Neuropsychological assessments

The battery assessed (i) general cognitive efficiency (progressive matrices, [1] MMSE, [2]); (ii) memory, including short term memory (the forward digit span test,[3]) and episodic memory for both verbal materials (a French adaptation of the selective reminding test,[4-5]) and visual materials (door test,[6]) materials, (iii) language abilities, including oral comprehension (the shortened token test,[7]) and confrontation naming (the DO80 test,[8]), (iv) visuospatial and constructive abilities (the Albert cancellation test,[9] the Rey-Osterrieth Complex Figure Test,[10]) and (v) the cognitive and behavioral components of executive functions (the GREFEX battery,[11]). For the cognitive component, 6 executive processes were assessed: (a) initiation, as indexed by the completion time in the trail-making test A and the Stroop naming and reading subtests (with impairment defined as 2 or 3 abnormal completion times)(b) rule deduction, as indexed by the number of categories achieved in the Modified Card Sorting Test; (c) information generation, as indexed by categorical fluency and literal fluency tests (with impairment defined as at least one poortest result); (d) action coordination, using the Mu index in a dual task; (e) inhibition, as indexed by the Stroop inhibition index (errors in the interference subtest minus errors in the naming subtest), and (f) shifting, as indexed by perseverations in the Modified Card Sorting Test and the trail-making test B; impairment defined when at least one performance parameter was impaired). Using normative data, patients with ≥ 2 impaired processes (with the cut-off score corresponding to the 5th percentile) were considered to suffer from cognitive dysexecutive syndrome.[11] Behavioral executive disorders were assessed with the Behavioral Dysexecutive Syndrome Inventory; this is a structured informant interview that compares current behavior with previous behavior in 12 domains: reduction of activities with apathy-abulia, hyperactivity with distractibility, disinhibition, lack of anticipation, lack of interest-withdrawal, stereotypic behavior, irritability, euphoria, anosognosia, confabulations, environmental dependency and social and sexual conduct disorders. Dysexecutive behavioral changes were considered to be those which (i) could not be more readily explained by perceptuomotor, psychiatric (especially depression) or other cognitive disorders, (ii) induced significant changes relative to premorbid behavior and (iii) induced significant changes in activities of daily living, social life or work. Patients with ≥3 impaired domains (with a cut-off score corresponding to the 5th percentile) were considered to be suffering from behavioral dysexecutive syndrome.[11]

References

1. Raven C (1965). Guide to using the coloured prrogressive matrices. London: Lewis.

2. Folstein MF, Folstein SE, McHugh PR (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189-198.

3. Signoret JL (1991).La Batterie d’Evaluation Mnésique: BEM 144. Paris: Elsevier.

4. Grober E, Buschke H (1987). Genuine memory deficits in dementia. Dev Neuropsychol 3:13-36.

5. Van der Linden M, Groupe Réflexion Evaluation de la Mémoire (2004). L’évaluation des troublesde la mémoire. Marseille: Solal.

6. Baddeley AD, Emslie H, Nimmo-Smith I (1994). Doors and people: a test of visual and verbal recall and recognition. Thames Valley Test Company: Suffolk.

7. De Renzi E, Faglioni P (1978). Normative data and screening power of a shortened version of the token test. Cortex 14:41-49.

8. Deloche G, Hannequin D (1989). Test de Dénomination Orale d’Images. Paris:Editions du centre de psychologie appliquée.

9. Albert ML (1973). A simple test of visual neglect. Neurology 23:658–664.

10. Rey A (1941). L’examen psychologique dans les cas d’encephalopathie traumatique. Arch de Psychologie 8:286-340.

11. Godefroy O, Azouvi P, Robert P, Roussel M, LeGall D, Meulemans T, on the behalf of the GREFEX study group. Dysexecutive syndrome: diagnostic criteria and validation study. Ann Neurol 2010;68:855-864

Table. Clinical and radiologic characteristics of cerebral venous thrombosis patients with or without cognitive impairmentand assessed with a comprehensive neuropsychological battery.

all patients
(n=44) / cognitive impairment
(n=12) / no cognitive impairment
(n=32) / p
Age (years) / 35.3 ± 12.7 / 32.9 ± 14.7 / 36.2 ± 12.0 / 0.45
Gender (M/F)
Educational level (0/1/2/3)
Handedness (right/other) / 4/40
10/20/11/4
38/7 / 2/10
2/6/3/1
10/2 / 2/30
8/13/8/3
27/5 / 0.30
0.89
0.57
Initial signs/symptoms
headache
altered mental status
seizure
partial seizure
generalized seizure
motor impairment
sensory impairment
aphasia
hemianopia
Outpatient clinical and neuropsychological assessments time after clinical event (months)
headache
motor impairment
sensory impairment
epileptic seizure
antiepileptic treatment
depressive symptoms
antidepressant treatment
modified Rankin scale score
mRss=0
mRss=1
mRss=2 / 40 (90)
6 (14)
10 (23)
15 (34)
18 (41)
8 (18)
14 (32)
5 (11)
22.0 ± 12.8
22 (50)
2 (5)
12 (27)
6 (14)
16 (36)
7 (16)
3 (7)
12 (27)
25 (56)
8 (17) / 10 (83)
4 (33)
0
2 (17)
4 (33)
4 (33)
3 (25)
3 (25)
22.8 ± 13.1
8 (67)
1 (8)
3 (25)
0
3 (25)
3 (25)
1 (8)
1 (8)
8 (67)
3 (25) / 30 (94)
2 (6)
10 (31)
13 (41)
14 (44)
5 (16)
11 (34)
2 (6)
21.7 ± 12.8
14 (44)
1 (3)
9 (28)
6 (19)
13 (41)
4 (12)
2 (6)
11 (34)
16 (50)
5 (16) / 0.30
0.039
0.041
0.17
0.73
0.66
0.72
0.12
0.80
0.31
0.48
1.00
0.17
0.49
0.37
1.00
0.12
Initial MRI
one or more parenchymal lesions
infarct
hemorrhage
edema
white matter lesions
right-side lesion
left-side lesion
parenchymal lesion location
frontal lobe
temporal lobe
occipital lobe
parietal lobe
basal ganglia
cerebellum
sinus involvement
number of occluded sinuses
superior sagittal sinus
deep sinus involvement
vein of Galen
straight sinus
transverse sinus
cortical vein
MRI follow-up
one or more parenchymal lesions / 29 (66)
17 (39)
19 (43)
13 (29)
5 (11)
10 (23)
22 (50)
6 (14)
13 (30)
0
16 (36)
2 (5)
4 (9)
1.7 ± 1.3
15 (34)
10 (23)
3 (7)
8 (18)
32 (73)
12 (27)
22 (50) / 10 (83)
7 (58)
6 (50)
5 (42)
0
5 (42)
7 (58)
2 (17)
4 (33)
0
4 (33)
2 (17)
2 (17)
2.2 ± 1.8
4 (33)
8 (67)
2 (17)
6 (50)
9 (75)
3 (25)
10 (83) / 19 (59)
10 (31)
13 (41)
8 (25)
5 (16)
5 (16)
15 (47)
4 (12)
9 (28)
0
12 (37)
0
2 (6)
1.5 ± 1.0
11 (34)
2 (6)
1 (3)
2 (6)
24 (75)
9 (28)
12 (37) / 0.17
0.16
0.73
0.30
0.30
0.10
0.74
0.66
0.73
-
1.00
0.07
0.30
0.26
1.00
< 0.001
0.18
0.011
0.71
1.00
0.042

Results are presented either as the mean ± standard deviation (age, time after clinical eventand the number of occluded sinuses) or as n (%), where n = number of patients and % = n as a percentage of the whole group; mRss: modified Rankin scale; MRI: magnetic resonance imaging)