Head Injury and Neuropsychological Issues

Pedersen et al (Neuropsychological Factors Related to College Ice Hockey Concussions) analyzed collegiate hockey players’ baseline neuropsychology test battery in relation to the test readministered after injury in 14 athletes. They found a decrease in performance on immediate and delayed word recall and designs after an initial concussion. Following a second sports-related concussion, athletes showed a decrease in visual motor speed. Pedersen et al discuss their findings in the context of both late life consequences, including chronic traumatic encephalopathy, and return-to-play decisions. Growing evidence suggests a link between head injury and late-life cognitive deficits, although much more work is needed in this area. It is unknown whether an early return to play has late-life consequences.

In Possible Link Between Toxoplasma gondii and the Anosmia Associated With Neurodegenerative Diseases, it is noted that T gondii is an intracellular protozoan infecting 30% to 50% of human population. Recently, it was suggested that chronic latent neuroinflammation caused by the parasite may be responsible for neurodegenerative diseases manifesting with the loss of smell. Studies in animals inoculated with the parasite revealed cysts in various regions of the brain, including the olfactory bulb. Development of behavioral changes was paralleled by the preferential persistence of cysts in defined anatomic structures of the brain, depending on the host, strain of the parasite, its virulence, and route of inoculation. Olfactory dysfunction in Alzheimer’s disease, multiple sclerosis, and schizophrenia may be associated with increased serum anti-T gondii immunoglobulin G antibody levels. Damage in the olfactory system may be also at least in part responsible for development of depression because T gondii infection worsened mood in affected patients.

Mendez et al remind us that the hallmark manifestations of behavioral variant frontotemporal dementia are abnormalities in social behavior. Using a Social Observation Inventory, Mendez et al compared patients with behavioral variant frontotemporal dementia, patients with Alzheimer’s disease, and caregivers. The behavioral variant frontotemporal dementia group showed the most disturbed social behavior. In contrast, the patients with Alzheimer’s disease were similar to caregivers. Additionally, the Social Observation Inventory scores correlated with scores on frontal-executive tests and socioemotional scales. Mendez et al concluded that watching informal social behavior during routine activities may be one of the best ways to distinguish patients with behavioral variant frontotemporal dementia from patients with other dementias.

Foley et al (Interactive Effects of Apolipoprotein e4 and Diabetes Risk on Later Myelinating White Matter Regions in Neurologically Healthy Older Aged Adults) examine interactive effects of apolipoprotein (Apo) e4 and diabetes risk on later myelinating white matter regions among healthy elderly patients at risk of Alzheimer’s disease. There were no differences in the ApoE group for any region of interest. Overall, their results suggest interactive effects of APOE4 and diabetes risk on later myelinating white matter regions.

López-Cánovas et al (Apolipoprotein E Alleles in Mild Cognitive Impaired Cuban Subjects) assessed the ApoE allele and genotype frequencies in Cuban patients with mild cognitive impairment. Cognitive impairments were characterized by both amnesia and executive deficits. The Apo ∊4 allele frequency was 0.196 in patients with mild cognitive impairment, 10-fold higher than in controls. Patients carrying the ∊4 allele exhibited poorer performance in Mini-Mental State Examination and tests assessing executive function and short-term memory than that of the noncarriers.

Lu et al (Vascular Risk Factors and Mild Cognitive Impairment in the Elderly Population in Southwest China) aimed to determine the impact of vascular risk factors on cognitive function of the aged patients from Chongqing, Southwest China. They found that hypertension, heart disease, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol were independently associated with mild cognitive impairment. General cardiovascular disease, diastolic blood pressure, triglycerides, and high-density lipoprotein cholesterol were not associated with cognitive deficits. Lu et al concluded that patients with vascular diseases have a higher risk of developing mild cognitive impairment.

In open-label, short-term repetitive transcranial magnetic stimulation in patients with Alzheimer’s disease with functional imaging correlates and literature review, Devi et al tested repetitive transcranial magnetic stimulation in patients with Alzheimer’s disease to see whether there was clinical benefit. Patients underwent structured cognitive assessments and functional magnetic resonance imaging at baseline, after repetitive transcranial magnetic stimulation and 4 weeks posttreatment. Patients showed improvement in verbal and nonverbal agility, which interest during cognitive task performance (also sustained 4 weeks posttreatment). Their results are consistent with other studies indicating that this form of intervention is worthy of further investigation.

Several previous studies showed that age-related macular degeneration and Alzheimer’s disease share common risk factors and histopathology changes as well as there is epidemiological evidence linking age-related macular degeneration to cognitive impairment. In Cognitive Dysfunction and Age-Related Macular Degeneration, Rozzini et al compared neuropsychological profiles in patients with late-stage age-related macular degeneration and control individuals. Those affected by late-stage age-related macular degeneration showed worse (global) cognitive function than controls, especially in memory tasks. Moreover, patients affected by the dry form of age-related macular degeneration were also impaired in executive functions. Overall, their data support the notion that age-related macular degeneration and dementia are associated.

In Pattern of and Risk Factors for Brain Microbleeds in Neurodegenerative Dementia, Olazarian et al conducted a study to describe the prevalence, locations, and risk factors for brain microbleeds in neurodegenerative dementia. They found brain microbleeds in almost 45% of patients. Those patients with numerous brain microbleeds displayed higher number of vascular risk factors and vascular diseases. Brain microbleeds were associated with ischemic lesions in the basal ganglia, clinical diagnosis of Alzheimer’s disease and cerebrovascular disease, cortical infarction, and anticoagulant treatment duration. The authors concluded that brain microbleeds are associated with vascular burden and Alzheimer’s disease. We agree that more research is warranted regarding the mechanisms and potential clinical implications of microbleeds.

In An Intergenerational Choir Formed to Lessen Alzheimer’s Disease Stigma in College Students and Decrease the Social Isolation of People With Alzheimer’s Disease and Their Family Members: A Pilot Study, Harris and Caporella formed an intergenerational choir to combat the stigma of Alzheimer’s disease in college students. Their hope was to lessen the social isolation of patients with Alzheimer’s disease and their family members. The choir was composed of college students, patients with Alzheimer’s disease, and family caregivers. They found a decrease in social isolation for the older choir members. Importantly, the college students showed an improved understanding of the positive qualities of those with Alzheimer’s disease.