Increased Frontal Gyrification Negatively Correlates with Executive Function in Patients with First-Episode Schizophrenia.

Increased Occipital Gyrification and Development of Psychotic Disorders in Individuals With an At-Risk Mental State: A Multicenter Study

Strong indications support the notion that idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) acts as a precursor to multiple α-synucleinopathies, including Parkinson's disease and dementia with Lewy bodies. Despite numerous investigations into the alterations in cortical thickness and the volume of subcortical areas associated with this condition, comprehensive studies on the cortical surface morphology, focusing on gyrification and sulcal depth changes, are scarce. The purpose of this research was to explore the cortical surface morphology in individuals with probable iRBD (piRBD), to pinpoint early-phase diagnostic markers. This study included 30 piRBD patients confirmed using the RBD Screening Questionnaire (RBDSQ) and 33 control individuals selected from the Parkinson's Progression Markers Initiative (PPMI) database. They underwent neurophysiological tests and MRI scans. The FreeSurfer software was utilized to estimate cortical thickness (CTH), cortical and subcortical volumetry, local gyrification index (LGI), and sulcus depth (SD). Subsequently, these parameters were compared between the two groups. Additionally, linear correlation analysis was employed to estimate the relationship between brain morphological parameters and clinical parameters. Compared to the healthy control (HC), piRBD patients exhibited a significant reduction in CTH, LGI, and cortical volume in the bilateral superior parietal, lateral occipital, orbitofrontal, temporo-occipital, bilateral rostral middle frontal, inferior parietal, and precentral brain regions. Moreover, a significant and notable correlation was observed between CTH and Geriatric Depression Scale (GDS), letter-number sequencing (LTNS), the Benton Judgment of Line Orientation (BJLO) test, and the symbol digit modalities test (SDMT) in several brain regions encompassing the motor cortex. Patients with piRBD displayed widespread atrophy in various brain regions, predominantly covering the motor and sensory cortex. Furthermore, LGI could serve as a prognostic biomarker of disease's progression in piRBD.

Increased brain gyrification in diverse cortical regions has been reported in patients with schizophrenia, possibly reflecting deviations in early neurodevelopment. However, it remains unknown whether patients with schizotypal disorder exhibit similar changes. This magnetic resonance imaging study investigated brain gyrification in 46 patients with schizotypal disorder (29 male, 17 female), 101 patients with schizophrenia (55 male, 46 female), and 77 healthy controls (44 male, 33 female). T1-weighted magnetic resonance images were obtained for each participant. Using FreeSurfer software, the local gyrification index (LGI) of the entire cortex was compared across the groups. Both schizophrenia and schizotypal disorder patients showed a significantly higher LGI in diverse cortical regions, including the bilateral prefrontal and left parietal cortices, as compared with controls, but its extent was broader in schizophrenia especially for the right prefrontal and left occipital regions. No significant correlations were found between the LGI and clinical variables (e.g., symptom severity, medication) for either of the patient groups. Increased LGI in the frontoparietal regions was common to both patient groups and might represent vulnerability to schizophrenia, while more diverse changes in schizophrenia patients might be associated with the manifestation of florid psychosis.

At present, no reliable predictors exist to distinguish future responders from nonresponders to treatment during the first episode of psychosis. Among potential neuroimaging predictors of treatment response, gyrification represents an important marker of the integrity of normal cortical development that may characterize, already at illness onset, a subgroup of patients with particularly poor outcome. To determine whether patients with first-episode psychosis who do not respond to 12 weeks of antipsychotic treatment already have significant gyrification defects at illness onset. Case-control study with 12 weeks' longitudinal follow-up to determine treatment response. Secondary psychiatric services in an inner-city area (South London, England). A total of 126 subjects, including 80 patients presenting with first-episode psychosis and 46 healthy controls. Patients were scanned at the outset and received various antipsychotic medications in a naturalistic clinical setting. They were followed up for 12 weeks and classified as responders or nonresponders if they reached criteria for symptom remission, evaluated with the Psychiatric and Personal History Schedule. Patients were exposed to naturalistic antipsychotic treatment for 12 weeks following a magnetic resonance imaging scan. Cortical gyrification was assessed using local gyrification index in a vertexwise fashion across the entire cortical surface with correction for multiple testing using permutation analysis. Differences in local gyrification index were assessed between responders, nonresponders, and healthy controls. The effect of diagnosis (affective vs nonaffective psychosis) on the local gyrification index was also investigated in responders and nonresponders. Patients with first-episode psychosis showed a significant reduction in gyrification (hypogyria) across multiple brain regions compared with healthy controls. Interestingly, nonresponders showed prominent hypogyria at bilateral insular, left frontal, and right temporal regions when compared with responders (all clusters significant at P < .05). These effects were present for both affective and nonaffective psychoses. Gyrification appears to be a useful predictor of antipsychotic treatment response. Early neurodevelopmental aberrations may predict unfavorable prognosis in psychosis, irrespective of the existing diagnostic boundaries.

Previous magnetic resonance imaging (MRI) studies reported increased brain gyrification in schizophrenia and schizotypal disorder, a prototypic disorder within the schizophrenia spectrum. This may reflect deviations in early neurodevelopment; however, it currently remains unclear whether the gyrification pattern longitudinally changes over the course of the schizophrenia spectrum. The present MRI study using FreeSurfer compared longitudinal changes (mean inter-scan interval of 2.7 years) in the local gyrification index (LGI) in the entire cortex among 23 patients with first-episode schizophrenia, 14 with schizotypal disorder, and 39 healthy controls. Significant differences were observed in longitudinal LGI changes between these groups; the schizophrenia group exhibited a progressive decline in LGI, predominantly in the fronto-temporal regions, whereas LGI increased over time in several brain regions in the schizotypal and control groups. In the schizophrenia group, a greater reduction in LGI over time in the right precentral and post central regions correlated with smaller improvements in negative symptoms during the follow-up period. The cumulative medication dosage during follow-up negatively correlated with a longitudinal LGI increase in the right superior parietal area in the schizotypal group, but did not affect longitudinal LGI changes in the schizophrenia group. Collectively, these results suggest that gyrification patterns in the schizophrenia spectrum reflect both early neurodevelopmental abnormalities as a vulnerability factor and active brain pathology in the early stages of schizophrenia.

14:15 DECREASED WHITE MATTER INTEGRITY IN PSYCHOTIC DISORDER: ASSOCIATION WITH CHILDHOOD TRAUMA?

Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning. The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke. Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT). Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke. Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more treatment to mitigate the dysfunction.

Few studies have explored the complex relationship of pro- and anti-inflammatory cytokines with cognitive function in adolescents with first-episode schizophrenia, bipolar disorder, or major depressive disorder. In total, 26, 35, and 29 adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder, respectively, and 22 age- and sex-matched controls were included in the current study. Cytokines, namely interleukin (IL)-2, IL-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP), were assessed. The Wisconsin Card Sorting Test (WCST) and the working memory task were administered to assess cognitive function. Using generalized linear models with adjustment for demographic data and clinical symptoms, patients with bipolar disorder were found to exhibit the highest levels of CRP (P=.023), IL-6 (P=.022), and TNF-α (P=.011), and had the lowest IL-2 levels (P=.034) among the four groups. According to the results of the WCST and working memory task, adolescents with schizophrenia exhibited the lowest performance in cognitive function. In addition, among the assessed cytokines, only CRP levels (P=.027) were negatively associated with WCST scores. Dysregulated pro- and anti-inflammatory cytokines and impaired cognitive functioning were observed in first-episode adolescent-onset schizophrenia, bipolar disorder, and major depressive disorder. The altered cytokine profiles may play important roles in the pathophysiology of schizophrenia, bipolar disorder, and major depressive disorder.

Background: severe and persistent mental condition Adults have a lifetime prevalence of schizophrenia that ranges from 0.4 to 1%. The purpose of this study was to compare the cognitive function of first-episode schizophrenic patients to that of multiple schizophrenic patients, as well as to examine cognitive function in patients with first-episode schizophrenia and the impact of treatment on first-degree relatives of the patient.&#x0D; Methods: The 200 participants in this cross-sectional case-control study were of both sexes and ranged in age from 18 to 50. There were five groups created for the subjects: Group I (n=50): Schizophrenia in its initial episode. Group II (n=50): Relatives of schizophrenia patients experiencing their first episode. Group III (n=50): Schizophrenia with multiple episodes. Healthy volunteers make up Group IV (n=50). Group V (n=36): Group I was followed up with one year following therapy.&#x0D; Results: Total IQ, attention, executive function, memory function, and social cognition were significantly different between patients and controls. First-degree relatives and the control group showed substantial differences in attention, executive function, and memory function. The Wisconsin Card Sorting Test (WCST) categories that were completed and the number of preservation errors, as well as the Trail Making Test (TMT) A and B, Mayer-Salovey-Caruso Perception and experiencing areas of emotional intelligence (MESCIT), mental control, logical memory, total number of digits, association learning, and visual reproduction are all measured by the Wechsler Memory Scale (WMS). Other than the perception branch and experiential region (social cognition), there was no statistically significant change in the overall IQ, WCST, Benton Visual Retention Test (BVRT), or MESCIT.&#x0D; Conclusions: In terms of general intelligence, attention, executive function, memory function, and social cognition, first episode patients outperformed many episode patients.

Background: Hypertension one of the main risk factors of cardiovascular diseases and premature death worldwide. Researches indicate different cognitive activities and executive functions in cardiovascular and hypertension patients compared to non-afflicted people. Objectives: Therefore, the purpose of this study was to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on executive functions in patients with hypertension. Materials &amp; Methods: The present study was a randomized clinical trial based on the pre-test, post-test, follow-up design. The statistical population consisted of all the people with hypertension who referred to Heshmat Heart Hospital in Rasht city, Iran, in 2021. Thirty-four qualified volunteers were included in the study by purposive sampling method and randomly assigned to two groups of MBSR and control. Wisconsin Card Sorting Test (computer version) were the instrument employed in this research; and MBSR sessions were held for 2 months (8 sessions, one 120-minute session each week). The research data were analyzed using repeated measures ANOVA and Bonferroni post-hoc test. Results: In the pre-test design, there wasn't a difference in the completed categories and perseverative errors, between the MBSR group (2±0.485 and 30.06±6.60) and the control group (2.06±0.659 and 29.88±9.4. In the post-test design, a significant difference in the completed categories and perseverative errors was found between the MBSR group (3.29±0.848 and 20.94±5.71) and the control group (2.18±0.636 and 29.94±8.70); which implies the MBSR group outperformed the control group in Improving executive functions of patients with hypertension. Finally, at the follow-up, all changes were still stable. Conclusions: MBSR was effective on executive functions of patients with hypertension. Therefore, it is suggested that the mentioned intervention be used in medical centres to improve the cognitive activities of patients with hypertension, so that its positive results include the condition of these patients.

Impaired working memory (WM) performance is considered as a central feature of schizophrenia. Divided into two components, verbal and spatial, WM has been shown to involve frontal and parietal regions. Verbal WM can be tested either visually or aurally. The present study aimed to test schizophrenic patients in both visual and auditory verbal WM in order to assess a possible distinct pattern of alteration of these two modalities. Twenty-four schizophrenic patients and 24 healthy controls were compared with 2-back continuous visual and auditory verbal WM testing. Both groups were also tested on a neuropsychological battery including Wisconsin Card Sorting Test (WCST). Schizophrenic patients were less efficient in both verbal WM tests. When taking age and educational level as covariates and both WM modalities as dependent variables, there was no differential effect of modalities across groups. In further exploratory analyses, partial correlations brought association between verbal WM and psychosocial adaptation, WCST and length of illness. These results suggest a similar pattern of alteration of both modalities of verbal WM in schizophrenic patients. The implications of this finding are discussed.

Reduced neuro-integration from the dorsolateral prefrontal cortex to the whole brain and executive dysfunction in schizophrenia patients and their relatives

The present study reviewed voxel-based morphometry (VBM) studies on high-risk individuals with schizophrenia, patients experiencing their first-episode schizophrenia (FES), and those with chronic schizophrenia. We predicted that gray matter abnormalities would show progressive changes, with most extensive abnormalities in the chronic group relative to FES and least in the high-risk group. Forty-one VBM studies were reviewed. Eight high-risk studies, 14 FES studies, and 19 chronic studies were analyzed using anatomical likelihood estimation meta-analysis. Less gray matter in the high-risk group relative to controls was observed in anterior cingulate regions, left amygdala, and right insula. Lower gray matter volumes in FES compared with controls were also found in the anterior cingulate and right insula but not the amygdala. Lower gray matter volumes in the chronic group were most extensive, incorporating similar regions to those found in FES and high-risk groups but extending to superior temporal gyri, thalamus, posterior cingulate, and parahippocampal gryus. Subtraction analysis revealed less frontotemporal, striatal, and cerebellar gray matter in FES than the high-risk group; the high-risk group had less gray matter in left subcallosal gyrus, left amygdala, and left inferior frontal gyrus compared with FES. Subtraction analysis confirmed lower gray matter volumes through ventral-dorsal anterior cingulate, right insula, left amygdala and thalamus in chronic schizophrenia relative to FES. Frontotemporal brain structural abnormalities are evident in nonpsychotic individuals at high risk of developing schizophrenia. The present meta-analysis indicates that these gray matter abnormalities become more extensive through first-episode and chronic illness. Thus, schizophrenia appears to be a progressive cortico-striato-thalamic loop disorder.

At present, little is known about brain functional connectivity and its small-world topologic properties in first-episode schizophrenia (SZ) patients during cool executive function task. In this paper, the Trail Making Test-B (TMT-B) task was used to evaluate the cool executive function of first-episode SZ patients and electroencephalography (EEG) data were recorded from 14 first-episode SZ patients and 14 healthy controls during this cool executive function task. Brain functional connectivity between all pairs of EEG channels was constructed based on mutual information (MI) analysis. The constructed brain functional networks were filtered by three thresholding schemes: absolute threshold, mean degree, and a novel data-driven scheme based on orthogonal minimal spanning trees (OMST), and graph theory was then used to study the topographical characteristics of the filtered brain graphs. Results indicated that the graph theoretical measures of the theta band showed obvious difference between SZ patients and healthy controls. In the theta band, the characteristic path length was significantly longer and the cluster coefficient was significantly smaller in the SZ patients for a wide range of absolute threshold T. However, the cluster coefficient showed no significant changes, and the characteristic path length was still significantly longer in SZ patients when calculated as a function of mean degree K. Interestingly, we also found that only the characteristic path length was significantly longer in SZ patients compared with healthy controls after using the OMST scheme. Pearson correlation analysis showed that the characteristic path length was positively correlated with executive time of TMT-B for the combined SZ patients and healthy controls (r = 0.507, P = 0.006), but not for SZ patients alone (r = 0.072, P = 0.612). The above results suggested a less optimal organization of the brain network and could be useful for understanding the pathophysiologic mechanisms underlying cool executive dysfunction in first-episode SZ patients.

Objective: Whereas there is growing evidence that repetitive transcranial magnetic stimulation (rTMS) favorably impacts on symptoms of obsessive-compulsive disorders (OCD), less is known regarding the influence of rTMS on cognitive performance of patients with OCD. Here, we tested the hypothesis that rTMS has a positive impact both on symptom severity and executive functions in such patients. Methods: We assessed 10 patients diagnosed with OCD (mean age: 33.5 years) and treated with a standard medication; they were randomly assigned either to a treatment-first or to a sham-first condition. Symptom severity (experts' ratings) and executive functions (Wisconsin Card Sorting Test) were assessed by independent raters unaware of the patients' group assignments at baseline, after 2 and 4 weeks. After 2 weeks, treatment switched to sham condition, and sham condition switched to treatment condition. Results: Under treatment but not under sham conditions, symptom severity decreased. Performance on the executive function test increased continuously with every new assessment and was unrelated to rTMS treatment. Conclusion: Whereas the present study confirmed previous research suggesting that rTMS improved symptoms of OCD, rTMS did not improve executive functions to a greater degree than sham treatment. More research is needed to investigate the effect of rTMS on executive functions in patients with OCD.