Wencke S. Veenstra

Social Cognition Impairments in Relation to General Cognitive Deficits, Injury Severity, and Prefrontal Lesions in Traumatic Brain Injury Patients

Impairments in social behavior are frequently found in moderate to severe traumatic brain injury (TBI) patients and are associated with an unfavorable outcome with regard to return to work and social reintegration. Neuropsychological tests measuring aspects of social cognition are thought to be sensitive to these problems. However, little is known about the effect of general cognitive problems on these tests, nor about their sensitivity to injury severity and frontal lesions. In the present study 28 chronic TBI patients with a moderate to severe TBI were assessed with tests for social cognition (emotion recognition, Theory of Mind, and empathy), and for general, non-social cognition (memory, mental speed, attention, and executive function). The patients performed significantly worse than healthy controls on all measures, with the highest effect size for the emotion recognition test, the Facial Expressions of Emotion-Stimuli and Tests (FEEST). Correlation analyses yielded no significant (partial) correlations between social and non-social cognition tests. Consequently, poor performance on social cognition tests was not due to general cognitive deficits. In addition, the emotion recognition test was the only measure that was significantly related to post-traumatic amnesia (PTA) duration, Glasgow Coma Scale (GCS) score, and the presence of prefrontal lesions. Hence, we conclude that social cognition tests are a valuable supplement to a standard neuropsychological examination, and we strongly recommend the incorporation of measurements of social cognition in clinical practice. Preferably, a broader range of social cognition tests would be applied, since our study demonstrated that each of the measures represents a unique aspect of social cognition, but if capacity is limited, at least a test for emotion recognition should be included.

Leisure and social participation in patients 4–10 years after aneurysmal subarachnoid haemorrhage

Abstract Objective: To investigate the long-term resumption of leisure and social activities in patients with aneurysmal subarachnoid haemorrhage (aSAH) and to determine the role of executive dysfunction and aneurysms in anterior brain regions in particular. Method: Leisure and social functioning of 200 patients with aSAH having anterior or posterior aneurysms was determined using the Role Resumption List (RRL). Executive functioning was investigated using the Dysexecutive Questionnaire (DEX) and sub-scales Social Convention (SC) and Executive Cognition (EC). Mood, fatigue and cognitive problems were investigated with the Hospital Anxiety and Depression Scale (HADS) and Brain Injury Symptom Checklist (BISC). Results: Of all patients, 46.5% reported complete return to previous leisure activities and 61.5% reported no changes in social interactions. HADS depression score, fatigue, DEX-EC sub-scale score and work status post-aSAH were predictors of leisure resumption. For social re-integration, HADS depression score, cognitive problems and fatigue were predictors. Aneurysm location did not influence leisure and social re-integration. Conclusions: A substantial number of the patients still experience problems in resuming previous activities in the chronic phase post-aSAH, influenced by cognitive, executive and depressive problems, as well as current work status and fatigue. Aneurysm location does not seem to influence this resumption.

Age of acquisition and naming performance in Frisian-Dutch bilingual speakers with dementia

Age of acquisition (AoA) of words is a recognised variable affecting language processing in speakers with and without language disorders. For bi- and multilingual speakers their languages can be differentially affected in neurological illness. Study of language loss in bilingual speakers with dementia has been relatively neglected. Objective We investigated whether AoA of words was associated with level of naming impairment in bilingual speakers with probable Alzheimers dementia within and across their languages. Methods Twenty-six Frisian-Dutch bilinguals with mild to moderate dementia named 90 pictures in each language, employing items with rated AoA and other word variable measures matched across languages. Quantitative (totals correct) and qualitative (error types and (in)appropriate switching) aspects were measured. Results Impaired retrieval occurred in Frisian (Language 1) and Dutch (Language 2), with a significant effect of AoA on naming in both languages. Earlier acquired words were better preserved and retrieved. Performance was identical across languages, but better in Dutch when controlling for covariates. However, participants demonstrated more inappropriate code switching within the Frisian test setting. On qualitative analysis, no differences in overall error distribution were found between languages for early or late acquired words. There existed a significantly higher percentage of semantically than visually-related errors. Conclusion These findings have implications for understanding problems in lexical retrieval among bilingual individuals with dementia and its relation to decline in other cognitive functions which may play a role in inappropriate code switching. We discuss the findings in the light of the close relationship between Frisian and Dutch and the pattern of usage across the life-span.

Functionele netwerken; preoperatieve en intraoperatieve mapping van cognitieve functies bij wakkere resectie van (laaggradige) gliomen

SamenvattingHet doel van glioomchirurgie is een zo maximaal mogelijke resectie, met behoud van cognitief functioneren en daarmee kwaliteit van leven voor de patiënt. Gezien het feit dat gliomen vaak gelegen zijn in zogenoemde eloquente gebieden en vanwege de enorme interindividuele anatomische en functionele variatie, is het van belang om goed geïnformeerd te zijn over de functionele betrokkenheid van hersengebieden die bij deze cognitieve functies betrokken zijn. Het is mogelijk om tijdens een wakkere glioomresectie gebieden te lokaliseren die sensomotorische functies, taal en overige hogere orde cognitieve functies beïnvloeden. Dit kan met preoperatieve functional imaging, in combinatie met intraoperatieve elektrische stimulatie (IES). De informatie die daarmee verkregen wordt, geeft inzicht in de corticale en subcorticale organisatie van functionele netwerken. Dergelijke informatie kan van nut zijn voor het plannen van de (mate) van resectie, selectie van intraoperatieve taken, voorspellen van postoperatief cognitief functioneren en het vroegtijdig plannen van cognitieve revalidatie.

Motor and non-motor determinants of health-related quality of life in young dystonia patients

OBJECTIVES To systematically investigate the relationship between motor and non-motor symptoms, and health-related quality of life (HR-QoL) in children and young adults with dystonia. METHODS In this prospective observational cross-sectional study, 60 patients (6-25 years) with childhood-onset dystonia underwent a multidisciplinary assessment of dystonia severity (Burke-Fahn-Marsden Dystonia Rating Scale, Global Clinical Impression), motor function (Gross Motor Function Measure, Melbourne Assessment of Unilateral Upper Limb Function), pain (visual analogue scale), intelligence (Wechsler Intelligence Scale), executive functioning (Behavior Rating Inventory of Executive Function) and anxiety/depression (Child/Adult Behavior Checklist). Measures were analyzed using a principal component analysis and subsequent multiple regression to evaluate which components were associated with HR-QoL (Pediatric Quality of life Inventory) for total group, and non-lesional (primary) and lesional (secondary) subgroups. RESULTS Patients (29 non-lesional, 31 lesional dystonia) had a mean age of 13.6 ± 5.9 years. The principal component analysis revealed three components: 1) motor symptoms; 2) psychiatric and behavioral symptoms; and 3) pain. HR-QoL was associated with motor symptoms and psychiatric and behavioral symptoms (R2 = 0.66) for the total sample and lesional dystonia, but in the non-lesional dystonia subgroup only with psychiatric and behavioral symptoms (R2 = 0.51). CONCLUSIONS Non-motor symptoms are important for HR-QoL in childhood-onset dystonia. We suggest a multidisciplinary assessment of motor and non-motor symptoms to optimize individual patient management.

Social cognition impairments after aneurysmal subarachnoid haemorrhage: Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness

&NA; Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal‐subcortical circuits underlying social cognition. Therefore, we aimed to investigate social cognition after aSAH and its associations with behavioural problems (deficits in interpersonal behaviour, apathy, and impaired self‐awareness) and focal as well as diffuse brain damage. 88 aSAH patients (in the subacute phase post‐aSAH) and 60 age‐, sex‐ and education‐matched healthy controls participated. Tasks for emotion recognition, Theory of Mind (ToM), and empathy as well as questionnaires were used. Cortical infarctions in frontal and non‐frontal areas on MRI, aneurysm circulation and aSAH‐related events were taken into account. Compared to healthy controls, aSAH patients performed significantly worse on tasks for emotion recognition, ToM and empathy. Poor performance on ToM and emotion recognition was associated with proxy‐ratings indicating impaired interpersonal behaviour and apathy and with indications of impaired self‐awareness. No associations were found between deficits in social cognition and frontal or non‐frontal cortical lesions on MRI. Also, aneurysm circulation and aSAH‐related events such as hydrocephalus, vasospasm, and treatment method did not explain why and how social cognitive deficits did occur after aSAH. In conclusion, emotion recognition, ToM and empathy were clearly impaired in aSAH patients and these deficits were related to apathy and deficits in interpersonal behaviour as reported by proxies and to impaired self‐awareness. This association strengthens the assumption of impaired social cognition as an underlying construct of behavioural problems after aSAH. Consequently, social cognition tests and proxy‐ratings should be used in clinical practice, irrespective of lesion location on MRI or aneurysm circulation, to improve the detection and treatment of apathy and deficits in interpersonal behaviour after aSAH. HighlightsAspects of social cognition (emotion recognition, ToM, and empathy) were impaired post‐aSAH.Social cognition deficits were associated to behavioural disturbances after aSAH.An association between impaired self‐awareness and deficits in social cognition was found.Social cognitive deficits were not related to lesion location on MRI or aneurysm circulation.

Sociale cognitie en executieve functies na een aneurysmatische subarachnoïdale bloeding

SamenvattingEen aneurysmatische subarachnoïdale bloeding (aSAB) is een ernstige aandoening met een hoge mortaliteit (30 %). Veel van de patiënten die een aSAB overleven, zullen te maken krijgen met neurologische restverschijnselen en de gevolgen daarvan voor hun dagelijks leven. Veranderingen in emotie en gedrag, zoals apathie, ongepast sociaal gedrag en beperkt zelfinzicht, komen daarbij frequent voor. Deze gedragsveranderingen hebben een negatieve invloed op kwaliteit van leven en het dagelijks functioneren van zowel patiënten als de naastbetrokkenen. Desondanks zijn de factoren die ten grondslag liggen aan deze gedragsproblemen tot op heden nauwelijks onderzocht. Stoornissen in de ‘hogere orde’, prefrontaal gelokaliseerde, functies, waaronder ook de zogenaamde sociale cognitie valt, worden in de literatuur steeds vaker genoemd als mogelijke oorzaak. In het onderstaande artikel wordt het onderzoek beschreven dat momenteel wordt uitgewerkt tot een proefschrift over executief functioneren en sociale cognitie bij patiënten die een aSAB hebben doorgemaakt. In het bijzonder wordt daarin aandacht besteed aan de relatie tussen stoornissen in sociale cognitie en gedragsveranderingen.

Social cognition impairments after aneurysmal subarachnoid hemorrhage

Objective: Many patients with primary brain tumors suffer from cognitive deficits. Treatment options for these deficits are scarce, time-consuming and costly. Recent studies showed promising results on the efficacy of cognitive rehabilitation in these patients. Also, the cognitive rehabilitation program (CRP) developed by our group proved effective in an RCT. To increase its accessibility, it was converted into the app-based CRP ReMind. We performed a pilot study to evaluate feasibility and patient experience of this new method of training. Participants and Methods: Prior to surgery, 15 patients with a presumed meningioma or low-grade glioma were included in this study. The CRP ReMind incorporated both retraining of attention and practicing of compensational strategies of attention, memory and executive functioning. Patients started 3 months after neurosurgery and spent several hours per week on the program for 10 weeks. Neuropsychological assessments were conducted one day before surgery, 3 months after surgery (i.e. before starting the program) and 6 months after surgery (i.e. immediately after finishing the program). At all time-points, questionnaires on psychosocial and subjective cognitive functioning were administered to patients and caregivers. Results: Feasibility (i.e. percentages of interested, adhered and dropped-out patients) and patient experience will be presented. Also, results of paired t-tests will be presented for a first impression of possible changes in cognitive functioning and patient-reported outcomes (PROs). Conclusions: This is the first study that provides evidence-based cognitive rehabilitation via a tablet-app in brain tumor patients. An RCT on the effects of ReMind on cognitive functioning and PROs is forth-coming.Objective: Although there is a vast body of literature on cognition in patients with low-grade gliomas (LGG; WHO grade I or II), this study is first using a brief (30 min) computerized neuropsychological screening battery (cNPS; i.e., CNS Vital Signs) as clinical care to examine cognitive function in LGG patients at group and individual level. Methods: LGG patients underwent cNPS 1 day pre-surgery (N=69), with follow-up 3 months post-surgery (N=54). Results: Pre-operatively, patients demonstrated significantly lower means on 6 out of 7 domains assessed: memory, reaction time, cognitive flexibility, processing speed, complex attention, and executive function, compared to healthy controls (HC; 1,069 American subjects). Effect sizes were small, Cohen’s ds ranging from -.21 to -.36. Post-surgery, there were no differences between patients and HC anymore, except for memory where performance was still lower function, compared to healthy controls (HC; 1,069 American subjects). Effect sizes were small, Cohen’s ds = -.49. Preoperatively, 24% of the patients scored low, and another 25% scored very low (i.e., respectively 1.5 or 2 standard deviation below average) in at least one domain. Post-surgery, respectively 30% and 15% of the patients scored within the low or very low range on at least one domain. Conclusions: In line with studies using conventional neuropsychological tests, the cNPS demonstrated that pre-surgery, LGG patients are faced with mild cognitive dysfunction in several domains. Post-surgery, performance did not differ from HC, except for the memory domain for which performance still deviated from HC. Practice effects and surgery effects will be further examined. Selection bias was minimal and results are generalizable to LGG patients undergoing surgery.Objective: Impaired social cognition (SC) is a possible underlying cause of behavioral and interpersonal changes after aneurysmal subarachnoid hemorrhage (aSAH). To date, SC has not been investigated after aSAH. Therefore, we aimed to investigate SC after aSAH and its relationship with frontal lesions. Participants and Methods; 89 aSAH patients (mean age 53.2 years) conducted a neuropsychological test battery in the subacute phase (mean = 4.8 months) post-SAH. A broad range of SC tests was administered; Emotion recognition (Facial Expressions of Emotion - Stimuli and Test; FEEST), Theory of Mind (Cartoon Test, Faux Pas Test; FP), and emotional empathy (FP Empathy Score, Balanced Emotional Empathy Scale; BEES) were investigated. Frontal infarctions on post-SAH MRI were registered. Between-group comparisons and correlations were used. Results: ASAH patients scored significantly worse on the FEEST (M = 45.64), Cartoons (M = 18.30) and Faux Pas (M FP correct = 4.17, M FP Empathy = 1.84) than controls (M = 48.76, M = 23.50, M = 4.63, M = 2.52 resp.), all ps < 0.05. BEES scores did not differ significantly between patients and controls. No significant correlations were found between the presence of frontal infarctions and SC tests. Conclusions: In the subacute phase after aSAH, several aspects of social cognition were clearly impaired (i.e. emotion recognition, Theory of Mind, empathy). These impairments were not related to frontal lesions. Considering the adverse consequences for daily functioning of social cognitive deficits, neuropsychological assessment after aSAH should include social cognition tests for all patients regardless of their lesion locations