Monthlong Intubated Patient with Life-Threatening COVID-19 and Cerebral Microbleeds Suffers Only Mild Cognitive Sequelae at 8-Month Follow-up

2022. Linda Backman (et al.). Archives of clinical neuropsychology 37 (2), 531-543

Article

Objective: To elaborate on possible cognitive sequelae related to COVID-19, associated cerebrovascular injuries as well as the general consequences from intensive care. COVID-19 is known to have several, serious CNS-related consequences, but neuropsychological studies of severe COVID-19 are still rare.

Methods: M., a 45-year-old man, who survived a severe COVID-19 disease course including Acute Respiratory Distress Syndrome (ARDS), cerebral microbleeds, and 35 days of mechanical ventilation, is described. We elaborate on M’s recovery and rehabilitation process from onset to the 8-month follow-up. The cognitive functions were evaluated with a comprehensive screening battery at 4 weeks after extubation and at the 8-month follow-up.

Results: Following extubation, M. was delirious, reported visual hallucinations, and had severe sleeping difficulties. At about 3 months after COVID-19 onset, M. showed mild to moderate deficits on tests measuring processing speed, working memory, and attention. At assessments at 8 months, M. performed better, with results above average on tests measuring learning, memory, word fluency, and visuospatial functions. Minor deficits were still found regarding logical reasoning, attention, executive functioning, and processing speed. There were no lingering psychiatric symptoms. While M. had returned to a part-time job, he was not able to resume previous work-tasks.

Conclusion: This case-study demonstrates possible cognitive deficits after severe COVID-19 and emphasizes the need of a neuropsychological follow-up, with tests sensitive to minor deficits. The main findings of this report provide some support that the long-term prognosis for cognition in severe COVID-19 may be hopeful.

WAIS-IV short form applied to a mixed neurological Swedish clinical sample

2021. Maria Lindau, Milena Lundberg, Mats Najström. Nordic Psychology

Article

The Wechsler Adult Intelligence Scale, fourth version (WAIS-IV), is a frequently used instrument for neuropsychological assessment. The aim was to assess the degree of conformity between the Scandinavian adaptation of the WAIS-IV and a short form of this scale (SF) in a mixed sample of neurological diagnoses. The SF comprised Block Design, Similarities, Digit Span, Arithmetic, Information, Digit Symbol (in the WAIS-IV named Coding), and Picture Completion, the latter here replaced by Matrix Reasoning. The sample consisted of 150 patients and included multiple sclerosis (n = 27), brain tumor (n = 15), traumatic brain injury (n = 60) and vascular brain damage (n = 48). There was a lack of congruence between the WAIS-IV and the SF in the entire sample, revealing selectively significantly higher scores for the SF on Full Scale IQ (FSIQ) and Processing Speed Index (PSI). On a diagnostic group level, the discrepancies were as follows: in the traumatic brain injury group on FSIQ, Verbal Comprehension Index (VCI) and PSI, in the vascular damage group the FSIQ was significantly higher on SF compared to the WAIS-IV. Since the results revealed several mismatches between the SF and the WAIS-IV, except for the MS and traumatic brain tumor group, there is a lack of interchangeability between these two sets of tests. Thus, generally the SF cannot be recommended as a substitute for the WAIS-IV in this type of mixed Swedish neurological sample. The small sample sizes make the generalizability of this study limited.

Comparing Traditional and Digitized Cognitive Tests Used in Standard Clinical Evaluation

2019. Stina Björngrim (et al.). Frontiers in Psychology 10

Article

The purpose of this study was to compare a new digitized cognitive test battery, Minnemera, with its correspondent traditional paper-based cognitive tests. Eighty-one healthy adults between the ages of 21 and 85 participated in the study. Participants performed the two different test versions (traditional paper-based and digitized) with an interval of four weeks between the tests. Test presentation (the order of the test versions presented) was counterbalanced in order to control for any possible test learning effects. The digitized tests were constructed so that there were only minor differences when compared to the traditional paper-based tests. Test results from the paper-based and digitized versions of the cognitive screening were compared within individuals by means of a correlation analysis and equivalence tests. The effects of demographic variables (age, gender and level of education) and test presentation were explored for each test measure and each test version through linear regression models. For each test measure, a significant correlation between traditional and digitized version was observed ranging between r = 0.34 and r = 0.67 with a median of r = 0.53 (corresponding to a large effect size). Score equivalence was observed for five out of six tests. In line with previous traditional cognitive studies, age was found to be the most prominent predictor of performance in all digitized tests, with younger participants performing better than older adults. Gender was the second strongest predictor, where women outperformed men in tests measuring verbal memory; men performed better than women in tests with a strong visual component. Finally, the educational level of the test subjects had an effect on executive functions, with a higher educational level linked to a better inhibition response and working memory span. This study suggests that the tests in the Minnemera cognitive screening battery are acceptably comparable to the traditional paper-based counterparts.

Cross-cultural applicability and reduction of the American seven-subtest short form of the WAIS on a Swedish non-clinical sample

2019. Maria Lindau, Mats Najström. Nordic Psychology 71 (3), 148-163

Article

The study aimed at investigating whether the seven-subtest short form based on WAIS-R (Ward 1990) was statistically valid to use on the Swedish version of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), if this abbreviation was fit to catch the heterogeneity in test performance across age and if this brief measure was possible to abbreviate even more. WAIS-IV data from a non-clinical sample consisting of 261 participants ranging between 18 and 74 in age was analyzed with bivariate and multiple regression analyses, a prorating method for calculation of Full Scale IQ (FSIQ) and its indices as well as paired-samples t-test. The results were contradictory. When the original WAIS-IV was compared to the seven-subtest short form the results showed a good congruence on FSIQ-level between the two sets, but on index level there were several cases of mismatches. In the younger and middle aged sample (<55 years) results on FSIQ as well as index level were in accordance, whereas in the elderly group (∼55 years) they were incongruent. The best reduction of the seven-subtest short form was a four-subtest model, encompassing Block Design, Similarities, Arithmetic and Coding, one subtest from each index, but the t-tests indicated several cases of mismatches between the full WAIS-IV measures and the prorated scores. Applied on the Swedish version of the WAIS-IV the seven-subtest formula appears to be applicable on an FSIQ level, to be suitable for a younger sample, but not for an elderly. Otherwise, this model and the four-subtest model are recommended to be used with caution.

Young pain patients’ experience in primary care

2017. Jenny Hiort, Maria Lindau, Monika Löfgren. Nordic Psychology 69 (2), 83-99

Article

The purpose was to explore interview data from young adults with long-standing pain about their experience of contacts with caregivers in a primary care setting, in order to synthesize and qualitatively analyse their reports about how they were received. Method: An emergent qualitative design was used. Open thematic research interviews were conducted with 11 young people (1 man, 10 women) (aged 20–31 years) with long-term pain. The interviews were recorded, transcribed verbatim and analysed using inductive thematic content analysis. Result: The analyses resulted in three themes; distrust experienced from care staffs, lonelinessand hopelessness forming the main theme Young adult with long-term pain. The informants described how they struggled with living with the pain, fighting with the care system and to obtain help. They reportedly felt they were not trusted and that they were not given any explanations or information why the pain spread and worsened. This left them feeling abandoned and alone and without hope concerning their pain, their feelings; and with doubts concerning their prospects. Much concern and doubt were expressed about their future work situation; whether they would be able to do work for which they had trained, and whether they would ever get any career opportunities. Conclusion: Living with long-term pain as a young adult and experiencing mistrust when in care might lead to feelings of loneliness, dependence and hopelessness and an existence marked by suffering and dependence. The experienced mistrust confined the young adult instead of allowing growth towards an adult identity and opportunities.

Predictive accuracy of Wechsler Adult Intelligence Scale, forth ed., (WAIS-IV) seven- and four- subtest short form models in estimating full scale IQ (FSIQ) and its indices in a Swedish non-clinical sample

2016. Maria Lindau, Mats Najström. Proceedings of 4th Global Experts Meeting on Neuropharmacology

Conference

Neurodegenerative disorders usually show characteristic cognitive profiles, determined by the anatomical dispersion of neuronal loss. Short-term/memory decline is a presenting symptom on Alzheimer’s disease, but atypical early signs also occur. The Wechlser Adult Intelligence Scale (WAIS) may be used to differentiate between normal and sub-normal cognitive performance levels, such as pre-dementia stages, AD and related disorders. According to Meyers et al., (2013), a brief measure consisting of a seven-subtest short form (SF) of the WAIS-IV including Block Design (BD), Similarities (SI), Digit Span (DS), Arithmetic (AR), Information (IN) Coding (CD) and Picture Completion (PC) provides a valid means of measuring cognitive level. In order to validate a short form of WAIS-IV on a Swedish non-clinical sample the aim of the present study was to assess the ability of the seven-subtest SF as well as a reduction of the number of subtests in the SF based on standardized β-values, to predict the full scale IQ (FSIQ) and its indices. WAIS-IV scaled score data from 98 healthy individuals (19-90 years M=46 years, SD=23 years, females=48, males=50) were analyzed with linear regression, which showed that the seven predictors explained 92.5% of the variance in FSIQ. When reducing the SF-set the four highest β-values were obtained from the following subtests: CD, β=0.34 (Processing Speed), SI, β=0.31 (Verbal Comprehension), BD, β=0.25 (Perceptual Reasoning), and AR, β=0.23 (Working memory), which showed to be one subtest from each of the four indices. FSIQ prediction rate of these four subtests was 88.1%. Each of the four subtests correlated significantly on p=<0.01 level with its index. To conclude, FSIQ prediction accuracy for the seven-subtest SF is very high, as well as for the four-subtest model. Since the four-subtest model strongly predicts FSIQ, as well as all its indices, it may be a valid, and timesaving, instrument to assess short-term memory (AR, partly CD) deficits typical for different stages of AD, signs on non-amnestic decline in AD, as well as typical clinical manifestations of frontotemporal degeneration, Parkinson’s disease, Lewy body disease, ischemic brain disorders and cognitive dysfunctions associated with depression. In unclear cases additional testing is necessary. Further analyses will reveal possible influences on the norms of age, genus and education.

Effects of Stress on Learning and Memory

2016. Maria Lindau, Ove Almkvist, A. Mohammed. Stress, 153-159

Chapter

Anosognosia and Anosodiaphoria in Mild Cognitive Impairment and Alzheimer's Disease

2014. Maria Lindau, R. Bjork. Dementia and Geriatric Cognitive Disorders 4 (3), 465-480

Article

Aims: To evaluate the occurrence of anosognosia (lack of awareness) and anosodiaphoria (insouciance) in mild cognitive impairment (MCI) and Alzheimer's disease (AD) and to evaluate the influence of a worsening of dementia on these phenomena. Methods: A self-evaluation scale was used assessing degrees of anosognosia and anosodiaphoria; furthermore, a neuropsychological assessment and statistical analyses with nonparametric tests which could cope with data on an ordinal scale level and small samples were employed. Results: Cognitive ability was lower in AD (n = 9) than in MCI patients (n = 12), but AD patients self-rated lower cognitive disabilities, which is interpreted as one relative sign of anosognosia in AD. Awareness of the reasons for cognitive problems was also lower in AD, which is considered as another sign of anosognosia. The main pattern in MCI found that the higher the awareness, the lower the cognitive ability. In AD low awareness paralleled low cognitive functioning. Anosodiaphoria was present in AD but not in MCI. Conclusion: According to the literature anosognosia and anosodiaphoria seem to increase with progression of dementia from MCI as a result of right hemispheric alterations.

Re-Evaluation of Clinical Dementia Diagnoses with Pittsburgh Compound B Positron Emission Tomography

2013. M. Degerman Gunnarsson (et al.). Dementia and geriatric cognitive disorders extra 3 (1), 472-481

Article

Objectives: There is an overlap regarding Pittsburgh compound B (PIB) retention in patients clinically diagnosed as Alzheimer's disease (AD) and non-AD dementia. The aim of the present study was to investigate whether there are any differences between PIB-positive and PIB-negative patients in a mixed cohort of patients with neurodegenerative dementia of mild severity regarding neuropsychological test performance and regional cerebral glucose metabolism measured with [18F]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET). Methods: Eighteen patients clinically diagnosed as probable AD or frontotemporal dementia were examined with PIB PET, FDG PET and neuropsychological tests and followed for 5-9 years in a clinical setting. Results: The PIB-positive patients (7 out of 18) had slower psychomotor speed and more impaired visual episodic memory than the PIB-negative patients; otherwise performance did not differ between the groups. The initial clinical diagnoses were changed in one third of the patients (6 out of 18) during follow-up. Conclusions: The subtle differences in neuropsychological performance, the overlap of hypometabolic patterns and clinical features between AD and non-AD dementia highlight the need for amyloid biomarkers and a readiness to re-evaluate the initial diagnosis.

Pittsburgh Compound-B and Alzheimer’s Disease Biomarkers in CSF, Plasma and Urine

2010. M. Degerman Gunnarsson (et al.). Dementia and Geriatric Cognitive Disorders 29 (3), 204-212

Article

Background: The positron emission tomography (PET) radiotracer Pittsburgh Compound-B (PIB) is an in vivo ligand for measuring β-amyloid (Aβ) load. Associations between PET PIB and cerebrospinal fluid (CSF) Aβ1–42 and apolipoprotein E &epsi;4 (APOE &epsi;4) have been observed in several studies, but the relations between PIB uptake and other biomarkers of Alzheimer’s disease (AD) are less investigated. Method: PET PIB, PET 18Fluoro-2-deoxy-D-glucose and different AD biomarkers were measured twice in CSF, plasma and urine 12 months apart in 10 patients with a clinical diagnosis of mild to moderate AD. Results: PIB retention was constant over 1 year, inversely related to low CSF Aβ1–42 (p = 0.01) and correlated positively to the numbers of the APOE &epsi;4 allele (0, 1 or 2) (p = 0.02). There was a relation between mean PIB retention and CSF ApoE protein (r = –0.59, p = 0.07), and plasma cystatin C (r = –0.56, p = 0.09). Conclusion: PIB retention is strongly related to CSF Aβ1–42, and to the numbers of the APOE &epsi;4 allele.

Differential CSF biomarker levels in APOE-epsilon 4-positive and -negative patients with memory impairment

2007. Christin Andersson (et al.). Dementia and Geriatric Cognitive Disorders 23 (2), 87-95

Article

Objectives: To investigate the relationships between episodic memory, APOE genotype, CSF markers (total tau, T-tau; phospho-tau, P-tau; beta-amyloid, A beta 42) and longitudinal cognitive decline. Methods: 124 memory clinic patients were retrospectively divided into 6 groups based on (i) episodic memory function (Rey Auditory Verbal Learning Test, RAVLT): severe, moderate or no impairment (SIM, MIM or NIM), and (ii) APOE genotype (epsilon 4+ or epsilon 4-). CSF marker levels and cognitive decline were compared across groups. Results: Episodic memory function, according to RAVLT scores, was significantly correlated with CSF marker levels only among epsilon 4+ subjects and not among epsilon 4- subjects. When comparing the 6 subgroups, SIM epsilon 4+ and MIM epsilon 4+ groups showed significantly lower A beta 42 levels than the other groups. T-tau and P- tau levels were significantly increased in SIM epsilon 4+ when compared to all the other groups, including the SIM epsilon 4- group. However, both SIM epsilon 4+ and SIM epsilon 4- declined cognitively during the follow-up. Conclusion: It remains to be determined whether APOE genotype affects the expression of biomarkers in CSF, or whether the different biomarker patterns reflect different types of disease processes in patients with progressive cognitive dysfunction.

Maria LindauAssociate Professor

Publications

Monthlong Intubated Patient with Life-Threatening COVID-19 and Cerebral Microbleeds Suffers Only Mild Cognitive Sequelae at 8-Month Follow-up

WAIS-IV short form applied to a mixed neurological Swedish clinical sample

Comparing Traditional and Digitized Cognitive Tests Used in Standard Clinical Evaluation

Cross-cultural applicability and reduction of the American seven-subtest short form of the WAIS on a Swedish non-clinical sample

Young pain patients’ experience in primary care

Predictive accuracy of Wechsler Adult Intelligence Scale, forth ed., (WAIS-IV) seven- and four- subtest short form models in estimating full scale IQ (FSIQ) and its indices in a Swedish non-clinical sample

Effects of Stress on Learning and Memory

Anosognosia and Anosodiaphoria in Mild Cognitive Impairment and Alzheimer's Disease

Re-Evaluation of Clinical Dementia Diagnoses with Pittsburgh Compound B Positron Emission Tomography

Pittsburgh Compound-B and Alzheimer’s Disease Biomarkers in CSF, Plasma and Urine

Differential CSF biomarker levels in APOE-epsilon 4-positive and -negative patients with memory impairment