Before and after its introduction in 1987, zopiclone was the object of investigation in 16 psychometric studies employing both healthy volunteers and insomniac patients. Their common purpose was to determine whether nocturnal doses (usually the standard 7.5 mg) possess residual sedative effects that interfere with skilled safety-relevant performance, such as car driving, over the following day. Most studies have found no residual effects. Those that did, have shown them to be modest in magnitude and not to persist for longer than about 12 hours from the time of dosage. Without altering the general conclusion that zopiclone possesses few if any residual effects of clinical relevance, it must be said that the studies reviewed failed to meet current methodological standards and may have left some important questions unanswered.

Objectives: The aim of this work was to study the change in different cognitive domains after stroke during a 2-year follow-up. Method: We evaluated both neuropsychologically and neurologically a consecutive cohort of working-age patients with a first-ever stroke at baseline (within the first weeks), 6 months, and 2 years after stroke-onset. A total of 153 patients participated in all examinations and were compared to 50 healthy controls. Results: Forty-nine percent of the patients were cognitively impaired at baseline, 41% at 6 months, and 39% at 2-year follow-up. We analyzed seven cognitive domains (impairment rates at baseline and 2-year follow-up): psychomotor speed (34%; 23%), executive functions (27%; 17%), visual memory (21%; 4%), visuospatial function (20%; 14%), verbal memory (18%; 12%), basic language processing (baseline 11%; 6 months 5%), and reasoning (2 years 14%). The patients who were cognitively impaired at baseline improved more within 6 months, than either the controls or cognitively intact patients in all cognitive domains (all p<.05). Later on, between 6 months and 2 years, the domain-specific change scores did not differ between patients who were cognitively intact and impaired at 6 months. Also, the cognitive status (intact or impaired) remained the same in 90% of patients between 6-month and 2-year follow-ups. At 2 years, half of the patients, who were categorized cognitively impaired, were rated as well-recovered according to neurological evaluation. Conclusions: Most of the cognitive improvement took place within 6 months. Long-lasting cognitive impairment was common even after good neurological recovery. An early neuropsychological examination is essential in evaluating cognitive dysfunction and need for rehabilitation. (JINS, 2018, 24, 117–127)

Objectives: Although motor adaptation is a highly relevant process for both everyday life as well as rehabilitation many details of this process are still unresolved. To evaluate the contribution of primary motor (M1), parietal and cerebellar areas to motor adaptation processes transcranial direct current stimulation (tDCS) has been applied. We hypothesized that anodal stimulation of the cerebellum and the M1 improves the learning process in mirror drawing, a task involving fine grained and spatially well-organized hand movements. Methods: High definition tDCS (HD-tDCS) allows a focal stimulation to modulate brain processes. In a single-session double-blind study, we compared the effects of different anodal stimulation procedures. The groups received stimulation either at the cerebellum (CER), at right parietal (PAR), or at left M1, and a SHAM group was included. Participants (n=83) had to complete several mirror drawing tasks before, during, and after stimulation. They were instructed to re-trace a line in the shape of a pentagonal star as fast and accurate as possible. Tracing time (seconds) and accuracy (deviation in mm) have been evaluated. Results: The results indicated that cerebellar HD-tDCS can facilitate motor adaptation in a single session. The stimulation at M1 showed only a tendency to increase motor adaptation and these effects were visible only during the first part of the stimulation. Stimulating the right parietal area, relevant for visuospatial processing did not lead to increased performance. Conclusions: Our results suggest that motor adaptation relies to a great extent on cerebellar functions and HD-tDCS can speed up this process. (JINS, 2016, 22, 928–936)

While distal sensory polyneuropathy (DSP) is the most common neurological condition associated with HIV, causing nerve damage in upper and lower extremities, its impact on neuropsychological test performance is unclear. In this study, we analyzed baseline data for 278 HIV-infected participants with comprehensive neurological and neurocognitive evaluations to examine the contribution of DSP and anatomic distribution of neuropathic signs (upper extremity or lower extremity) on standardized domain scores. We found that participants with DSP performed significantly worse in multiple domains containing timed psychomotor tests (i.e., motor, information processing speed and executive functioning). With regard to executive functioning, differences were limited to a test with a motor component (Trail Making Test, Part B). The group with clinically detectable neuropathic signs in the upper extremities and the group with signs limited to the lower extremities both performed worse in the motor domain than the group without DSP. Participants with DSP demonstrated a unique pattern of impairment limited to neuropsychological domains with timed psychomotor tests. These results suggest that caution should be used in interpretation of neuropsychological tests in patients with DSP, as some abnormalities may be exacerbated by peripheral nervous system pathology. (JINS, 2012, 19, 1–10)

Antipsychotic medications can contribute to neurocognitive and motor impairments, but specific links to individualized pharmacological treatment regimens are unclear. In 68 participants with stabilized first-episode psychosis (FEP), we investigated the links between neuropsychological functions and an established anticholinergic potency index and a new D2 antagonist potency index developed in our lab. Each participant's psychiatric medication regimen was converted into estimated receptor antagonist loads based upon specific medication dosage(s) and reported in vitro brain muscarinic cholinergic and D2 receptor antagonism. In addition to the global neuropsychological impairments of FEP participants, the findings supported the hypothesized links between receptor antagonist loads and specific deficits. Higher anticholinergic load was associated with poorer delayed verbal memory but was not related to motor functioning. In contrast, higher D2 load was associated with poorer motor functioning but not verbal memory. These selective antagonist load associations explained 19% of the variance in motor functioning and 17% of the variance in delayed verbal memory. Evidently, some of the neuropsychological impairments found in persons with FEP are selectively related to the specific pharmacodynamics and the dosing of their medication regimens. Moreover, these effects can be readily estimated from practical and inexpensive indices. (JINS, 2012, 18, 1–11)

A previous study reported preliminary results of enhanced processing of simple visual information in the form of faster reaction times, in female fragile X premutation carriers (fXPCs). In this study, we assessed manual and oral motor reaction times in 30 female fXPCs and 20 neurotypical (NT) controls. Participants completed two versions of the reaction time task; one version required a manual motor response and the other version required an oral motor response. Results revealed that the female fXPCs displayed faster reaction times for both manual and oral motor responses relative to NT controls. Molecular measures including CGG repeat length, FMR1 mRNA levels, and age were not associated with performance in either group. Given previously reported age and CGG repeat modulated performance on a magnitude comparison task in this same group of premutation carriers, results from the current study seem to suggest that female fXPCs may have spared basic psychomotor functionality. (JINS, 2011, 17, 746–750)

Limb praxis can be influenced by age, gender, and education. The present study investigated the influence of these variables on gesture production by healthy elderly subjects. We evaluated 96 individuals divided into two age groups (60–74 and 75–88 years). Each group contained 48 men and 48 women and was subdivided into four groups according to education: illiterates and 1–3, 4–7, and 8 or more years of education. Individuals were requested to carry out tasks on verbal command and imitation. There were no differences between the performance of men and women, while older individuals performed worse than their younger counterparts. Regarding educational level, three major groups emerged: illiterates, individuals with 1–7 years of education, and those with 8 or more years of education. In conclusion, age and education significantly influenced the performance of individuals in limb praxis tests. (JINS, 2009, 15, 618–622.)

Past research suggests that the similarity between the objects associated with actions impacts visual action identification and action production. Indeed, people often confuse actions that are visually similar, as well as actions that are associated with visually similar objects. However, because the action errors often involve actions that are visually similar and are associated with visually similar objects, it is difficult to disambiguate between the influences of object similarity and action similarity. In our experiments, healthy participants were asked to learn to associate nonword names and actions with novel objects. Participants were first shown each object and its action and were then asked to visually identify each object. In Experiment 1, participants were then asked to produce the action associated with each object, and in Experiment 2, they were asked to visually identify the action associated with each object. Actions were confused more often when they were associated with similar objects than when they were associated with dissimilar objects. Furthermore, following an object naming error, participants were more likely to produce the action associated with the erroneous name than any other erroneous action. The results suggest that the visual characteristics of the objects influenced action production and action identification. (JINS, 2007, 13, 1021–1034.)

Huntington's disease (HD) is a neurodegenerative disorder diagnosed clinically with the development of choreiform movements. However, neuropsychological studies have demonstrated cognitive and psychiatric changes during the preclinical phase (pre-HD) prior to formal diagnosis. Previous studies have demonstrated the sensitivity of time reproduction tasks to basal ganglia pathology, as seen in clinical HD and Parkinson's disease. In this study, 29 pre-HD participants, ranging from 3 to 39 years from estimated onset (YEO) of HD based on genetic testing and chronological age, were administered the paced finger-tapping task using target intervals of 600 and 1200 ms. Mean inter-response interval, a measure of timing accuracy, did not systematically deviate from the target interval as a function of YEO. In contrast, timing variability increased curvilinearly as a function of YEO, but not with chronological age alone. Motor timing variability, but not accuracy, may serve as a marker to define the earliest behavioral changes in HD. The present study is among the first to examine the relationship between behavioral measures and YEO in pre-HD. (JINS, 2007, 13, 539–543.)

Amnestic mild cognitive impairment (MCI) has been defined as a precursor to Alzheimer's disease (AD), although it is sometimes difficult to identify which persons with MCI will eventually convert to AD. We sought to predict MCI conversion to AD over a two-year follow-up period using baseline demographic and neuropsychological test data from 49 MCI patients. Using a stepwise discriminant function analysis with Dementia Rating Scale (DRS) Initiation/Perseveration and Wechsler Memory Scale, third edition (WMS-III) Visual Reproduction Percent Retention scores, we correctly classified 85.7% of the sample as either AD converters or MCI nonconverters, with 76.9% sensitivity and 88.9% specificity. Adding race, the presence of vascular risk factors, or cholinesterase inhibitor use to the analysis did not greatly change the classification rates obtained with neuropsychological test data. Examining neuropsychological test cutoff scores revealed that DRS Initiation/Perseveration scores below 37 and Visual Reproduction Percent Retention scores below 26% correctly identified AD converters with 76.9% sensitivity and 91.7% specificity. These results demonstrate that commonly administered neuropsychological tests identify persons with MCI at baseline who are at risk for conversion to AD within 1–2 years. Such methods could aid in identifying MCI patients who might benefit from early treatment, in providing prognostic information to patients, and identifying potential clinical trial participants. (JINS, 2006, 12, 166–175.)

Introduction: Once fitted with hearing aids, much reliance is placed on patients' own ability to manage their devices effectively. There has, however, been little research to assess how patients' own confidence compares with their actual ability to manage their hearing aids. This study compares patients' perceptions of their ability to insert their hearing aids with their observed ability to insert the devices satisfactorily.

Method: Eighty-five patients provided a rating of their level of confidence in fitting their hearing aid, using a visual analogue score (VAS). This was then compared with their observed level of ability, assessed by an audiologist, also using a VAS (both scores 0–100 mm).

Results: We found a weak to moderate correlation between the subjective and objective scores (Pearson r = 0.4912).

Conclusions: From these results, we would advise caution when accepting a patient's perceived level of ability as the only indicator of their true ability to insert their hearing aid. This also has important implications for follow-up services that rely only on telephone conversations with patients after a first fitting.

Treatment for childhood acute lymphoblastic leukemia (ALL), which includes CNS prophylaxis, is associated with central and peripheral neurotoxicity. The purpose of the present study was to analyze the effects of chemotherapy on various levels of visuomotor control in survivors of childhood ALL treated without cranial irradiation, and to identify risk factors for possible deficits. Visuomotor function was compared between children after treatment for ALL (n = 34), children after treatment for Wilms tumor, which consists of non-CNS directed chemotherapy (n = 38), and healthy controls (n = 151). Three tasks were administered: a simple visual reaction time task and two tasks measuring visuomotor control with one requiring a higher level of cognitive control than the other. Visuomotor deficits were detected only in the ALL group, with poorer performance restricted to the condition requiring the highest level of control. Significant risk factors for poorer performance were female gender and a short time since end of treatment, and a trend was found for a young age at diagnosis. A high cumulative methotrexate dose was an adverse predictive factor in girls. The results indicate that chemotherapy-induced central neurotoxicity in childhood ALL treatment is associated with higher order visuomotor control deficits. Girls appear to be particularly vulnerable. (JINS, 2005, 11, 554–565.)

Background and objective: Cognitive dysfunction has been reported after general anaesthesia, but its assessment is time consuming and difficult to evaluate. This pilot study assessed the feasibility of using the Sustained Attention to Response Test to assess 35 ASA I-II adults (mean age 31.6 yr) undergoing day case surgery under general anaesthesia, and 25 ASA I-II adults (mean age 47.8 yr) undergoing day case surgery under local anaesthesia.

Methods: The Sustained Attention to Response Test was performed before surgery and repeated 2 h after surgery.

Results: When patients repeated the test after surgery under local anaesthesia, the number of incorrect responses increased, but reaction times decreased (P < 0.05). Following general anaesthesia, the number of incorrect responses increased (P < 0.05), but reaction times remained unchanged.

Conclusions: The Sustained Attention to Response Test is simple to administer and may be a useful tool when comparing different anaesthetic techniques and their effects on postoperative deficits in sustained attention.

Background and objective: The aim was to examine the immediate effects of short-term anaesthesia on the different components of psychomotor performance of the upper extremity and cognitive functions, and to find out if there were any differences in the sensitivities of the different tests. The measured psychomotor aspects were simple reaction time, choice reaction time, speed of movement, index finger-tapping speed, co-ordination, visual spatial memory capacity, digit-symbol substitution and the Maddox Wing test.

Methods: The subjects were 30 female patients aged 24–50 yr who had been through a minor gynaecological operation. Anaesthesia had been induced with propofol and alfentanil. The measurements were mainly made with the HPM/BEP system, and the tests were performed 1 h before the anaesthesia and immediately after the wake-up.

Results: Short-term anaesthesia prolonged the simple reaction time by 7% and the choice reaction times by 25% (one-choice) and 7% (two-choice) and decreased the speed of movement by 10% (one-choice) and 19% (two-choice), index finger-tapping speed by 7% and co-ordination by 7%. In addition, visual spatial memory capacity decreased by 21%, digit-symbol substitution increased by 5% and the Maddox Wing test increased by 68%.

Conclusions: Based on the results, it seems that short-term anaesthesia reduces both signal processing at the central level, and motor control and co-ordination of movements at the peripheral level, and has a decreasing effect on motor performance in the above-mentioned aspects measured immediately after wake-up.

Background and objective The use of tension-free tape in the vagina is a relatively new surgical procedure for the treatment of urinary incontinence. Traditionally, the procedure is carried out using local anaesthesia and sedation. We aimed to assess the quality of anaesthesia obtained during insertion of tension-free vaginal tape using local anaesthetic infiltration and intravenous conscious sedation.

Methods Twenty-four patients were studied using intravenous midazolam, fentanyl and infiltration with 0.5% prilocaine and epinephrine. Visual analogue scores before operation were used to assess anxiety. The digit symbol substitution test was used before and after surgery to assess psychomotor recovery, and amnesia for the procedure was assessed by means of picture recall. A nurse, anaesthetist and surgeon independently assessed quality of anaesthesia based on vocalization, facial expression, movement and co-operation with incontinence testing.

Results The nurse, anaesthetist and surgeon reported good or excellent conditions in 18, 14 and 22 cases, respectively. There was no significant psychomotor impairment using the digit symbol substitution test, with mean (standard deviation) preoperative and postoperative scores of 22 (8) and 21 (7) correctly matched symbol digit pairs. There was a significant correlation between preoperative anxiety and intraoperative fentanyl requirement (r=0.48, P < 0.05).

Conclusion Satisfactory anaesthetic conditions can be achieved for the insertion of tension-free vaginal tape using local anaesthesia with sedation.

The effects of acute tryptophan depletion were investigated in 20 healthy volunteers. Ten of them received a balanced amino acid solution and 10 a tryptophan-free solution. The fall in tryptophan levels induced by the oral administration of a mixture tryptophan-free of L-amino acids was - 77% for free tryptophan and - 81% for total tryptophan. Before treatment, there were intergroup differences affecting alertness parameters (critical flicker threshold, recognition reaction time), plasma levels of prolactin and baseline performance in the proofreading correction test. In the tryptophan-depleted group, the number of errors reported during the unpleasant sound signal was increased (+ 48%) after treatment, whereas the number of errors fell (— 15%) in the group receiving the tryptophan supplement. Conversely the levels of prolactin were correlated with those of serum tryptophan. Few subjective effects were reported.