Utility and validity of a brief cognitive assessment tool in patients with epileptic and nonepileptic seizures

Walterfang, Mark; Choi, Yves; O’Brien, Terence J.; Cordy, Nerissa; Yerra, Raju; Adams, Sophia J.; Velakoulis, Dennis

doi:10.1016/j.yebeh.2011.02.025

Cited by 17 publications

(11 citation statements)

References 44 publications

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“…Patients with FMD and healthy subjects performed similarly on verbal fluency tests 19. In comparison with normative data, patients who had NEA showed either naming and/or fluency abnormalities,42 78 79 or normal performances on a composite language score including naming, verbal comprehension and vocabulary 80. In comparison with patients with ES, patients who had NEA showed similar79 82 83 or better43 44 78 81 85 87 performance on language assessment (including confrontational naming, verbal fluency, verbal comprehension and/or writing speed).…”

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 81%

“…In comparison with normative data, patients who had NEA demonstrated memory abnormalities,77 78 including impairment of working memory associated with poor attention and processing speed 79. However, normal memory performance has also been reported 8080–85 similarly/better43 79 or better44 86 87 than patients with epileptic seizures (ESs).…”

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 94%

“…In comparison with normative data, patients who had NEA demonstrated abnormalities in attention (associated with poor processing speed and working memory) 42 77 79. In comparison with patients with ES, patients who had NEA performed similarly on tests of attention43 44 80 83 85 and executive function,80 82 87 with just one study reporting worse performance on attention 79…”

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 96%

“…However, normal memory performance has also been reported 8080–85 similarly/better43 79 or better44 86 87 than patients with epileptic seizures (ESs).…”

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 99%

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A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

Teodoro

Edwards

Isaacs

2018

J Neurol Neurosurg Psychiatry

176

159

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BackgroundFunctional cognitive disorder (FCD) describes cognitive dysfunction in the absence of an organic cause. It is increasingly prevalent in healthcare settings yet its key neuropsychological features have not been reported in large patient cohorts. We hypothesised that cognitive profiles in fibromyalgia (FM), chronic fatigue syndrome (CFS) and functional neurological disorders (FNDs) would provide a template for characterising FCD.MethodsWe conducted a systematic review of studies with cognition-related outcomes in FM, CFS and FND.ResultsWe selected 52 studies on FM, 95 on CFS and 39 on FND. We found a general discordance between high rates of subjective cognitive symptoms, including forgetfulness, distractibility and word-finding difficulties, and inconsistent objective neuropsychological deficits. Objective deficits were reported, including poor selective and divided attention, slow information processing and vulnerability to distraction. In some studies, cognitive performance was inversely correlated with pain, exertion and fatigue. Performance validity testing demonstrated poor effort in only a minority of subjects, and patients with CFS showed a heightened perception of effort.DiscussionThe cognitive profiles of FM, CFS and non-cognitive FND are similar to the proposed features of FCD, suggesting common mechanistic underpinnings. Similar findings have been reported in patients with mild traumatic brain injury and whiplash. We hypothesise that pain, fatigue and excessive interoceptive monitoring produce a decrease in externally directed attention. This increases susceptibility to distraction and slows information processing, interfering with cognitive function, in particular multitasking. Routine cognitive processes are experienced as unduly effortful. This may reflect a switch from an automatic to a less efficient controlled or explicit cognitive mode, a mechanism that has also been proposed for impaired motor control in FND. These experiences might then be overinterpreted due to memory perfectionism and heightened self-monitoring of cognitive performance.

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Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 81%

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 94%

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 96%

“…However, normal memory performance has also been reported 8080–85 similarly/better43 79 or better44 86 87 than patients with epileptic seizures (ESs).…”

Section: Results: Evidence For Abnormal Cognition In Fm Cfs and Fndmentioning

confidence: 99%

See 2 more Smart Citations

A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

Teodoro

Edwards

Isaacs

2018

J Neurol Neurosurg Psychiatry

176

159

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“…(NUCOG). 24 The NUCOG is a validated, brief cognitive screening instrument developed by the Neuropsychiatry Unit of the Royal Melbourne Hospital, Australia. Scores range from 0 to 100, with lower scores indicating possible objective cognitive impairment.…”

Section: Neuropsychiatry Unit Cognitive Screening Toolmentioning

confidence: 99%

Clinical predictors of discordance between screening tests and psychiatric assessment for depressive and anxiety disorders among patients being evaluated for seizure disorders

et al. 2021

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Objective: This study was undertaken to identify factors that predict discordance between the screening instruments Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder scale (GAD-7), and diagnoses made by qualified psychiatrists among patients with seizure disorders. Importantly, this is not a validation study; rather, it investigates clinicodemographic predictors of discordance between screening tests and psychiatric assessment. Methods: Adult patients admitted for inpatient video-electroencephalographic monitoring completed eight psychometric instruments, including the NDDI-E and GAD-7, and psychiatric assessment. Patients were grouped according to agreement between the screening instrument and psychiatrists' diagnoses. Screening was "discordant" if the outcome differed from the psychiatrist's diagnosis, including both false positive and false negative results. Bayesian statistical analyses were used to identify factors associated with discordance. Results: A total of 411 patients met inclusion criteria; mean age was 39.6 years, and 55.5% (n = 228) were female. Depression screening was discordant in 33% of cases (n = 136/411), driven by false positives (n = 76/136, 56%) rather than false negatives (n = 60/136, 44%). Likewise, anxiety screening was discordant in one third of cases (n = 121/411, 29%) due to false positives (n = 60/121, 50%) and false negatives (n = 61/121, 50%). Seven clinical factors were predictive of discordant screening for both depression and anxiety: greater dissociative symptoms, greater patient-reported adverse events, subjective cognitive impairment, negative affect, detachment, disinhibition, and psychoticism. When the analyses were restricted to only patients with psychogenic nonepileptic seizures (PNES) or epilepsy, the rate of discordant depression screening was higher in the PNES group (n = 29, 47%) compared to the epilepsy group (n = 70, 30%, Bayes factor for the alternative hypothesis = 4.65). | MATERIALS AND METHODS | SettingData were obtained from patients admitted to VEM units of the comprehensive epilepsy programs at the Royal Melbourne Hospital and the Alfred Hospital, in Melbourne, Australia, between April 2018 and March 2020. The diagnostic procedures have previously been described. 17 Patients admitted for VEM undergo comprehensive epileptological and psychiatric assessments. Seizure-and medication-related clinical data were extracted from medical records.Significance: Patients with seizure disorders who self-report a variety of psychiatric and other symptoms should be evaluated more thoroughly for depression and anxiety, regardless of screening test results, especially if they have PNES and not epilepsy.Clinical assessment by a qualified psychiatrist remains essential in diagnosing depressive and anxiety disorders among such patients.

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Causes and Types of Cognitive Domain Impairments in Epilepsy

Maccotta

Vega

Hogan

et al. 2015

Epilepsy and the Interictal State

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Utility and validity of a brief cognitive assessment tool in patients with epileptic and nonepileptic seizures

Cited by 17 publications

References 44 publications

A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

Clinical predictors of discordance between screening tests and psychiatric assessment for depressive and anxiety disorders among patients being evaluated for seizure disorders

Causes and Types of Cognitive Domain Impairments in Epilepsy

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