José Antonio Periañez

Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities

The aim of this study was to clarify which cognitive mechanisms underlie Trail Making Test (TMT) direct and derived scores. A comprehensive review of the literature on the topic was carried out to clarify which cognitive factors had been related to TMT performance. Following the review, we explored the relative contribution from working memory, inhibition/interference control, task-switching ability, and visuomotor speed to TMT performance. Forty-one healthy old subjects participated in the study and performed a battery of neuropsychological tests including the TMT, the Digit Symbol subtest [Wechsler Adult Intelligence Scale (Third Version) (WAIS-III)], a Finger Tapping Test, the Digits Forward and Backward subtests (WAIS-III), Stroop Test, and a task-switching paradigm inspired in the Wisconsin Card Sorting Test. Correlation and regression analyses were used in order to clarify the joint and unique contributions from different cognitive factors to the prediction of TMT scores. The results suggest that TMT-A requires mainly visuoperceptual abilities, TMT-B reflects primarily working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, providing a relatively pure indicator of executive control abilities.

Attentional control and slowness of information processing after severe traumatic brain injury

Attention is a basic cognitive function and a prerequisite for other cognitive processes and is frequently impaired after traumatic brain injury. In the present study, 29 severe traumatic brain injury patients and 30 control subjects completed a battery of three neuropsychological tests of attention (WCST, TMT, Stroop). The aim was to clarify the attentional mechanisms underlying tests performance and to explore the types of attentional impairment after severe traumatic brain injury. Significant differences were found between the control and clinical groups in almost all measures. However, some of these differences disappeared when the speed of information processing was controlled using covariance analysis. In addition, a factor analysis revealed a four-factor solution explaining 89.6% of the variance in the data, i.e. cognitive flexibility, speed of processing, interference and working memory. This result supports the view of at least four different subprocesses of attentional control underlie test performance and allows one to differentiate between high- and low-level processes. The implications for neuropsychological assessment and rehabilitation are discussed.

Cannabis use and cognitive functioning in first-episode schizophrenia patients

Cannabis is one of the most widely used illicit drugs in the world. In healthy individuals cannabis is associated with cognitive impairments. Research into the effect of cannabis use in schizophrenia has yielded contradictory findings. Our aim has been to explore the correlates of cannabis use in cognitive and psychopathological features, both cross-sectional and longitudinally, in early phases of schizophrenia. 104 patients with a first episode of non-affective psychosis and 37 healthy controls were studied. Patients were classified according to their use of cannabis prior to the onset of the illness (47 users vs. 57 non-users). They were cross-sectionally and longitudinally studied and compared on clinical and cognitive variables and also on their level of premorbid adjustment. Cannabis user patients had better attention and executive functions than non-cannabis user patients at baseline and after 1 year of treatment. Both groups showed similar improvement in their cognitive functioning during the 1-year follow-up period. We also found that users had a better social premorbid adjustment, particularly during the early periods of life. The amount of cannabis consumed and the length of time of consumption did not significantly relate to cognitive performance. The use of cannabis does not seem to be associated with a negative effect on cognition in a representative sample of first-episode schizophrenia patients. Cannabis user patients appear to comprise a subgroup of patients with a better premorbid adjustment and premorbid frontal cognitive functions.

Brain oscillatory activity associated with task switching and feedback processing

In this study, we sought to dissociate event-related potentials (ERPs) and the oscillatory activity associated with signals indicating feedback about performance (outcome-based behavioral adjustment) and the signals indicating the need to change or maintain a task set (rule-based behavioral adjustment). With this purpose in mind, we noninvasively recorded electroencephalographic signals, using a modified version of the Wisconsin card sorting task, in which feedback processing and task switching could be studied separately. A similar late positive component was observed for the switch and correct feedback signals on the first trials of a series, but feedback-related negativity was observed only for incorrect feedback. Moreover, whereas theta power showed a significant increase after a switch cue and after the first positive feedback of a new series, a selective frontal beta–gamma increase was observed exclusively in the first positive feedback (i.e., after the selection of the new rule). Importantly, for the switch cue, beta–alpha activity was suppressed rather than increased. This clear dissociation between the cue and feedback stimuli in task switching emphasizes the need to accurately study brain oscillatory activity to disentangle the role of different cognitive control processes.

Course of cognitive deficits in first episode of non-affective psychosis: a 3-year follow-up study.

Cognitive dysfunctions are critical determinants of the quality of life and functionality in schizophrenia. Whether the cognitive deficits present at an early stage, are static or change across ones lifespan is still under debate. This study aims to investigate the long-term (3 years) course of cognitive deficits in a large and representative cohort of first episode schizophrenia spectrum patients (N=155),and evaluate their influence on disability. In addition, a healthy control sample (N=43) was also studied for comparison. This study evaluates the performance of patients and controls in a battery of cognitive assessments using baseline, 1-year and 3-year follow-up designs. The results show that, although cognitively outperformed by the controls at any time, the cognitive performance of the patients improved similar to the controls in all cognitive functions except verbal and visual memory. Even though the course of cognitive performance across the sample as a whole was stable, the subgroup of patients who experienced a cognitive decline had worse functionality and lesser amelioration of negative symptoms. Overall, there is no significant deterioration in the cognitive function in a group of first episode schizophrenia spectrum disorder patients, with the possible exception of tasks that were associated with episodic memory. However, patients whose cognitive performance demonstrated a declining trend may present with a poorer progression in terms of clinical and disability variables.

The Role of Low and High Spatial Frequencies in Exogenous Attention to Biologically Salient Stimuli

Exogenous attention can be understood as an adaptive tool that permits the detection and processing of biologically salient events even when the individual is engaged in a resource-consuming task. Indirect data suggest that the spatial frequency of stimulation may be a crucial element in this process. Behavioral and neural data (both functional and structural) were analyzed for 36 participants engaged in a digit categorization task in which distracters were presented. Distracters were biologically salient or anodyne images, and had three spatial frequency formats: intact, low spatial frequencies only, and high spatial frequencies only. Behavior confirmed enhanced exogenous attention to biologically salient distracters. The activity in the right and left intraparietal sulci and the right middle frontal gyrus was associated with this behavioral pattern and was greater in response to salient than to neutral distracters, the three areas presenting strong correlations to each other. Importantly, the enhanced response of this network to biologically salient distracters with respect to neutral distracters relied on low spatial frequencies to a significantly greater extent than on high spatial frequencies. Structural analyses suggested the involvement of internal capsule, superior longitudinal fasciculus and corpus callosum in this network. Results confirm that exogenous attention is preferentially captured by biologically salient information, and suggest that the architecture and function underlying this process are low spatial frequency-biased.

The contribution of depressive symptoms to slowness of information processing in relapsing remitting multiple sclerosis

Background: Slowness of information processing has been suggested as a fundamental factor modulating cognitive impairment in multiple sclerosis (MS). However, the contribution of depressive symptoms (DS) to slowness remains unclear. One of the most accepted hypotheses on the impact of depression on the general population suggests that depression interferes only with tasks requiring high cognitive demands. However, no studies have investigated if the same pattern occurs in MS. Objective: The aim of this study was to determine the profile of the contribution of DS to slowness. Methods: Four Reaction Time (RT) tasks requiring an increasing level of cognitive demands were administered to 35 relapsing remitting MS patients with DS, 33 MS patients without DS, 17 depressed non-MS patients and 27 controls. Results: MS patients without DS obtained longer RTs than controls in all the tasks. On the contrary, depressed non-MS patients were slower than controls only in the most demanding task. Finally, MS patients with DS were slower than MS patients without DS not only in the most demanding task but also in the task requiring a lower level of cognitive demands. Conclusion: The contribution of DS to slowness depends on the level of cognitive demands. However, its impact on MS is more deleterious than on the general population.

Clinical Spanish Norms of the Stroop Test for Traumatic Brain Injury and Schizophrenia

The Stroop Color-Word Test is a useful tool to evaluate executive attention and speed of processing. Recent studies have provided norms for different populations of healthy individuals to avoid misinterpretation of scores due to demographic and cultural differences. In addition, clinical norms may improve the assessment of cognitive dysfunction severity and its clinical course. Spanish normative data are provided for 158 closed traumatic brain injury (TBI) and 149 first-episode schizophrenia spectrum disorder (SCH) patients. A group of 285 Spanish healthy individuals (HC) was also considered for comparison purposes. Differences between groups were found in all Stroop scores with HC outperforming both clinical groups (p .3 in all cases). TBI patients scored lower than SCH patients in word-reading (p < .001 and d = .6), and color-naming conditions (p < .001 and d = .4), but not in the color-word condition (p = .34 and d = .03). However, SCH patients exhibited a higher interference effect as compared to TBI (p < .002 and d = .5). Three sets of norms stratified by age and education (HC), and by education (TBI and SCH) are presented for clinical use.