[The use of RBANS test (Repeatable Battery for the Assessment of Neuropsychological Status) in neurocognitive testing of patients suffering from schizophrenia and dementia]
INTRODUCTION: The purpose of our study was to find out whether the Hungarian adaptation of the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status), a brief neurocognitive screening test, is appropriate for the differentiation of healthy and non-healthy subject groups, or for the detection of differences between the cognitive performance of patient groups. PATIENTS AND METHODS: The test battery was administrated to 38 healthy subjects, 69 schizophrenic patients, and 18 patients suffering from dementia (10 probable Alzheimer-type and eight vascular dementia). RESULTS: There was a significant decrease of performance in all patient groups compared to the healthy group. In the schizophrenic group, the test indicated a deterioration of functioning in all cognitive areas. The patient group with Alzheimer-type dementia performed only slightly better than the schizophrenic group, because the fall of performance was not significant only one of the cognitive areas (in the visuo-spatial tasks) when compared to the healthy group. There was no difference between the performance of patients with vascular dementia and that of healthy subjects in direct memory, verbal and visuo-spatial tasks. The test results indicated an even deterioration of cognitive areas in patients with Alzheimer-type dementia. As for the vascular dementia group, the most vulnerable area proved to be that of attention, while their verbal functions were relatively spared. The deterioration in other cognitive functions shown by schizophrenic subjects was more moderate, but still significant. A comparison of the RBANS scores of the schizophrenic patients in our study and the result of an American study was also carried out. The global indeces showed no difference; only the pattern of the sub-scales was a little different. CONCLUSION: The Hungarian version of the RBANS seems approprite for the differentiation of healthy and deteriorated cognitive performance in a Hungarian patient population.
Diagnostic accuracy of the RBANS in mild cognitive impairment: limitations on assessing milder impairments.
Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84108, USA. email@example.com
The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has demonstrated adequate sensitivity in detecting cognitive impairment in a number of neuropsychiatric conditions, including Alzheimer's disease. However, its ability to detect milder cognitive deficits in the elderly has not been examined. The current study examined the clinical utility of the RBANS by comparing two groups: Patients with Mild Cognitive Impairment (MCI; n = 72) and cognitively intact peers (n = 71). Significant differences were observed on the RBANS Total score, 3 of the 5 Indexes, and 6 of the 12 subtests, with individuals with MCI performing worse than the comparison participants. Specificity was very good, but sensitivity ranged from poor to moderate. Areas under the receiver operating characteristic curves for the RBANS Immediate and Delayed Memory Indexes and the Total Scale score were adequate. Although significant differences were observed between groups and the areas under the curves were adequate, the lower sensitivity values of the RBANS suggests that caution should be used when diagnosing conditions such as MCI.
The role of attention and immediate memory in vulnerability to interpersonal criticism during family transactions in schizophrenia.
Objective Cognitive dysfunctions may represent vulnerability markers to psychosocial stress in schizophrenia. The purpose of this study was to investigate the possibility that cognitive deficits are associated with the emergence of unusual thoughts during a stressful family transaction. Methods The cognitive performance of 80 patients with schizophrenia was characterized by the five index scores of the repeatable brief assessment of neuropsychological status (RBANS) test battery (immediate and delayed memory, visuospatial/constructional functions, language, and attention). The patients and one of their family members participated in a 20-minute interaction during which the number of relatives' harsh criticisms and the number of patients' unusual thoughts was measured. Results Regression analyses revealed that criticism together with attention/immediate memory best predicted the number of unusual thoughts (>25% of variance). In patients with poor attention/immediate memory, there was a significant positive relationship between the number of criticisms and unusual thoughts. Conclusions The results indicate that family criticism is related to thinking disturbances in patients with poor attention/immediate memory. The enhancement of these cognitive functions may increase resistance to psychosocial stress in schizophrenia.
Semmelweis University, Budapest, Hungary.
Previous studies indicated that oxytocin plays an important role in human trust, which is impaired in patients with severe mental disorders. In this study, we measured plasma oxytocin levels in patients with schizophrenia (n=50) and in healthy controls (n=50) after neutral and trust-related interpersonal interactions. Trust-related interactions were associated with increased oxytocin levels in controls. This effect was absent in patients with schizophrenia. Low oxytocin levels measured after trust-related interactions significantly predicted the negative symptoms of schizophrenia but were not related to positive symptoms, depression, anxiety, and neuropsychological functions. These results suggest that decreased trust-related oxytocin release is related to the negative symptoms and may be associated with social withdrawal, isolation, and flattened affect in schizophrenia.
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The disturbance of source-monitoring is one of the various impairments in cognitive functioning observed in schizophrenic patients. The process of source-monitoring allows individuals to distinguish self generated thoughts and behaviours from those generated by others. The aim of the present study is to review the general psychological definition of source memory and source-monitoring and its neurological basis as well as the models for explanation of source-monitoring deficits. The relationship between source-monitoring-deficits and psychopathological symptoms as well as the effect of antipsychotic treatment on source-monitoring disturbances are introduced. There is evidence suggesting, that a selective source-monitoring deficit is in the occurrence of auditory hallucinations. The disturbance of prospective memory may influence unfavorably the compliance. Administration of antipsychotics in general can improve source-monitoring deficits. The neuropsychiatric perspective provides a more accurate and comprehensive understanding of schizophrenia.
Jahn Ferenc Dél-pesti Kórház, I. Pszichiátriai és Pszichiátriai Rehabilitációs Osztály. firstname.lastname@example.org
This article reviews the published clinical data on schizophrenic patients managed with the new formulation of quetiapine, the once-daily extended release quetiapine fumarate (quetiapine XR). Quetiapine XR has been developed to reduce the frequency of quetiapine dosing by introducing once-daily administration and to simplify the treatment initiation schedule. Quetiapine XR (400 to 800 mg/day) was effective versus placebo across a broad range of symptom domains in acute schizophrenia and was as well tolerated as the immediate release (IR) formulation. Rapid dose escalation of quetiapine XR (300 mg on day 1,600 mg on day 2, and 800 mg on day 3) was also well tolerated, with a therapeutically effective dose reached by day 2. Clinically stable patients with schizophrenia receiving quetiapine IR (400-800 mg/day) can be switched to an equivalent once-daily dose of quetiapine XR (400-800 mg/day once-daily) without clinical deterioration or compromise in tolerability. Evidence from a clinical trial has shown that patients with schizophrenia who had a history of unsatisfactory treatment (tolerability or efficacy) on typical or atypical antipsychotic experienced improved efficacy and clinical benefit when switched to quetiapine XR. Once-daily quetiapine XR (400-800 mg/nap) was effective compared with placebo in preventing relapse in patients with clinically stable schizophrenia, and was well tolerated during long-term use. Patients could be switched from their ongoing antipsychotic to quetiapine XR within 4 days without compromising efficacy, enabling a dose of 600 mg/day and 800 mg/day to be reached by Day 2 and Day 3 respectively. This new, once-daily formulation of quetiapine offers psychiatrists and patients valuable new treatment options for the short and long-term treatment of schizophrenia.
[Switching patients with schizophrenia to ziprasidone from conventional or other atypical antipsychotics.]
Dél-pesti Psychiatric Hospital, Budapest, Hungary.
Objectives. The aim of the study was to assess the efficacy, tolerability and safety of ziprasidone in patients with schizophrenia who were already treated with conventional or other atypical antipsychotics that had to be switched due the lack of efficacy or bad tolerance. Methods. The study was a 12-week, open label, multicenter, non comparative trial on oral ziprasidone. 106 patients with DSM-IV schizophrenia were switched to ziprasidone from their previous antipsychotic without a washout phase. The study required fixed dosing with ziprasidone. For the first week the patient received 80 mg of study drug daily, followed for 3 weeks 120 mg/day. Subsequently for 8 weeks either 80 mg, or 120 mg, or 160 mg total daily dose could be given at the discretion of the investigator. Baseline and outcome assessment included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity of Illness Subscale (CGI-S) and Global Improvement Subscale (CGI-I), Calgary Depression Scale (CAD), Hamilton Depression Scale (HAMD), Drug Attitude Inventory (DAI), Simpson Angus Extrapyramidal Symptoms Rating Scale (SAS) and Barnes Akathisia Rating Scale (BARS). Changes in overall body weight were also evaluated. Results. After 12 weeks on ziprasidone therapy, significant improvements were observed on all major symptoms measures and subscales. 34 (51,5%) patients (ITT) were rated much or very much improved on CGI-I at week 12. The mean SAS score significantly reduced during the ziprasidone treatment period (p<0.001). In the DAI ziprasidone treatment was also favorable rated. During treatment with ziprasidone for 12 weeks the body weight of the patients was significantly reduced (mean: 1,2 kg, SD=3,79, p=0.002). 58 adverse events occured in 41 subjects (38.7%), of whom 7 patients (6.6%) encountered 9 severe adverse events. The adverse events were mainly mild and moderate. 15 patients (14.2%) were discontinued from the study due to adverse events. The reason for discontinuation in 4 cases was mainly insufficient clinical response. Conclusion. Switching patients from their previous antipsychotic to ziprasidone without a washout phase was generally well tolerated and was associated with symptoms improvements 12 weeks later. At least 50% of patients who needed to be switched because of unsatisfactory efficacy or poor tolerance were significantly improved on ziprasidone therapy. The favorable safety profile of ziprasidone treatment was consistent with that seen in other clinical trials. Keywords: switching, ziprasidone, schizophrenia.
Dél-pesti Psychiatric Hospital, Budapest;, Hungary.
Agitation is common in patients with acute schizophrenia or bipolar mania, and when severe can result in agressive or violent behaviour. Pharmacotherapy for acute psychotic agitation includes the use of antipsychotic and benzodiazepine drugs, either alone or in combination. Although oral treatment is preferred, options in the pharmacotherapy of acute agitation include the parenteral administration of antipsychotics in order to facilitate onset of drug action and quickly alleviate symptoms. Until recently only conventional antipsychotic and benzodiazepine drugs were available as intramuscular injections. Olanzapine has been one of the first atypical antipsychotics available for im administration. Four randomized placebo and comparator controlled , double-blind clinical trials have demonstrated the efficacy of olanzapine in reducing acute agitation in patients with schizophrenia, bipolar mania and Alzheimer and vascular dementia. Evidence from these clinical trials has shown that IM olanzapine associated with faster onset of action and more favorable profile of adverse events, than monotherapy with IM haloperidol. Current clinical experience and one naturalistic study with intramuscular olanzapine suggest that it is efficacious and can be safely used in "real world" patients with severe agitation. Intramuscular olanzapine have shown ease of transition to same agent oral therapy once the acute agitation has diminished. The orally disintegrating tablet formulation of olanzapine was effective rapidly reducing psychopathology, while improving medication compliance, attitudes and behaviours. This new formulation of olanzapine may offer an alternative strategy in the treatment of acutely ill, noncompliant schizophrenic patients. Evidence suggests that the new formulations of olanzapine should be among the first-line choices in the treatment of agitation in acute psychosis. Keywords: olanzapine, intramuscular, orally disintegrating tablet, agitation, psychosis.
Jahn Ferenc Dél-pesti Kórház, l Pszichiátriai és Pszichiátriai Rehabilitációs Osztály. email@example.com
Schizophrenia is a severe and chronic illness as well as one of the most expensive illnesses to treat. Relapse and rehospitalisation contributes significantly to the economic burden of schizophrenia. Partial compliance with antipsychotic medication was associated with an increased risk of inpatient hospitalization. Health care resource use is significantly reduced in patients with stable schizophrenia or schizoaffective disorder receiving long-acting, injectable risperidone. It is highly likely that these reductions will decrease healthcare costs in patients receiving long-acting risperidone. In this article cost-effectiveness models of long-acting risperidone developed for different countries are discussed. Long-acting risperidone produced additional clinical benefit and cost savings compared with other treatment strategies, despite significant variations in cost-effectiveness. One factor remained valid for each country: improved adherence arising through the use of long-acting risperidone provides a cost-effective strategy for treating patients with schizophrenia. On the basis of the cost-effectiveness evaluations in different countries long-acting risperidone seems to offer a cost saving treatment option for patient with schizophrenia under Hungarian circumstances. Further assessment of these models in a pragmatic study and actual monitoring of health care resource utilization should confirm the above assumption.
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Laura Casas-Hernanz, Maite Garolera, Dolors Badenes-Guia, Juan Carlos Cejudo-Bolivar, Josep Royo, Miquel Aguilar
Servei de Neurologia, Hospital Universitari Mutua Terrassa, Terrassa, Spain.
The role of carotid stenosis on cognition remains to be determined. To study whether people with stenosis of the carotid artery have increased cognitive impairments, we studied 53 patients with moderate or severe carotid stenosis (with no symptoms of stroke or dementia) and 53 controls. We describe which cognitive functions were impaired in the patients and whether there were differences based on the side, the severity of the stenosis or the presence of neurological symptoms. Using the Repeatable Battery for the Assessment of Neuropsychological Status, we found that the patients with carotid stenosis had lower cognitive performances in attention, verbal memory, visuospatial capacity and verbal fluency. Patients with lesser degrees of stenosis than healthy control patients had better scores in learning and memory. The results from this study suggest that patients with severe carotid stenosis have a lower cognitive status than healthy control patients, which is associated with the degree of total carotid stenosis.
Psychiatry Department, Richard L. Roudebush Veterans Administration Medical Center, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. firstname.lastname@example.org
When testing memory and cognitive abilities, clinicians often administer batteries including multiple tests with similar content. Care must be taken so that such similarities do not unduly impact test performance. This brief report reviews findings from our own clinic, where administration of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in tandem with other screening instruments has led to apparent carry-over at an overall rate of more than one third of cases. Specific combinations of RBANS plus three other instruments are reported, along with cautions and caveats for appropriate interpretation.
Department of Neurosurgery, Harborview Medical Center, Box 359766, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. email@example.com
Neuropsychological or neurocognitive tests provide information regarding the cognitive and emotional status of the concussed athlete. The development and availability of computerized testing platforms has allowed the application of baseline and follow-up testing models, and provide a more precise measurement of reaction time and processing speed. A combination of computerized assessment and a more expanded battery of tests may be a better approach to understanding the nature of the cognitive impact of sports concussion in youth athletes. This approach may be especially important for athletes with general risk factors and other potential modifiers or influencers on the cognitive performance data.
Department of Neurology, University of Utah, Salt Lake City, 84108, USA. firstname.lastname@example.org
The present study provides supplemental data for the Repeatable Battery for the Assessment of Neuropsychological Status (Randolph, 1998) by reporting base rate data on discrepancies between subtests of this measure. These discrepancies are organized by general level of ability and include both age and education corrections. The data come from the Oklahoma Longitudinal Assessment of Health Outcomes in Mature Adults study and include cognitive performances of 718 community-dwelling older adults. These findings offer the possibility of increased sensitivity at detecting clinically significant differences that might not be identified when relying on base rate data from a greater age range. Similarly, these data highlight the mediating effects of the global level of cognitive functioning on discrepancy scores.
Differential effects of chronic cannabis use on preattentional cognitive functioning in abstinent schizophrenic patients and healthy subjects.
Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Mitte, Charitéplatz 1, 10177 Berlin, Germany. email@example.com
INTRODUCTION A number of studies indicate a higher risk for psychosis as well as for neurocognitive deficits in healthy cannabis users. However, little is known about the impact of cannabis use on outcome in schizophrenia. In fact, there is growing evidence that cannabis-using schizophrenic patients may show preserved or even better neurocognitive performance compared to schizophrenic non-users. METHODS We measured mismatch negativity (MMN) to investigate preattentional neurocognitive functioning in long-term abstinent chronic cannabis users with (SZCA n=27) and without schizophrenia (COCA n=32) compared to schizophrenic patients (SZ n=26) and healthy controls (CO n=34) without any chronic drug use. RESULTS Healthy cannabis users showed reduced frontal MMN compared to controls (p=0.036). In contrast, cannabis-using schizophrenic patients showed increased frontal MMN compared to schizophrenic patients without cannabis use (p=0.038). Comparing non-cannabis users, schizophrenic patients showed reduced frontal MMN (p=0.001). No significant differences were found between CO and SZCA (p=0.27), and COCA and SZCA (p=0.50). CONCLUSION Results suggest that chronic cannabis use may have different effects on preattentional neurocognitive functioning in schizophrenic patients when compared to healthy subjects. This may be related to preexisting differences in the endocannabinoid system between schizophrenic patients and healthy subjects. However, due to the naturalistic design of the study, the results must be interpreted with caution.
Cognitive performance and cholinergic transmission: influence of muscarinic and nicotinic receptor blockade.
Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany. firstname.lastname@example.org
The cholinergic system is essential in mediating cognitive processes. Although there has been extensive research regarding cholinergic receptor subsystems, the specific contribution of the muscarinic and nicotinic receptor system to cognitive processes still has not been sufficiently explored. In the present study, we examined the selective contribution of muscarinic and nicotinic antagonism to cognitive performance in healthy human subjects. A single-blind, double-dummy, time-elapsed, repeated measures cross-over design was used on 15 healthy males. Subjects completed a neuropsychological test battery assessing a wide range of cognitive domains after 0.4 mg scopolamine (intravenous), 0.2 mg/kg mecamylamine (max. 15 mg; oral) or placebo. Subjects were tested under three conditions: placebo/placebo (PP), scopolamine/placebo (SP) and mecamylamine/placebo (MP). Results show that scopolamine significantly impaired the free recall and recognition performance in the verbal learning test. No other cognitive domain was affected, neither by scopolamine nor by mecamylamine. In line with the existing literature, antagonism of muscarinic receptors resulted in specific cognitive impairments, predominantly memory performance.
Spanish validation of the Brief Assessment in Cognition in Schizophrenia (BACS) in patients with schizophrenia and healthy controls.
N Segarra, M Bernardo, F Gutierrez, A Justicia, E Fernadez-Egea, M Allas, G Safont, F Contreras, J Gascon, P A Soler-Insa, J M Menchon, C Junque, R S E Keefe
Schizophrenia Clinic Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic de, Barcelona, Spain.
Neurocognitive impairment is a core feature of schizophrenia and is closely associated with functional outcome. The importance of cognitive assessment is broadly accepted today, and an easy-to-use, internationality validated cognitive assessment tool is needed by researchers and in daily clinical practice. The Brief Assessment of Cognition in Schizophrenia (BACS) has been validated in English, French, Japanese and Italian. It is as sensitive to cognitive dysfunction as a standard test battery, with the advantage of requiring less than 35minutes to complete. In our study, we tested the psychometric characteristics of a Spanish version of the BACS in 117 patients with schizophrenia-spectrum disorders and 36 healthy controls. All BACS cognitive subtests discriminated between patients and controls (P<.001), and the concurrent validity between the BACS and a traditional neuropsychological test battery was similar to that reported in other languages. We conclude that the BACS can facilitate the comparison of the cognitive performance of patients with schizophrenia in many different countries.
Psychol Med. 2010 Feb 5;:1-8 20132582
Neurocognitive functioning before and after the first psychotic episode: does psychosis result in cognitive deterioration?
H E Becker, D H Nieman, S Wiltink, P M Dingemans, J R van de Fliert, E Velthorst, L de Haan, T A van Amelsvoort, D H Linszen
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
BACKGROUND: Cognitive impairment is considered to be a core characteristic of schizophrenia. The relationship between psychosis and cognitive deterioration, however, remains unclear. This longitudinal study investigated the neuropsychological functioning of patients before and after their first psychotic episode. Cognitive functioning of participants who later developed a psychosis was compared to that of people at ultra-high risk (UHR) for psychosis who did not develop psychosis at follow-up and healthy controls.MethodParticipants were 41 persons at UHR for psychosis (the UHR group), of whom 17 developed psychosis between the first and second assessment. Seventeen healthy controls were included in the study. Cognitive performance was assessed at intake (T0) and again after 18 months (T1). The areas of cognitive functioning assessed include verbal memory and learning, visuospatial working memory, executive function, sustained attention and motor speed. RESULTS: The transition group did not perform significantly worse at the second assessment than at the first on any of the outcome measures. The UHR group performed better on a verbal learning and memory test at T1 compared to T0. At T0, the control group scored significantly better than the UHR group and the transition group on the verbal learning and memory test and the verbal fluency test. CONCLUSIONS: The results indicate that no cognitive deterioration occurs during the first psychotic episode. Problems in verbal memory may be present before the first episode of psychosis.
Use of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to investigate group and gender differences in schizophrenia and bipolar disorder.
Mental Health Research Institute of Victoria, Level 2, 161 Barry Street, Carlton South, Vic. 3053, Australia. email@example.com
Objective: Gender differences exist in schizophrenia and bipolar disorder (BD), therefore the aim of the present study was to clarify the role of gender in cognitive deficits in these disorders. Methods: Cognitive performance was examined in schizophrenia (24M : 14F) and BD (16M : 24F) patients compared with age-, IQ- and gender-matched control participants (21M : 22F). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess five cognitive domains: immediate memory/learning, visuospatial ability, language, attention, and delayed memory, which are summed to provide a Total score. Results: In comparison to controls, schizophrenia patients showed deficits on all domains, while BD patients had impaired immediate memory/learning, language and Total score. Schizophrenia patients showed deficits compared to BD in the Total score, immediate and delayed memory and visuospatial ability. The Total and domain scores were not different in men and women across or within groups. There were gender effects on four of the 12 individual cognitive tasks, in which female patients outperformed male patients. Further, there were gender differences across groups for three of the individual tasks: female schizophrenia patients showed poorer story memory and story recall compared to male schizophrenia patients; female BD patients had enhanced figure copy performance compared to male BD patients. Conclusions: The RBANS highlighted the cognitive deficits in schizophrenia and BD patients compared to controls and also each other. There were no overall gender differences in cognition.
Inefficient neural activity in patients with schizophrenia and nonpsychotic relatives of schizophrenic patients: Evidence from a working memory task.
Susanne Karch, Gregor Leicht, Ina Giegling, Jürgen Lutz, Jörg Kunz, Moritz Buselmeier, Patric Hey, Alexander Spörl, Lorenz Jäger, Thomas Meindl, Oliver Pogarell, Hans-Jürgen Möller, Ulrich Hegerl, Dan Rujescu, Christoph Mulert
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, D-80336 Munich, Germany.
Studies of schizophrenia with functional MRI have shown hyper- and hypoactivations in various brain regions including the prefrontal cortex. Functional anomalies have also been reported in first-degree relatives of schizophrenic patients. The aim of this study was to examine working memory related brain functions in healthy subjects, schizophrenic patients and unaffected relatives and to determine the influence of psychopathology on these processes. A parametric n-back working memory task and functional MRI were used to examine 61 patients with schizophrenia, 11 nonpsychotic relatives of schizophrenic patients and a comparison group of 61 healthy subjects. The results indicated increased as well as decreased brain functions in schizophrenic patients compared to the control group depending on the task difficulty and the performance: during the attention task (0-back), which served as control condition, behavioral responses of patients and healthy subjects hardly differed but BOLD responses were considerably enhanced in schizophrenic patients. With increasing task difficulty differences between groups in BOLD responses diminished whereas behavioral deficits of patients increased. The examination of attention-independent working memory-functions (2- vs. 0-back) produced hypoactivations in patients, especially in frontal, temporal and subcortical brain regions. Furthermore, positive symptoms were associated with parietal dysfunctions. Behavioral performance and neural responses of unaffected relatives of schizophrenic patients were intermediate between schizophrenic patients and controls indicating slight brain dysfunctions. In addition, compensatory strategies were demonstrated. These findings suggest that the genetic risk for schizophrenia is accompanied by neural inefficiency which is associated with cognitive deficits, especially in difficult tasks.