, domain capture varied considerably across reviewed studies. Irrespective of the method of capturing PROs or FPS, the quantified level of association between these two areas was moderate at best, providing evidence that FPS and PRO assessments offer unique information to assist clinicians in their decision-making.

Learning and memory performance in a cohort of clinically referred breast cancer survivors: the role of attention versus forgetting in patient-reported memory complaints

While forgetfulness is widely reported by breast cancer survivors, studies documenting objective memory performance yield mixed, largely inconsistent, results. Failure to find consistent, objective memory issues may be due to the possibility that cancer survivors misattribute their experience of forgetfulness to primary memory issues rather than to difficulties in attention at the time of learning.

Stress-Related Changes in Attentional Bias to Social Threat in Young Adults: Psychobiological Associations with the Early Family Environment

This study investigated the association of chronic childhood stress exposure with acute stress-related attentional alterations that have been previously linked to vulnerability to mental and physical illness in early adulthood. Participants were randomized in a crossover design to complete both a mild laboratory social stress task and a computerized task assessing attentional bias to socially threatening words. Salivary cortisol was measured throughout the study. Exposure to acute laboratory stress altered attentional processing, and this relationship was moderated by chronic childhood stress exposure. Also, a positive association between cortisol reactivity and attentional bias was observed, with cortisol reactivity negatively related to childhood chronic stress exposure. While previous work has supported a role for early chronic stress exposure in influencing acute stress reactivity, this work provides initial insight into how both prior chronic childhood stress and current acute stress together relate to the attentional gateway and may be associated with stress adaptation and psychological vulnerability into adulthood.