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Dementia and Lower Urinary Tract Dysfunction
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
There may be a cerebral vascular component in the etiology of elderly OAB and incontinence.31 This is because MRI health surveys show that WMD occurs in around 10% of the general population, which is akin to that of OAB (10%–14%). In addition, WMD increases significantly with age and preferentially affects the prefrontal deep white matter.32 The frequency of nocturia in patients with Alzheimer's disease (44%) was less than that in WMD (84%), and it was intermediate (60%) in patients with both Alzheimer's disease and WMD.33 This suggests that WMD is a more significant burden of OAB in the geriatric population than Alzheimer's disease. In one study,34 detrusor overactivity (DO) was independent of general cognitive status (the mean MMSE score or any of its subdomains). In contrast, the presence of DO was significantly associated with the inhibitory control subdomain in the frontal assessment battery (FAB) test (p < 0.01). This finding agrees with the fact that brain perfusion was most severely reduced in the frontal lobe of subjects with WMD.32 The bladder is under general inhibitory control concerning decision-making and emotion by the prefrontal cortex. In patients with WMD, this neural network might be impaired, leading to both frontal cortex-related behavior changes and DO.34
Frontotemporal Dementia
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Two bedside neuropsychological tests that have been developed to assess executive function include the Frontal Assessment Battery or FAB (Dubois, Slachevsky, Litvan, & Pillon, 2000) and the Executive Interview or EXIT (Moorhouse, Gorman, & Rockwood, 2009; Royall, Mahurin, & Gray, 1992). The FAB is a 10-minute test composed of six subtests measuring various skills, such as conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and autonomy. The patient is asked to carry out a simple task to assess each skill. Research using the FAB for differential diagnosis among patients with FTD, AD, and VaD has shown limited discrimination and only on one or more subtests but not in terms of total scores (Boban, Malojcić, & Mimica, 2012; Lipton et al., 2005). The EXIT is a 25-item test that takes about 10 minutes and measures skills similar to those the measured on the FAB, but it also incorporates frontal release signs and shortened versions of several neuropsychological tasks. It can serve as an ideal supplement to the MMSE since it highlights dysfunction not well-captured on that instrument. However, it has not been shown to specifically identify FTD versus other forms of dementia. A quick assessment of frontal lobe function using items from a variety of cognitive screens including the FAB and EXIT can be found in Table 7.3.
Acute pain management in the elderly patient
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Pamela E Macintyre, Richard Upton
In an interesting study looking at the placebo component of analgesic therapies, Benedetti et al.75[III] studied the effect of both “overtly applied” and “covertly applied” local anesthetic on pain after venipuncture in patients with Alzheimer’s disease. They determined that patients with reduced Frontal Assessment Battery scores (a measure of frontal executive function) had a reduced placebo component to their pain relief which, in turn, reduced treatment efficacy, so that dose increases were required to produce adequate analgesia. They also found that reduced connectivity between prefrontal lobes and the rest of the brain disrupted the placebo component and commented that their results emphasize the active part that cognition and prefrontal lobes play in therapeutic outcome.
Repetitive transcranial magnetic stimulation (rTMS) fails to improve cognition in patients with parkinson’s disease: a Meta-analysis of randomized controlled trials
Published in International Journal of Neuroscience, 2022
Pei Kun He, Li Min Wang, Jia Ning Chen, Yu Hu Zhang, Yu Yuan Gao, Qi Huan Xu, Yi Hui Qiu, Hui Min Cai, You Li, Zhi Heng Huang, Shu Jun Feng, Jie Hao Zhao, Gui Xian Ma, Kun Nie, Li Juan Wang
Thirdly, a lack of sensitivity of the neurological test might underlay the null pooled effect. Benninger et al. [13], Benninger et al. [14], and Eungseok Oh et al. [20] used the Frontal Assessment Battery (FAB), while Sedlackova et al. [29], Pal et al. [16], Makkos et.al [15], and Randver et al. [17] conducted the Trail-Making Test Part B (TMT-B) to assess executive function. The Frontal Assessment Battery was proven to have a low sensitivity in detecting executive dysfunction related to dementia in PD [41]. A meta-analysis confirmed an improvement in the score of TMT-A and TMT-B in patients with depression after using rTMS over DLPFC [42], but not in patients with PD [16]. This might be due to the fact that the TMT-B test is associated with physical performance as it requires patients to connect the number and letter alternatively in a sequential order [43], which might lower the sensitivity to differentiate the frontal lobe dysfunction in PD, a disease characterized by dyskinesia. Furthermore, a study showed that the status of motor impairment (measured by the Unified Parkinson's Disease Rating Scale-III, UPDRS III) was the most important moderator to predict the Wisconsin Card Sorting Test performance, a test used to evaluate executive function in PD [44]. Therefore, we suggest that researchers adjust the UPDRS III score or use a modified value, such as TMT (B-A), in cognitive tests in which motor performance is an important influencing factor.
Cognition-immune interactions between executive function and working memory, tumour necrosis factor-alpha (TNF-alpha) and soluble TNF receptors (sTNFR1 and sTNFR2) in bipolar disorder
Published in The World Journal of Biological Psychiatry, 2022
Robson Zazula, Seetal Dodd, Olivia M. Dean, Michael Berk, Chiara C. Bortolasci, Waldiceu A. Verri, Heber O. Vargas, Sandra O. V Nunes
Current research suggest TNF-α and its receptors (sTNFR1 and 2) have an essential role in cognition among individuals with BD. Barbosa et al. (2012) evaluated executive functioning through the Frontal Assessment Battery (FAB), a brief exam to evaluate neurocognitive process related to the frontal lobe, compared with plasma levels of TNF-α and its receptors. They did not find significant differences between individuals with BD and controls on TNF-α levels and both soluble sTNFR1 and sTNFR2, but identified that individuals with BD were significantly more impaired in executive function (p = .006), in particular subtests evaluating sensitivity to interference (p = .02) and inhibitory control (p = .02). There was a positive correlation between plasma levels of TNF-α and inhibitory control, a subtest of the main assessment tool (ρ = .050, p = .002). Doganavsargil-Baysal et al. (2013) used Rey's Auditory Verbal Learning Test (RAVLT), to assess verbal learning and memory, and the Wisconsin Card Sorting Test (WCST), to assess executive and visual-motor function. There were significantly higher levels of sTNFR1 and sTNFR2, and worse performance in both instruments for individuals with BD. However, there was a negative correlation only between TNF-α and delayed recall, a subtest of RAVLT (r = –.275, p = .044; (Doganavsargil-Baysal et al. 2013).
Frontal Lobe Functions in Normal Aging: Metacognition, Autonomy, and Quality of Life
Published in Experimental Aging Research, 2019
Cristina Calso, Jérémy Besnard, Philippe Allain
The Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) provides a brief screen for cognitive impairment in normal aging. In the present study, old and very old adults’ MMSE scores had to be within the normal range (≥26/30). All participants were screened with the National Adult Reading Test (NART; Nelson, 1982), emphasizing previous word knowledge for correct pronunciations. Other global cognition measures have been the Frontal Assessment Battery (FAB; French version, Dubois, Slachevsky, Litvan, & Pillon, 2000) and 2-min phonemic (“s”) and semantic (“animals”) verbal fluency (VF; Cardebat et al., 1996), involving monitoring, task setting and energization processes. The enhanced cued recall (Van der Linden et al., 2004) allows an accurate measurement of short- and long-term memory.