Javier Oltra-Cucarella

Neuropsychological Impairments in Anorexia Nervosa: A Spanish Sample Pilot Study

This work was aimed at obtaining a profile of neuropsychological impairments in young Spanish participants with anorexia nervosa (AN) to demonstrate that right-hemisphere and frontal capacity impairments are present not only in the acute phase but also after weight recovery in a Spanish sample compared with a healthy control group. Twelve patients with AN in the acute phase (body mass index [BMI] < 17) were compared both to 16 healthy control subjects and 12 weight-recovered AN participants (BMI ≥ 17) matched by age, IQ, and educational level by utilizing a wide neuropsychological battery. Differences were found between AN groups only for long-term verbal memory, which worsens as BMI increases. Among participants with AN as a group, results showed differences in speed of information processing, working memory, visual memory, and inhibition, unrelated to attentional capabilities. We cannot support the hypothesis of a specific right cerebral dysfunction in patients with AN. A general cognitive dysfunction, primarily in information processing, working memory, visual and verbal memory, as well as frontal impairments such as impulsivity and poor behavioral control, appeared unrelated to BMI. We support previous works affirming that neuropsychological impairments in AN are not a consequence of the illness but a risk factor for it to develop.

Differential effects of cognition-focused interventions for people with Alzheimer’s disease: A meta-analysis.

Objective: The efficacy of cognition-focused interventions (CFIs) for the treatment of Alzheimer’s disease (AD) has been questioned recently. To date, the specific effects of cognitive rehabilitation (CR), cognitive training (CT), and cognitive stimulation [CS] have not been analyzed due to inconsistencies in the use of the comparison groups. This work aims to analyze the differential effects of CFIs by removing the influence of the comparison group from the estimates of the effects. Method: a literature search performed in Pubmed, Proquest, and Embase databases yielded 65 potential studies, of which 33 studies with a sample size of 1,225 individuals were meta-analyzed. Each intervention group was treated as the unit of analysis to remove the confounding effects of the comparison condition. Measures of general cognitive functioning, memory and functional outcomes were compared using the hierarchical robust variance estimator metaregression. Age, education, sex, risk of bias, sample size, duration of intervention, the proportion of drop-outs, pharmacological treatment, and severity of disease were included as covariates. Results: Only CT differed from no cognition-focused interventions (NCFI) for memory outcomes in univariate analyses, but differences became nonsignificant when covariates were included in the model. CR showed a significantly higher effect in outcomes measuring functioning in targeted domains with no differences in standard cognitive tests relative to NCFI. Conclusions: This work supports previous findings questioning the efficacy of CT or CS for AD. Moving toward CFIs focused on relevant goals and including measures related to the skills, abilities or activities that are the focus of the intervention is encouraged.

Impaired executive functioning influences verbal memory in anorexia nervosa.

BACKGROUND How executive functioning affects delayed verbal recall in AN has never been tested. We investigated the influence of speed of information processing (SIP) and inhibition on delayed verbal recall in females with AN. METHODS Measures of SIP and inhibition from 35 females with AN were analyzed using hierarchical multiple regression after controlling for age, depressive symptomatology and body mass index. Each predictor was evaluated using structure coefficients, common variance and dominance weights. RESULTS The combination of measures of SIP and inhibition accounted for almost 80% of the variance on the delayed recall of the story recall task. When the rest of the variables were partialled out, SIP and inhibition accounted for more than 50% of the variance. CONCLUSIONS As it occurs with visuospatial abilities in AN, basic cognitive abilities such as speed of information processing and cognitive inhibition may affect other cognitive functions such as delayed verbal memory regardless of immediate recall. These findings may help interpret performance on cognitive tests in future research.

Risk of progression to Alzheimer’s disease for different neuropsychological Mild Cognitive Impairment subtypes: A hierarchical meta-analysis of longitudinal studies.

Mild Cognitive Impairment (MCI) is a heterogeneous condition between normal aging and dementia. Upon neuropsychological testing, MCI can be divided into 4 groups: single-domain amnestic MCI (sd-aMCI), multiple-domain amnestic MCI (md-aMCI), single- and multiple-domain nonamnestic MCI (sd-naMCI, md-naMCI). Some controversy exists about whether the risk of progression to Alzheimer’s disease (risk-AD) is increased in all MCI subtypes. We meta-analyzed the risk-AD for 4 MCI groups using random-effects metaregression with the Hierarchical Robust Variance Estimator and sample size, criterion for objective cognitive impairment, length of follow-up and source of recruitment as covariates. From a pool of 134 available studies, 81 groups from 33 studies (N = 4,907) were meta-analyzed. All the studies were rated as having a high risk of bias. aMCI is overrepresented in studies from memory clinics. Multivariate analyses showed that md-aMCI had a similar risk-AD relative to sd-aMCI, whereas both sd-naMCI and md-naMCI showed a lower risk-AD compared with sd-aMCI. The risk-AD was significantly associated with differences in sample sizes across studies and between groups within studies. md-aMCI had a similar risk-AD relative to sd-aMCI in studies from memory clinics and in studies in the community. Several potential sources of bias such as blindness of AD diagnosis, the MCI diagnosis approach and the reporting of demographics were associated with the risk-AD. This work provides important data for use in both clinical and research scenarios.

Encoding deficits in low-educated individuals with non-amnestic Mild Cognitive Impairment. Analysis of memory processes using the Item Specific Deficit Approach

This work aims to analyze encoding impairments using new assessment scores in patients with naMCI who present to memory clinics with subjective cognitive complaints. The sample included 102 participants, of whom 28 were classified as healthy controls (HC), 24 as amnestic MCI (aMCI), 24 as naMCI and 26 patients as Alzheimers disease (AD). Research outcomes were the Encoding, Consolidation and Retrieval deficit indices from the Item Specific Deficit Approach, and traditional indices (immediate total recall, delayed cued recall, delayed total recall) derived from the Free and Cued Selective Reminding Test (FCSRT). We found no differences in immediate recall or delayed recall between HC and naMCI on the FCSRT, both scoring higher than aMCI and AD. naMCI showed encoding deficits in between HC and aMCI, with no differences between naMCI and HC on consolidation or retrieval deficit indices. The ISDA indices were better than traditional indices to discriminate between HC and naMCI (sensitivity: 70.8%, specificity: 78.6%), whereas the opposite pattern was found between naMCI and aMCI (sensitivity: 70.8%, specificity: 91.7%). New indices derived from neuropsychological tests may help to identify objective memory impairments in naMCI. Whether these new indices are useful for predicting conversion to AD needs further research.

Using Base Rate of Low Scores to Identify Progression from Amnestic Mild Cognitive Impairment to Alzheimer's Disease: base rate of low scores for MCI diagnosis

To investigate the implications of obtaining one or more low scores on a battery of cognitive tests on diagnosing mild cognitive impairment (MCI).

Prediction of Violence, Suicide Behaviors and Suicide Ideation in a Sample of Institutionalized Offenders With Schizophrenia and Other Psychosis

This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal justice system. Patients were prospectively monitored within the institution for 18 months. During the follow-up period, 25% of offenders were involved in any suicidal behavior including acts of self-harm, suicidal ideation and suicide attempts and 34% were physically or verbally violent. The S-RAMM and HCR-20 risk assessment tools were strongly correlated and were able to predict suicidal behavior and violence with a moderate-large effect size (AUCs = 0.81–0.85; AUCs = 0.78–0.80 respectively). Patients scoring above the mean on the S-RAMM (>20-point cut-off) had a five times increased risk of suicide related events (OR = 5.05, 95% CI = 2.6–9.7) and sevenfold risk of violence in the HCR-20 (>21-point cut-off) (OR = 7.13, 95% CI = 2.0–21.2) than those scoring below the mean. Offenders at high risk for suicide and violence had significantly more suicide attempts (p < 0.001) and more prior sentences for violent crimes (p < 0.001). These results support the use of the S-RAMM and HCR-20 for clinical practice by providing evidence of the utility of these measures for predicting risk for suicidal and violent behavior in mentally disordered offenders.