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Long-term health-related quality of life (HRQoL) is an important consideration in planning treatment for individuals with brain tumours. The current study examined relationships between HRQoL and anatomical location of the lesion in patients 6-24 months post-surgery. Following left-hemisphere tumour resection, 37 individuals underwent behavioural testing and MRI. A principal component analysis across 10 HRQoL measures identified two components explaining ~62% of the variance: a communication-related and a mood-related component. Three lesion maps were generated per participant capturing (1) the primary resection, (2) the resection plus residual tumour, oedema, and peri-resection treatment effect (resection+), and (3) residual tumour, oedema, and peri-resection treatment effect alone (residual). Relationships between HRQoL components and lesion maps were examined using voxel-wise lesion symptom-mapping as well as general linear models predicting tract- and voxel-wise disconnection severities. Communication-related quality of life was significantly associated with lesions comprising both the resection+ and residual tumour in the left medial inferior parietal lobe. Voxel-wise analyses of white matter disconnection severities revealed significant associations between communication-related quality of life and thalamostriatal fibres for the residual tumour lesions. None of the analyses involving mood-related quality of life or the primary resection lesion maps were significant. The findings highlight the role of the residual tumour, oedema, and peri-resection treatment effects and associated white matter disconnection in communication-related quality of life following treatment. [ABSTRACT FROM AUTHOR]

Objective: Motor neurone disease [MND] encompasses broad cognitive impairments, which are not fully captured by most screening tools. This study evaluated the specificity and sensitivity of the Edinburgh Cognitive and Behavioral ALS Screen [ECAS] in detecting impairments in executive function and social cognition. Methods: Participants (MND = 64; Healthy Controls = 45) completed the ECAS and standard neuropsychology tests of executive function and social cognition. Sensitivity and specificity of the ECAS were assessed at three levels (ALS-Specific score, executive function domain score, individual subtests: social cognition, inhibition, working memory, alternation). Results: MND patients were impaired on standard social cognition, initiation, visuomotor alternation, and verbal learning tests but not on inhibition or working memory tests, relative to controls. ECAS results revealed that the ALS-Specific score was high in specificity but low-to-moderately sensitive in identifying social cognition, inhibition, and working memory deficits, and that both sensitivity and specificity were high for identifying alternation deficits. The ECAS executive function domain score was high in specificity but poor in sensitivity for all four executive function domain subtests. The individual ECAS subtests were highly specific with good sensitivity, but the social cognition subtest lacked sensitivity. Conclusions: Impairments in social cognition may go undetected when using the ECAS as a screening tool. Thus, social cognition may need to be considered as a standalone component, distinct from the other executive functions. In addition, the test itself may need to be adjusted to encompass other aspects of social cognition that are affected in MND. Cognitive screening tools are key to detect cognitive changes in MND, with the domains most affected being executive functions, language, and social cognition. The ECAS measure, developed for MND, has good specificity but lacks sensitivity to impairments in social cognition. Clinical implications are that cognitive impairments in social cognition may not be identified in MND patients by the ECAS. Adjustment to the ECAS cognitive screening tool widely-used in MND is suggested. [ABSTRACT FROM AUTHOR]

Executive functions comprise a suite of higher-order cognitive processes, which interact with other processes, such as emotion, to drive goal-directed behavior. The Hayling Sentence Completion Test is a widely used standard neuropsychological tool to measure executive functions, namely verbal initiation and suppression. The current studies aimed to establish and validate an emotion-eliciting version of the Hayling Sentence Completion Test, in order to examine the executive processes of initiation and suppression in an emotional context. Study 1 aimed to provide a quantitative evaluation of the emotional content of the Emotional Hayling Test. Study 2 investigated the differences between the Standard and Emotional Hayling Tests, and explored how performance relates to specific emotional properties of the sentences within the Emotional Hayling. Study 1 included N = 100 participants, who were asked to rate each Emotional Hayling Sentence stem in terms of valence (pleasant-unpleasant) and arousal (intensity: low-high). Study 2 included N = 204 participants who completed the Emotional Hayling Test, along with other neuropsychological measures of cognitive and affective functioning. As designed, the sentence stimuli in the Emotional Hayling were rated as significantly higher in absolute emotional valence and arousal, compared to the Standard Hayling (Study 1). Overall, initiation and suppression on the Emotional Hayling were significantly poorer than on the Standard Hayling (Study 2). Finally, within the Emotional Hayling, participants made more suppression errors in response to negative sentences compared to positive sentences, and this effect was present in younger but not older adults. Reduced performance on the Emotional Hayling Test, particularly in response to negative sentences, is consistent with the emotional content placing increased demands on the executive function system. We present the Emotional Hayling Test as a promising clinical tool, with the potential to capture disruptions in emotional processing. [ABSTRACT FROM AUTHOR]

The ability to select an idea from an array of competing options is critical for successful propositional language production, and deficient idea selection contributes to propositional language impairments in clinical populations. We investigate whether three clinical idea selection tasks are sensitive to selection demands in neurologically unimpaired adults, and whether performance relates to age. 154 neurologically normal adults aged 18–89 years completed a neuropsychological baseline and three idea selection tasks. Stimuli either activated a dominant response or multiple competing response options. All three idea selection tasks were sensitive to selection demands in terms of reaction times but not errors. Older age was associated with greater effects of selection demands on Sentence Completion task performance only. Exploratory analyses revealed a potential role of executive functioning. Overall, we demonstrate that clinical idea selection tasks are sensitive to idea selection demands in a non-clinical sample, and show some age-related differences in performance. [ABSTRACT FROM AUTHOR]

Although social cognitive difficulties are common following stroke, the extent to which such difficulties observed in the acute phase are related to long-term socioemotional outcomes remains poorly understood. To address this question empirically, 53 stroke patients completed a measure of Theory of Mind (The Reading the Mind in the Eyes Test) and a cognitive flexibility measure that has been related to social cognitive processes (a Reversal Learning Task) at hospital bedside. These participants then completed measures of socioemotional functioning at a 6-month follow-up. Baseline difficulties on the two measures were found to predict distinct types of socioemotional difficulties. The RMET uniquely predicted self-reported depression and loneliness whereas the Reversal Learning task uniquely predicted peer-reported social behavior, specifically social inappropriateness and stereotyping and prejudice. Importantly, a measure of general cognitive function did not explain variance in these outcome measures, suggesting that social cognitive difficulties are linked to poor socioemotional outcomes. By showing for the first time that social cognitive deficits observed acutely post-stroke are related to longer term functional outcomes, these findings reinforce the importance of including brief social cognitive measures as part of routine post-stroke clinical assessment. [ABSTRACT FROM AUTHOR]

Conceptual preparation mechanisms such as novel idea generation and selection from amongst competing alternatives are critical for language production and may contribute to age-related language deficits. This study investigated whether older adults show diminished idea generation and selection abilities, compared to younger adults. Twenty younger (18-35 years) and 20 older (60-80 years) adults completed two novel experimental tasks, an idea generation task and a selection task. Older participants were slower than younger participants overall on both tasks. Importantly, this difference was more pronounced for task conditions with greater demands on generation and selection. Older adults were also significantly reduced on a semantic, but not phonemic, word fluency task. Overall, the older group showed evidence of age-related decline specific to idea generation and selection ability. This has implications for the message formulation stage of propositional language decline in normal aging. [ABSTRACT FROM AUTHOR]

Introduction: Anomia is an impairment of naming: the retrieval of specific lexical items from the mental lexicon. Theoretically, whether anomia reflects a failure of selection at the preverbal "idea" level or at the subsequent linguistic formulation stage remains a topic of debate. We investigated the preverbal mechanism of idea selection for sentence generation, which requires the selection of a proposition from among competing alternatives during message formulation, in patients with severe anomia. Method: Patients with lesions to the left temporal lobe (N = 12), presenting with clinically defined anomia, and matched healthy controls (N = 24) completed sentence-level tasks that required the oral generation of a sentence or single word when presented with a word, a word pair, or a sentence. Selection demands were manipulated so that the stimuli activated many competing response options (low constraint) or one dominant or few response options (high constraint). Results: There was no effect of stimuli constraint in the patient group that differed from that in the healthy control group on any of the generation tasks, suggesting that idea-level selection is intact in the patient group. Conclusions: These findings have implications for theoretical models of spoken language production and for clinical treatments of anomia. [ABSTRACT FROM AUTHOR]

Introduction: Normal aging is associated with deficits in various aspects of spoken language production, including idea generation and selection, and involves activity in frontal brain areas including left inferior frontal cortex (LIFG). These conceptual preparation processes, largely involving executive control, precede formulation and articulation stages and are critical for language production. Noninvasive brain stimulation (e.g., transcranial direct current stimulation, tDCS) has proven beneficial for age-related fluency and naming deficits, but this has not been extended to conceptual preparation mechanisms. Method: We investigated whether tDCS could facilitate idea generation and selection in 24 older adults aged 60-80 years. In the first phase, participants completed an idea generation test and a selection test with no stimulation. In the second phase they completed an alternate version of the tests in conjunction with either active or sham stimulation. Active stimulation applied 1-mA anodal tDCS over LIFG for the test duration (10 min). Results: Responses were faster following active stimulation than following sham. Furthermore, improvements were specific to test conditions involving novel generation (p = .030) and selection (p = .001) and were not observed in control conditions for which these mechanisms were minimally involved. Conclusions: We concluded that tDCS benefits conceptual preparation mechanisms. This preliminary evidence is an important step for addressing agerelated decline in propositional language generation, which is integral to conversational speech. This approach could also be extended toward rehabilitation in neurological patients with deficits in these processes. [ABSTRACT FROM AUTHOR]

Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an immune-mediated neurological disorder that (among other severe neuropsychiatric symptoms) affects cognition. This study aimed to summarize current knowledge regarding the rates, nature, and predictors of neuropsychological dysfunction in patients recovering from anti-NMDAR encephalitis.Method: A systematic review of studies describing neuropsychological outcomes following anti-NMDAR encephalitis was conducted. Electronic databases Medline, PsycINFO, EMBASE, and CINAHL were searched from inception to September 2016. Results were summarized using descriptive statistics and a series of chi-square analyses.Results: Of 4030 identified studies, 44 were included. These reported neuropsychological outcomes for 109 treated patients (83.5% female,Mage = 22.5 years, range = 2–67) recovering from anti-NMDAR encephalitis. High rates of neuropsychological dysfunction were identified, with diverse impairments of variable severity documented in >75% of patients at assessments conducted during acute, subacute, and longer term recovery periods. Despite this, cognitive outcomes were ultimately considered favorable in most cases (74.3%). This estimate does not account for the potential impact of relapses. The frequency of impairments in overall intellectual functioning, language, attention, working memory, and visuospatial functions were significantly higher within the acute recovery period than in later phases of convalescence. However, rates of impaired processing speed, episodic memory, and aspects of executive functioning were consistent across time points. Adverse neuropsychological outcomes occurred at significantly higher frequency in patients where immunotherapy was delayed, χ2(1,N = 66) = 10.84,p < .003.Conclusions: Neuropsychological deficits are prevalent at all points of recovery from anti-NMDAR encephalitis, although improvement in cognitive outcomes can be expected as patients recover. Some cognitive deficits may be less likely than others to resolve. Close neuropsychological monitoring is warranted in this population. Longitudinal studies of neuropsychological functioning of patients with anti-NMDAR encephalitis are needed to accurately inform prognosis. [ABSTRACT FROM AUTHOR]

Neuropsychological consequences of bi-thalamic damage are scarcely known. This case study documents cognitive (in particular memory and executive) functioning in a man with a medial bi-thalamic infarct in the first year (8 and 12 months) post injury. NG showed persistent memory (including autobiographical) impairment, but improved executive functions at one year post injury. On a response inhibition task his speed of response improved but his ability to inhibit a "prepotent" automatic response declined, corresponding to an increase in behavioral disinhibition. Despite this, he showed intact performances on several social cognition tasks. This case contributes to our understanding of the role of the thalamus in mediating retrograde memory, executive, and social cognition functions. [ABSTRACT FROM AUTHOR]

Distinguished from nominal language, propositional language generation refers to the spontaneous and voluntary aspect of language that introduces novel concepts to a specific context. Propositional language can be impaired in a range of neurological disorders, including stroke, despite well-preserved nominal language. Although external support can increase speech rate in patients with reduced propositional speech, no specific investigation of propositional speech has been carried out in unselected stroke patients. The current study investigated propositional language in an unselected post-acute stroke group (N= 18) with mild cognitive impairment and prominent executive dysfunction, but without significant aphasia. Specifically, we investigated whether genre or external support affected the number of words, sentences, and novel ideas produced, compared to healthy controls (N= 27). Results showed that discourse genre was not associated with differential performances. By contrast, speech quantity increased without external support although, for stroke patients, speech novelty decreased. Overall, the novelty deficit in unselected stroke patients highlights the importance of assessing cognition and propositional speech. Our findings suggest that for stroke patients with mild cognitive deficits, including executive dysfunction, introducing external support improved speech quality but not quantity. Implications for both assessment and rehabilitation of social communication are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Comorbidity of mental illness and alcohol and other drugs (AOD) raises workforce challenges in terms of appropriate knowledge, skills and attitudes required for delivering best care. Aim: (1) To assess the knowledge, skills and attitudes of mental health staff in relation to AOD use and (2) to inform development of training to provide effective screening and interventions for people with both mental health and AOD problems (co-morbidity). Method: Quantitative survey of knowledge, skills and attitudes regarding AOD issues completed by multidisciplinary mental health staff ( n = 104/218) working across acute and community settings. Results: A 47.7% response rate was achieved. Generally staff held positive attitudes and motivation towards working with people with comorbidity, but there was an absence of formal training, experience or knowledge. Most staff believed they could deal with AOD issues; however, confidence was higher with assessment over AOD-related interventions (brief interventions, motivational approaches and goal setting) and only 24% of staff correctly identified standard drinks. Most staff recognized that AOD assessment and intervention is part of their role and access to training would facilitate their ability to improve service to mental health consumers. Conclusion: Integrated care for people with comorbidity requires mental health service providers to address identified gaps in clinician's knowledge, skills and attitudes with training in relation to AOD. To ensure effective training uptake and implementation, workforce leaders need to target identified barriers with initiatives such as support, mentoring and appropriate tools in relation to AOD. [ABSTRACT FROM AUTHOR]

Different theoretical interpretations have been offered in order to account for a specific language impairment termed dynamic aphasia. We report a patient (CH) who presented with a dynamic aphasia in the context of nonfluent progressive aphasia. CH had the hallmark of reduced spontaneous speech in the context of preserved naming, reading, and single word repetition and comprehension. Articulatory and grammatical difficulties were also present. CH had a very severe verbal generation impairment despite being able to describe pictorial scenes and action sequences well. In the experimental investigations CH was severely impaired in word, phrase, and sentence generation tasks when many competing responses were activated by a stimulus. By contrast, he could generate verbal responses satisfactorily when a dominant response was activated by a stimulus. For the first time, we demonstrated that the verbal generation impairment was specific to the production of language. Strikingly, our patient was unimpaired on a number of nonverbal generation tasks (e.g., design fluency, gesture fluency, and motor movement generation). MRI revealed focal left frontal atrophy that predominantly affected Brodmann's Areas 44 and 45. Our findings are discussed with reference to alternative accounts of dynamic aphasia and models of speech production. We interpret our patient's impairment as being underpinned by an inability to select between competing verbal response options. This interpretation converges with evidence from the neuroimaging literature, which implicates the left inferior frontal gyrus in the selection of a response among competing information. We conclude that the left posterior inferior frontal gyrus is involved in the generation of verbal output, and specifically in the selection between competing verbal responses. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women undergoing fertility treatment. Method. This study was a cross-sectional, self-report survey of 454 women at various stages of treatment for infertility. At the time of study, 139 women had not taken fertility drugs and 315 women had taken one or more cycles of CC or hMG. All subjects were asked to complete the State-Trait Anxiety Inventory (STAI). Women taking CC or hMG were also asked to complete a self-administered questionnaire on the side-effects of their medications. Result(s). In the CC group ( n ?=?162) and hMG group ( n ?=?153), 77.8% (126 of 162) and 94.8% (145 of 153) reported at least one side-effect, respectively. Irritability, mood swings, feeling down, and bloating had high frequencies in both CC and hMG groups, with a higher mean number of side effects reported in the hMG group (4.4?±?3.7 for the CC group and 6.8?±?3.7 for the hMG group, p < 0.001). There was no significant difference among the CC, hMG and no medication groups for mean state and trait anxiety scores. However, there were significant differences among the three side-effect groups (those who reported 1 to 4, 5 to 7, and more than 7 side-effects) for the mean scores of state (df?=?2, F ?=?8.7, p < 0.001) and trait (df?=?2, F ?=?11.9, p < 0.001) anxiety in women taking fertility drugs. Conclusion(s). Women taking CC or hMG reported high frequencies of psychological side-effects, and should be advised of these before treatment. [ABSTRACT FROM AUTHOR]

Background: It is not known whether the age of acquisition (AoA) of a word has any significant effect on the spelling performance of normal or impaired speakers. One way to explore this question is to examine the effects of AoA on surface dysgraphia. Aims: We report MK, a patient who suffered herpes simplex viral encephalitis (HSVE) resulting in semantic anomia and surface dysgraphia that we characterise as a tendency to produce a legitimate alternative spelling of a component defined as a LASC error. Methods & Procedures: We describe MK's neuropsychological profile, giving details of impaired naming, spoken and written word comprehension, written picture naming, oral reading, and spelling to dictation, but preserved repetition of whole words. We report experiments designed (1) to test the effect of AoA on spelling by controlling for word frequency as well as other correlated variables using logistic regression and ANOVA, and (2) to test the effects of AoA and sound to spelling predictability on MK's spelling. Outcomes and Results: The results show an effect of AoA but no independent effect of frequency on spelling and an interaction between AoA and predictability, i.e., an effect of AoA on unpredictable word spelling but no effect of AoA on predictable word spelling. Conclusions: We discuss these data with reference to accounts of AoA that locate the effect at the level of mappings between input (phonological) and output (orthographic) representations. We argue that the effect of AoA on spelling is not the result of lexeme activation per se but instead reflects the largely unpredictable mappings between sound and spelling that characterise the majority of English word spellings. [ABSTRACT FROM AUTHOR]

Creativity refers to the ability to produce ideas or actions that are novel and useful, incorporating convergent and divergent thinking. Currently, limited attention has been paid to changes in creativity with disease progression (e.g. mild cognitive impairment and Alzheimer’s disease). Therefore, this study examined the patterns of creativity between healthy controls (n = 36), adults with mild cognitive impairment (MCI; n = 23), and adults with Alzheimer’s disease (AD; n = 21). The study explored whether performance on creativity tasks can predict clinical group and contributing cognitive processes. Various cognitive tests were administered to participants, including measures of creativity. Our findings suggested that creative thought is reduced in individuals with MCI and AD, such that the AD group generated the lowest number of correct responses and made the most errors on all creativity tasks, indicating that creative ability decreases as dementia progresses. Performance on creativity tasks could also predict clinical group (depending on the task, ranging from 49% to 82% of those having MCI), indicating sensitivity to novel idea generation, which has been linked to frontal lobe impairment. Our findings suggested that core cognitive processes underlying creativity, including semantic knowledge and executive functions, are critical for producing new creative thoughts. [ABSTRACT FROM AUTHOR]