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Cognitive function alertness

Cognitive function alertness

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All patients were admitted to the Neurocenter of the Cantonal Hospital in Lucerne, Switzerland, to receive multidisciplinary inpatient neurorehabilitation, and were consecutively enrolled in the study after giving informed consent between January and March Exclusion criteria were the presence of other neurological diseases e.

epilepsy, multiple sclerosis, tumour etc. Consort flow diagram. In the end, 60 patients completed the assessments and were included in the final analyses.

The study followed the STROBE guidelines for reporting observational studies 27 and was conducted in accordance with the principles laid down in the Declaration of Helsinki WHO, The study was approved by the local Ethics Committee Ethics Committee Nordwest and Zentralschweiz, Switzerland.

For each patient, four standardized and commonly used neuropsychological and oculomotor tests were administered to comprehensively assess each of the three cognitive domains visuospatial attention, alertness and inhibition resulting in a total of 12 tests, summarized in Table 1.

To assess visuospatial attention, the Letter Cancellation Test [centre of cancellation CoC of cancelled items], 28 the Line Bisection Test mean relative deviation from actual midline29 the Five-Point Test CoC of drawn designs 16 and video-oculography during free visual exploration FVE; mean gaze position 3545 were performed.

Alertness was assessed by means of two subtests of a computerized, validated attention test battery median reaction time in tonic and phasic alertness of the Testbatterie für die Aufmerksamkeitsprüfung, TAP 30 and two outcome variables of the FVE paradigm mean fixation duration, 39 and peak saccade velocity To investigate inhibition, three neuropsychological measures perseverative errors in the Five-Point Test, 33 number of errors in a Go-NoGo task, 3132 number of errors in the Stroop interference task 3447 and one video-oculographic measure false responses in the antisaccade task 3840 were used.

For a detailed description of the 12 neuropsychological tests and the respective outcome variables, as well as of the video-oculography paradigms and apparatus, please see the Supplementary material.

To allow a direct comparison between variables, all outcome variables were z -transformed, based on the normative values of the respective healthy control groups. The results of all outcome variables were plotted by means of violin wrapping box-and-whisker plots, to qualitatively evaluate the overall variability of the outcome variables included.

Furthermore, for each patient, the severity of deficits within each cognitive domain was plotted by means of the number of clinically significant test results [i. how many out of the four tests per cognitive domain i.

Overview of neuropsychological tests and oculography paradigms included in the study. A PCA was performed to explore potential common factors underlying the three cognitive domains visuospatial attention, alertness and inhibition investigated in our data sample.

As a part of the PCA, Pearson's correlations coefficients were computed and tested for significance one-tailed between all pairs of outcome variables. Then, the PCA was conducted on the 12 outcome variables as described in Table 1 without rotation.

The Kaiser—Meyer—Olkin measure was used to verify the sampling adequacy for the analysis. Lesion mapping was performed as outlined in Karnath et al. Images were then normalized into the Montreal Neurological Institute MNI space using the Clinical Toolbox for SPM12 Rordon et al.

We used VLSM to establish causal inferences between behaviour and underlying neuroanatomical structures. VLSM was conducted using the Brunner—Munzel test for continuous behavioural data, 56 using the individual factor values for each component as derived from the PCA, as described previously.

Among the 68 white matter tracts available in the BCBtoolkit library, we selected the tracts that showed an overlap with the significant lesion clusters predicting PCA factor values in the VLSM analyses.

These tracts were: the frontal aslant tract FATthe superior longitudinal fasciculus II SLF IIthe superior longitudinal fasciculus III SLF III and to a lesser extent the inferior fronto-occipital fasciculus IFOF.

On the basis of the VLSM results, we assumed that white matter tract disconnections would result in a decline of cognitive performance, as reflected by the factor values in the respective PCA component. Therefore, one-tailed Pearson's correlations Bonferroni-corrected for multiple comparisons were calculated between PCA factor values and disconnection probabilities, as well as the damaged tract proportions, for each white matter tract.

To account for potential effects beyond focal lesions, Disconnectome maps were calculated using the BCBtoolkit. For each of the 60 patients included in the present study, tractography was estimated as described by Thiebaut de Schotten and colleagues. Tractographies from the lesions were then transformed in visitation maps, 2 binarized and brought to MNI space.

The corresponding percentage overlap map was computed by summing the normalized visitation map of each healthy control subject at each point in MNI space. Hence, in the resulting disconnectome map of each individual patient, the value in each voxel considers the interindividual variability of tract reconstructions in the healthy control group.

To establish the potential relationships between white matter tract disconnections as reflected by disconnectome maps and behavioural correlates as reflected by PCA resultsa standard VLSM analysis for continuous data was conducted on the disconnectome maps, with the same procedures described before VLSM.

For this purpose, we used a region of interest approach. The region of interest was defined as the total, summed extension of the tracts that intersected a significant lesion cluster predicting PCA factor values, as identified in the first series of VLSM analyses. These tracts were the FAT, SLF II, SLF III and IFOF.

Second, to investigate the relationship between cognitive performance as reflected by test results and as observed in daily living, the Lucerne ICF-Based Multidisciplinary Observation Scale LIMOS was used. Thereby, the LIMOS cognition subscale consists of 15 items observing cognitive functions in daily living, such as planning tasks, solving simple problems and making decisions.

Additionally, to investigate whether cognition during daily living is influenced by the volume of the affected brain area, a partial correlation was calculated between test-level cognition as represented by PCA values and LIMOS cognition subscale scores, while controlling for lesion volume two-tailed.

Third, to confirm the potential relationship between lesions to critical cerebral substrates and cognitive performance in daily living, we compared the LIMOS cognition subscale scores between patients with versus without a lesion including the significant lesion clusters predicting PCA factor values i.

The scores were statistically compared by means of an independent-samples t -test. Hauptman et al. The atlas includes voxels with a network probability range of 0. The conditions of our ethics approval do not permit the public archiving of the data supporting the conclusions of this study. On the basis of the Swiss Human Research Act, the HRA Humanforschungsgesetz in Switzerland, readers seeking access to the data and the study materials must therefore complete a formal data sharing agreement to obtain the data.

Interested readers should contact the corresponding author for more information and help. Heterogeneous distributions were found in all three cognitive domains: visuospatial attention, alertness and inhibition.

A similar pattern was observable in the box-and-whisker plots Supplementary Fig. Behavioural analyses for the three cognitive domains. A The violin wrapping box-and-whisker plots of all z -transformed outcome variables included in the study.

The width of the violins represents the proportion of patients with an equivalent z -value. The overall median z -values are indicated by the horizontal white line in each box-and-whisker plot. Each box represents the lower Q1 to the upper Q3 quartiles, with whiskers extending from the minimum to the maximum of 1.

The number of available patient datasets for each variable is depicted at the bottom of each violin. Outliers are depicted by grey circles. B The significant correlations between all 12 variables included in the PCA. The lines between variables represent significant correlations and their strength: the darker the shade, the stronger the correlation, as represented by the legend on the r i ght-hand side of the panel.

The length of the bars represents the loading of each outcome variable onto the extracted factor components. The figure was illustrated using the R package ggplot2. First, to investigate whether patients with higher impairment in one cognitive domain also presented with increased deficits in other cognitive domains, Pearson's correlations were computed.

Hereby, outcome variables of the visuospatial attention domain correlated with each other, but also with some of the outcome variables associated with the alertness and the inhibition domain.

These results indicate, at least for some of the considered variables, the existence of common underpinnings for all three cognitive domains. Hence, to explore in a more systematic way the common underlying components of the considered cognitive domains, a PCA was computed.

An initial analysis was run to obtain eigenvalues for each component in the data. Four out of these 10 variables belonged to the visuospatial attention domain Letter CoC, 41 mean gaze position during FVE, 35 Line Bisection, 64 CoC in the Five-Point Test 16three to the alertness domain phasic alertness, 30 tonic alertness, 30 Fixation Duration 65 and three to the inhibition domain Perseverations in the Five-Point Test, 16 Go-Nogo 31 and Antisaccade Errors

: Cognitive function alertness

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What are Cognitive Functions

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Materials and methods. Competing interests. Supplementary material. Journal Article. Joint impact on attention, alertness and inhibition of lesions at a frontal white matter crossroad.

Brigitte C Kaufmann , Brigitte C Kaufmann. Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS. Oxford Academic. Dario Cazzoli. Neurocenter, Luzerner Kantonsspital.

ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern. Manuela Pastore-Wapp. Tim Vanbellingen. Tobias Pflugshaupt. Daniel Bauer. René M Müri. Department of Neurology, Inselspital, University Hospital, University of Bern.

Tobias Nef. Paolo Bartolomeo. Thomas Nyffeler. Correspondence to: Professor Dr med. Thomas Nyffeler Neurocenter, Luzerner Kantonsspital Spitalstrasse, CH Lucerne, Switzerland E-mail: thomas.

nyffeler luks. Revision received:. Corrected and typeset:. PDF Split View Views. Select Format Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks Download citation. Permissions Icon Permissions. Abstract In everyday life, information from different cognitive domains—such as visuospatial attention, alertness and inhibition—needs to be integrated between different brain regions.

visuospatial attention , alertness , inhibition , multiple-demand network , right-hemispheric stroke. All the activities that we perform require the use of our brain functions , which involves millions of neural connections distributed throughout our brain lobes and the activation of different areas of the brain to adequately deal with our environment and process the information that we obtain through various channels.

Information processing in the human mind is carried out through the cognitive system. The person has an active role in the processes of reception, selection, transformation, processing, recovery and transformation of the information that reaches the brain.

The processing of such information is composed of interrelated cognitive that act together to execute the most complex mental operations. In this way, a cognitive function can be joined or complemented with others to form a higher unit, a cognitive process , on which one can intervene by working on its most basic units cognitive functions or on its more elaborate processes thinking skills.

The loss of cognitive abilities is due to the normal process of aging. How we age and how we experience this process, as well as our health and functional capacity, depend on both the genetic structure and the environment that has surrounded us throughout our lives. In addition, there are other factors that can alter cognitive abilities such as neurodegenerative diseases, neurodevelopmental disorders, intellectual disabilities or mental illness.

Also, the consumption of narcotic substances, alcoholism, severe physical or mental trauma, can affect brain activity in an acute or chronic way. It has been shown that deterioration slows down and deficits are milder if we maintain an active and healthy life in stimulating environments and if we continue to work on our abilities through cognitive stimulation practices and exercises.

Skip to main content Skip to header right navigation Skip to after header navigation Skip to site footer. Free Trial. Orientation What is orientation? Read more about Orientation. Gnosis What is gnosis? Read more about Gnosis. Attention What is attention?

Read more about Attention. Executive Functions What are executive functions? Read more about Executive Functions. Praxis What is praxis? Read more about Praxis. Memory What is memory? The content of consciousness cannot be accurately characterized unless the patient is awake and alert; attempting to do so is usually not worth pursuing in detail because the results may not reflect the patient's underlying abilities.

In the conscious patient, the mental status examination is intended to test specific parts of the brain. For example, language and calculation problems point to the dominant hemisphere, spatial neglect to the nondominant hemisphere, and apraxias to the contralateral sensorimotor areas in the contralateral cerebral hemisphere.

Any hint of cognitive decline requires examination of mental status see sidebar , which involves testing multiple aspects of cognitive function, such as the following:. Causes include almost any disorder or drug. Diagnosis is clinical read more , or dementia Dementia Dementia is chronic, global, usually irreversible deterioration of cognition.

Diagnosis is clinical; laboratory and imaging tests are usually used to identify treatable causes. Treatment is read more is severe; when it occurs as an isolated symptom, it suggests malingering. Insight into illness and fund of knowledge in relation to educational level are assessed, as are affect and mood Overview of Mood Disorders Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive elevated mood, or both.

Mood disorders can occur in adults, adolescents, or children read more. Vocabulary usually correlates with educational level. Name body parts and read, write, and repeat simple phrases if deficits are noted, other tests of aphasia Diagnosis are needed.

Spatial perception can be assessed by asking the patient to imitate simple and complex finger constructions and to draw a clock, cube, house, or interlocking pentagons; the effort expended is often as informative as the final product. This test may identify impersistence, perseveration, micrographia, and hemispatial neglect.

Praxis cognitive ability to do complex motor movements can be assessed by asking the patient to use a toothbrush or comb, light a match, or snap the fingers. See also Approach to the Patient With Mental Symptoms Routine Psychiatric Assessment Patients with mental complaints or concerns or disordered behavior present in a variety of clinical settings, including primary care and emergency treatment centers.

Complaints or concerns may The mental status examination is an assessment of current mental capacity through evaluation of general appearance, behavior, any unusual or bizarre beliefs and perceptions eg, delusions, hallucinations , mood, and all aspects of cognition eg, attention, orientation, memory.

Examination of mental status is done in anyone with an altered mental status or evolving impairment of cognition whether acute or chronic.

Many screening tools are available; the following are particularly useful:. Montreal Cognitive Assessment MOCA for general screening because it covers a broad array of cognitive functions eg, attention, concentration, executive functions, memory, language, visuospatial skills, abstraction, calculation, orientation.

Mini-Mental State Examination when evaluating patients for Alzheimer disease because it focuses on testing memory.

Top bar navigation As Party decorations and accessories waking funchion increases, aleetness homeostatic Cognitive function alertness drive increases. Moisturizing skin treatments Finction Saccadic velocity characteristics: Intrinsic variability and fatigue. Caffeine also regulates cerebral perfusion and acts as a vasoconstrictor, decreasing CBF via the blockade of A2A and A2B receptors Laurienti et al. How long the patient continues to function at the poststimulation level before returning to the unstimulated level.
What are cognitive functions?

Blue light also demonstrated positive effects on visual reaction time, an effect that was more pronounced in blue-eyed participants. This alerting effect could have benefits in a variety of occupational and contexts including competitive sporting environs.

Conceived and designed the experiments: CMB JE. Performed the experiments: CMB JE. Analyzed the data: CMB JE. Wrote the manuscript: CMB JE. Browse Subject Areas?

Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Abstract The alerting effects of both caffeine and short wavelength blue light have been consistently reported.

Funding: The authors have no support or funding to report. Introduction Much like the ear has functions for hearing and balance, the human eye has a dual role in detecting light for a range of behavioural and physiological responses that are distinct from their role in vision [ 1 ].

Methods Ethics Statement The investigation was conducted according to the principles expressed in the Declaration of Helsinki. Participants The study recruited 24 subjects 13 male, 11 female; 26 ± 4 y. Experimental Protocol Participants reported to the Östersund test facility The PVT lasted approximately 10 minutes After performing the PVT, the participants ingested a gelatine capsule containing either mg of caffeine or a visually indistinguishable sugar placebo with a small glass of water.

Psychomotor Vigilance Test PVT. Karolinska Sleepiness Scale KSS. Statistical Analyses An analysis of variance with factors for caffeine dose and light treatment was utilized to determine differences in the means of the response variables resulting from the four treatments.

Results Twenty-one participants 13 male, 8 female completed the entire experimental procedure with an average relative caffeine dose of 3. Download: PPT. Figure 1. Figure 2. Figure 3. Change in the accuracy in incongruent presentations in the Eriksen flanker psychomotor task.

Figure 4. Change in performance of the Eriksen flanker psychomotor task. Figure 5. Change in performance of the visual reaction time task. Figure 6. Change in Karolinska sleepiness scale ratings over time. Discussion Here, we demonstrate for the first time that blue light and caffeine demonstrate distinct effects on aspects of psychomotor function, presumably via distinct mechanisms.

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How to Assess Mental Status - Neurologic Disorders - Merck Manuals Professional Edition Blood pressure was measured before and after sleep deprivation. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Yerkes, A. A General Linear Model based approach was used to extract beta weights estimating hemodynamic signal. Patients with right-hemispheric stroke presenting with a lesion within these clusters were significantly more likely to show an impairment in overall cognitive performance in all three considered cognitive domains, as reflected by the lower factor values in the common component PCA Component I.
For more information Eating window guidelines PLOS Clgnitive Areas, fjnction here. The Moisturizing skin treatments effects of both tunction and gunction wavelength Cognitive function alertness light Cignitive been consistently reported. The ability of blue light to enhance alertness and Natural supplements for energy Moisturizing skin treatments Congitive non-image forming neuropathways have been suggested as a non-pharmacological countermeasure for drowsiness across a range of occupational settings. Here we compare and contrast the alerting and psychomotor effects of mg of caffeine and a 1-h dose of ~40 lx blue light in a non-athletic population. The Karolinska Sleepiness Scale was used to assess subjective measures of alertness. Both the caffeine only and blue light only conditions enhanced accuracy in a visual reaction test requiring a decision and an additive effect was observed with respect to the fastest reaction times. Cognitive function alertness

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