Qualitative evaluation of divergent thinking in patients with schizophrenia

Patients with schizophrenia show deficits across a broad spectrum of neurocognitive domains. In particular, deficits in verbal fluency are common. Verbal fluency tests are neuropsychological tests that assess frontal lobe function or executive function but also assess divergent thinking. However, few studies have considered the impairment of verbal fluency from the viewpoint of divergent thinking. To consider the structure of divergent thinking, not only verbal assessments but also non-verbal assessments are indispensable. We administered several fluency tests, the idea fluency test, the design fluency test, and word (letter and category) fluency tests to 26 patients with schizophrenia and 26 healthy control subjects to evaluate divergent thinking in both groups and assessed their responses qualitatively. An acceptable minimal level of intelligence was maintained in the patient group. Although attention and executive functioning were relatively preserved in the subjects with schizophrenia, they demonstrated significant deficits in divergent thinking and had particular difficulty in producing ideas and designs requiring concept flexibility, a conversion of viewpoint, originality, or novelty. Research on deficits in divergent thinking in patients with schizophrenia may contribute to the development of cognitive and behavioral rehabilitation programs.     

Swedish norms for word fluency tests: FAS, animals and verbs

Verbal fluency tests are useful measures of acquired language impairment and cognitive decline of various etiologies. The aim of this study was to provide normative data for the Swedish population on the three verbal fluency tests, FAS, Animals and Verbs. A group of 165 healthy participants ranging from 16 to 89 years of age were assessed with the verbal fluency tests and tests of level of intellectual functioning. The sample was stratified by education, age and gender. Level of education had a substantial influence on the performance on verbal fluency, most clearly so in FAS and Verbs. Intellectual level had a positive and significant correlation with all measures of word fluency. Moreover, there was an interaction between age and gender such that women aged between 30 and 64 years outperformed elderly men on FAS and Verbs. Guidelines for instructions and scoring in Swedish are given in the article.     

Inferior Parietal Perfusion, Lateralization, and Neuropsychological Dysfunction in Alzheimer's Disease

The severity of inferior parietal perfusion deficits in Alzheimer's disease (AD) is strongly associated with global intellectual decline. The relationship to specific losses of neuropsychological functioning, however, is less clear, as is the relative importance of the side (left vs. right) of hemispheric deficit. In this study, 53 patients with probable AD and 35 elderly controls received both a resting¹³³Xe rCBF measurement and neuropsychological examination. AD patients demonstrated the expected bilateral deficits in inferior parietal perfusion, as well as impairment on measures of mental status, intelligence, verbal and visual memory, attention, language, and construction abilities. The severity of this bilateral parietal deficit, in turn, was associated with virtually all of these AD-related neuropsychological impairments, most strongly with declining Performance IQ. Left-sided deficits correlated better with overall declines in IQ, as well as with declining attention and language fluency. Right-sided deficits, on the other hand, correlated best with declines in mental status and—paradoxically—verbal memory and contributed independently to declines in Full Scale and Performance IQ. In terms of the number and strength of their association to neuropsychological measures, left-sided deficits appear much more predictive of cognitive decline in AD. Right-sided deficits, however, may be most important for predicting aspects of performance skill that are only indirectly assessed in standard paper-and-pencil format. Overall, it appears that both sides make significant, but independent contributions to general functional decline in AD, but that left-sided deficits are more closely associated with cognitive decline as measured by most standard neuropsychological measures.     

Limitations in Verbal Fluency Following Heavy Burdens of Early Childhood Diarrhea in Brazilian Shantytown Children

The effects of heavy burdens of diarrhea in the first 2 years of life on specific executive control function like verbal fluency are not well understood. In previous studies, we have shown associations of early childhood diarrhea (ECD) with nonverbal intelligence and school functioning. Therefore, we postulated that ECD might affect early neuropsychological development leading to long-term deficits in normal cognitive development. Based on our extensive 14-year prospective cohort studies of early childhood diarrheal illnesses in a Brazilian shantytown community, we examined ECD correlations between specific impairments of higher mental function and executive skills in shantytown children 5–10 years later (now at 6–12) years of age. Specifically we examined whether heavy diarrheal illnesses correlate with reduced performance on selected tests of executive function. Our study, for the first time, suggests a disproportional impairment in semantic but not phonetic fluency in a subset of children with heavy burdens of diarrhea in their first 2 years of life even when controlling for maternal education, breastfeeding, and child schooling. Similar semantic decrements have been associated with impaired recovery from brain injury. These exploratory studies suggest the importance of verbal fluency tests to assess executive functioning in children challenged by poor nutrition and diarrhea in early life. In addition, our unique findings show the potential influences of early childhood diarrhea on language development that is so critical to productive adulthood and potentially set a foundation for new neuropsychological approaches, which assess early burdens of enteric illnesses on childhood development.     

Limitations in verbal fluency following heavy burdens of early childhood diarrhea in Brazilian shantytown children.

The effects of heavy burdens of diarrhea in the first 2 years of life on specific executive control function like verbal fluency are not well understood. In previous studies, we have shown associations of early childhood diarrhea (ECD) with nonverbal intelligence and school functioning. Therefore, we postulated that ECD might affect early neuropsychological development leading to long-term deficits in normal cognitive development. Based on our extensive 14-year prospective cohort studies of early childhood diarrheal illnesses in a Brazilian shantytown community, we examined ECD correlations between specific impairments of higher mental function and executive skills in shantytown children 5-10 years later (now at 6-12) years of age. Specifically we examined whether heavy diarrheal illnesses correlate with reduced performance on selected tests of executive function. Our study, for the first time, suggests a disproportional impairment in semantic but not phonetic fluency in a subset of children with heavy burdens of diarrhea in their first 2 years of life even when controlling for maternal education, breastfeeding, and child schooling. Similar semantic decrements have been associated with impaired recovery from brain injury. These exploratory studies suggest the importance of verbal fluency tests to assess executive functioning in children challenged by poor nutrition and diarrhea in early life. In addition, our unique findings show the potential influences of early childhood diarrhea on language development that is so critical to productive adulthood and potentially set a foundation for new neuropsychological approaches, which assess early burdens of enteric illnesses on childhood development.     

Developmental change in the relation between executive functions and symptoms of ADHD and co‐occurring behaviour problems

In a sample of 92 children aged 6–13 years this study investigates the normal developmental change in the relation between executive functioning (EF) and the core behavioural symptoms associated with attention deficit hyperactivity disorder (ADHD) (hyperactivity/impulsivity and inattention) as well as symptoms often co‐occurring with childhood hyperactivity (conduct‐ and internalizing problems). EF was assessed by using multiple tests grouped through prior factor analysis, resulting in cognitive measures relating to disinhibition, speed/arousal, verbal working memory, non‐verbal working memory, and fluency. The results showed that although disinhibition was positively related to hyperactivity/impulsivity and inattention mainly for the youngest age group, there were no significant age effects for these relations. Instead, age effects were found for the relations between speed/arousal and inattention as well as for the relations between verbal working memory/fluency and inattention. In the oldest age group poor performance on these cognitive measures was associated with high ratings of inattention. For the total sample a relation was obtained between disinhibition and hyperactivity/impulsivity as well as between both working memory measures and internalizing problems. In conclusion, the results from this study suggest that poor inhibition is most clearly associated with ADHD symptoms for younger children, whereas poor functioning with regard to later developing and more complex executive functions such as working memory and fluency is associated with ADHD symptoms for older children. Copyright © 2006 John Wiley & Sons, Ltd.     

Cognitive functioning in healthy older adults aged 64-81: a cohort study into the effects of age, sex, and education

The objective of this study was to determine a possible differential effect of age, education, and sex on cognitive speed, verbal memory, executive functioning, and verbal fluency in healthy older adults. A group of 578 healthy participants in the age range of 64-81 was recruited from a large population study of healthy adults (Maastricht Aging Study). Even in healthy individuals in this restricted age range, there is a clear, age-related decrease in performance on executive functioning, verbal fluency, verbal memory, and cognitive speed tasks. The capacity to inhibit information is affected most. Education had a substantial effect on cognitive functioning: participants with a middle or high level of education performed better on cognitive tests than did participants with a low level of education. Women performed better than men on verbal memory tasks. Therefore, education and sex must be taken into account when examining an older individual's cognitive performance.     

Executive functioning in older adults with mild cognitive impairment: MCI has effects on planning, but not on inhibition

In this study, we compared executive functioning in 32 mild cognitive impairment (MCI) individuals with that of normally aging controls. Cognitive planning tests (Trail Making, Porteus Maze Test, verbal fluency tests) show a group difference favoring the normal controls, but tests for inhibition of prepotent responses (no-go accuracy, two measures of the Stroop effect, and negative priming) failed to uncover a significant group difference. The results indicate that there is no general executive control function impairment in MCI; rather, the deficits found are compatible with the hypothesis that MCI is an accelerated form of normal aging.     

Neuropsychological outcome following unilateral stereotactic pallidotomy in intractable Parkinson's disease

Neuropsychological functioning was examined at baseline and 2- to 3-month follow-up in 40 subjects with advanced Parkinson's disease (PD) who underwent unilateral posteroventral pallidotomy. Most subjects demonstrated improved verbal learning, visual memory, confrontation naming, and figural fluency at follow-up. Right pallidotomy was associated with decreased cognitive flexibility and increased verbal fluency, whereas Left pallidotomy uniquely resulted in a decline in verbal fluency. Significant motor improvement was demonstrated in both groups. Pallidotomy appears to be an effective treatment for advanced PD, providing a significant improvement in motor functioning, while resulting in few deleterious neurocognitive changes in most cases.     

Executive Functioning in Older Adults with Mild Cognitive Impairment: MCI Has Effects on Planning,But Not on Inhibition

ABSTRACT

In this study, we compared executive functioning in 32 mild cognitive impairment (MCI) individuals with that of normally aging controls. Cognitive planning tests (Trail Making, Porteus Maze Test, verbal fluency tests) show a group difference favoring the normal controls, but tests for inhibition of prepotent responses (no-go accuracy, two measures of the Stroop effect, and negative priming) failed to uncover a significant group difference. The results indicate that there is no general executive control function impairment in MCI; rather, the deficits found are compatible with the hypothesis that MCI is an accelerated form of normal aging.     

Terminal decline and cognitive performance in very old age: does cause of death matter?

Cross-sectional differences and longitudinal changes in cognitive functioning in relation to mortality across a 7-year follow-up period, with 3 times of measurement, were examined in a population-based sample of very old adults. The authors also sought to determine whether cause of death (cerebro/cardiovascular disease [CVD]; non-CVD) modified the magnitude of mortality-related cognitive deficits. Cognitive performance was indexed by tests of general cognitive ability, episodic memory, primary memory, verbal fluency, and visuospatial ability. Results indicated cross-sectional differences on all domains of functioning, with persons who would die within 3 years after baseline testing performing more poorly. Longitudinally, greater decrements were observed on all domains for persons who would die after the first follow-up period, as compared with survivors. Cause of death failed to modify the magnitude of the cross-sectional and longitudinal deficits. The pattern of results point to the general nature of this phenomenon.     

Which Executive Functioning Deficits Are Associated With AD/HD,ODD/CD and Comorbid AD/HD+ODD/CD?

This study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3)~whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99~children ages 6–12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).     

Influence of depression on verbal fluency performance

Abstract

Neuropsychologists are often faced with the challenge of assessing older adults who exhibit both cognitive deficits and symptoms of depression. This study examined factors associated with diminished fluency in elderly adults. Three groups were tested: 54 community elderly, 35 institutionalized elderly, and 40 young adults using the Controlled Oral Word Association test. Significant incremental contributions to performance on verbal fluency included age, education, depression, and the interaction term for depression and functional impairment. Diminished verbal fluency was associated with depression among older adults who were not functionally impaired. the results suggest that variables other than cerebral integrity must be taken into consideration when interpreting older adults' performance on fluency tests.     

Emotional Intelligence and cognitive abilities – associations and sex differences

In order to expand on previous research, this cross-sectional study investigated the relationship between Emotional Intelligence (EI) and cognitive abilities in healthy adults with a special focus on potential sex differences. EI was assessed by means of the Mayer-Salovey-Caruso-Emotional-Intelligence Test (MSCEIT), whereas cognitive abilities were investigated using the Brief Assessment of Cognition in Schizophrenia (BACS), which measures key aspects of cognitive functioning, i.e. verbal memory, working memory, motor speed, verbal fluency, attention and processing speed, and reasoning and problem solving. 137 subjects (65% female) with a mean age of 38.7 ± 11.8 years were included into the study. While males and females were comparable with regard to EI, men achieved significantly higher BACS composite scores and outperformed women in the BACS subscales motor speed, attention and processing speed, and reasoning and problem solving. Verbal fluency significantly predicted EI, whereas the MSCEIT subscale understanding emotions significantly predicted the BACS composite score. Our findings support previous research and emphasize the relevance of considering cognitive abilities when assessing ability EI in healthy individuals.     

Cognitive assessment in Chinese patients with aneurysmal subarachnoid hemorrhage

A subgroup of patients who survive aneurysmal subarachnoid hemorrhage (SAH) may have significant cognitive deficits. The aim of the current study was to determine the efficiency of cognitive tests and frequency of cognitive impairments associated with aneurysmal SAH in Chinese. A series of 116 patients with aneurysmal SAH were assessed before surgery. Only 37 patients have completed all tests. The other 79 patients had discontinued because of their clinical conditions, recurring severe headaches, refusing or misunderstanding due to low education. We found that one or more cognitive functions were impaired in 70.3% of the 37 patients, SAH patients were especially impaired in functions that are related to visual reproduction, verbal fluency, and executive functions. The results suggest that the patients have impressive cognitive deficits after aneurysmal SAH. A battery of appropriate cognitive tests should be developed for use by doctors and nurses.     

Semantic and phonemic verbal fluency in Parkinson's disease: Influence of clinical and demographic variables

Changes of cognitive function in PD have been extensively documented and defined as a 'frontal' type executive dysfunction. One of the main components of this executive dysfunction is the impairment of verbal fluency. The aim of the present study was to assess semantic and phonemic fluency in a large sample of PD patients and to investigate the effect of clinical and sociodemographic variables on verbal fluency in this patient group. Three hundred patients with idiopathic Parkinson's disease who were consecutive referrals to our clinic and 50 age and education matched healthy controls completed the phonemic and semantic verbal fluency tasks. Both phonemic and semantic verbal fluency were significantly impaired in PD patients relative to matched controls. Stage of illness, presence of depression, education and age influenced verbal fluency measures. Regression analyses established that global measures of cognitive ability (MMSE) and executive function (FAB) and side of onset of motor symptoms predicted 36-37% of variance of phonemic or semantic verbal fluency measures. Thus, future studies aimed at assessing cognitive functioning in PD patients treated by deep brain stimulation (DBS) should adequately take into account several factors (stage of illness, depression, executive functioning) which may potentially influence performance on verbal fluency tasks.     

Everyday Cognitive Functioning in Cardiac Patients: Relationships Between Self-report,Report of a Significant Other and Cognitive Test Performance

ABSTRACT

Candidates for cardiac bypass surgery often experience cognitive decline. Such decline is likely to affect their everyday cognitive functioning. The aim of the present study was to compare cardiac patients' ratings of their everyday cognitive functioning against significant others' ratings and selected neuropsychological tests. Sixty-nine patients completed a battery of standardised cognitive tests. Patients and significant others also completed the Everyday Function Questionnaire independently of each other. Patient and significant other ratings of patients' everyday cognitive difficulties were found to be similar. Despite the similarities in ratings of difficulties, some everyday cognitive tasks were attributed to different processes. Patients' and significant others' ratings were most closely associated with the neuropsychological test of visual memory. Tests of the patients' verbal memory and fluency were only related to significant others' ratings. Test scores of attention and planning were largely unrelated to ratings by either patients or their significant others.     

A cognitive assessment of highly superior autobiographical memory

Highly Superior Autobiographical Memory (HSAM) is characterised as the ability to accurately recall an exceptional number of experiences and their associated dates from events occurring throughout much of one's lifetime. The source of this ability has only begun to be explored. The present study explores whether other enhanced cognitive processes may be critical influences underlying HSAM abilities. We investigated whether enhanced abilities in the domains of verbal fluency, attention/inhibition, executive functioning, mnemonic discrimination, perception, visual working memory, or the processing of and memory for emotional details might contribute critically to HSAM. The results suggest that superior cognitive functioning is an unlikely basis of HSAM, as only modest advantages were found in only a few tests. In addition, we examined HSAM subjects’ memory of the testing episodes. Interestingly, HSAM participants recalled details of their own experiences far better than those experiences that the experimenter shared with them. These findings provide additional evidence that HSAM involves, relatively selectively, recollection of personal, autobiographical material.     

Stress, Coping and Cognitive Deficits in Women After Surgery for Breast Cancer

Research on neuropsychological difficulties among cancer patients has focused on chemotherapy as a primary cause, yet several studies have now shown that some patients evidence cognitive weaknesses prior to chemotherapy. As an alternative to the ‘chemo–brain’ theory, this study examined the hypothesis that stress and coping style may be associated with observed neuropsychological difficulties among female cancer patients. Thirty-six women completed neuropsychological testing and psychological questionnaires following surgery for breast cancer and prior to any subsequent treatments. Twenty-seven percent of participants evidenced deficits on at least one measure of verbal fluency, and 14% of participants were impaired on at least one memory measure. Self-reported stress was correlated with deficits in memory, verbal fluency, and attention. Subsequent mediational analyses indicated that use of passive coping styles may underlie this relationship between stress and neuropsychological deficits. These findings highlight the potential relevance of psychological mechanisms, such as coping style, in cancer patients’ experience of neuropsychological deficits.     

Chronic glucocorticoid hypersecretion in Cushing’s syndrome exacerbates cognitive aging

Cumulative exposure to glucocorticoid hormones (GC) over the lifespan has been associated with cognitive impairment and may contribute to physical and cognitive degeneration in aging. The objective of the present study was to examine whether the pattern of cognitive deficits in patients with Cushing’s syndrome (CS), a disorder characterized by chronic exposure to elevated levels of glucocorticoids (GC), is similar to that observed in older individuals. Ten subjects with CS were compared to sex-, age-, and education-matched healthy controls and older subjects (age of CS subjects + 15 yr). All participants were administered tests to assess attention, visuospatial processing, learning and memory, reasoning, concept formation and verbal fluency. MANCOVAs with depression scores as covariate and polynomial contrasts revealed that the age-matched control group performed better than the CS and older subject groups in visual target detection, trail making test, stroop task, digit symbol substitution, block design, object assembly, visual reproduction, spatial memory and similarities. The CS and older subjects performed similarly on these tasks. Further, a principal component analysis revealed two significant factors, representing general cognitive function and verbal memory explaining 39.9% and 10.0% of the variance, respectively. Additional MANCOVAs with depression as a covariate revealed that CS and older control subjects showed impaired performance on general cognitive function compared to age-matched controls. These results suggest that hypersecretion of GCs has “aging-like” effects on cognitive performance in individuals with CS.