1.老年猴视皮层神经元对图形对比度的反应及其潜伏期特征; 2. 极低频磁场对脑功能的影响及眶额叶认知功能的研究

1.老年猴视皮层神经元对图形对比度的反应及潜伏期特征: 在正常衰老过程中人类的视觉功能受到严重影响，例如空间和时间对比度敏感性下降以及信息处理时间的延长。虽然部分视觉功能的退化与眼睛的光学系统老化有关，但是它并不能解释所有视觉功能的下降。此外，我们以前的研究和别人的研究结果都表明衰老过程中视觉中枢系统功能的改变可能是视觉功能下降的主要原因。因此，利用单位放电记录技术（single-unit recording technique），我们比较了年轻猕猴和老年猕猴的初级视觉皮层（primary visual cortex，又称V1）神经元对比度反应之间的差异，以及V1和内侧颞叶（medial temporal cortex，MT）视觉区神经元反应潜伏期及其变异性之间的差异。结果显示，与年轻猴相比，老年猴V1区神经元对比度敏感性降低，同时伴随着神经元活动信噪比下降；老年猴V1区和MT区神经元反应潜伏期及其变异性显著增加。然而，两个年龄组MT区神经元平均潜伏期之间差异小于V1区神经元平均潜伏期之间的差异，说明MT区神经元能够自我调整老化带来的影响。另外，两个年龄组V1区神经元潜伏期和变异性都具有正相关关系，但是MT区神经元则没有这种相关性。这些结果表明，在老化过程中皮层神经元的对比度和潜伏期反应特性发生了改变。我们推测这种改变可能与视觉皮层内抑制系统功能的降低有关，但是具体的分子机制和神经环路还不清楚。总之，本实验的研究结果为更好的理解老年人在视觉信息处理中时间和空间对比度敏感性及处理速度下降提供了新线索。2.极低频磁场对脑功能的影响及眶额叶认知功能的研究: 实验目的：（1）研究极低频磁场(20 Hz, 14 mT)照射对长期吗啡处理引起的大鼠背侧海马神经元多巴胺D2密度降低的影响；（2）小鼠青春期长期极低频磁场(50 Hz, 2 mT)照射对空间学习记忆的影响；（3）初步探讨了眶额叶在大鼠新异性探索行为中的作用。实验1，我们用免疫组化的方法检测了大鼠背侧海马神经元多巴胺D2受体密度的变化。结果显示，在长期吗啡处理后戒断早期背侧海马神经元多巴胺D2受体密度相对于对照组减少，磁场和吗啡共同作用会强化这种适应，但是这种变化很快恢复正常。这些结果表明长期吗啡处理会引起海马多巴胺系统产生适应；磁场强化了长期吗啡处理对背侧海马多巴胺系统的影响,这为我们先前发现磁场照射延缓了大鼠条件位置偏好消退的研究结果提供了一个内在神经基础。实验2，我们分别用Y-迷宫（two-trial Y-maze）和Morris水迷宫两种行为装置研究了青春期早期磁场暴露对小鼠短时空间识别记忆和长时空间参考记忆的影响。结果显示，磁场暴露并没有影响小鼠Y-迷宫作业，但是提高了水迷宫任务的学习以及记忆保持。这些结果表明磁场对空间记忆的影响是任务依赖性的。实验3，我们用旷场和Y-迷宫两种行为装置研究了眶额叶电损伤对大鼠新异性探索行为的影响。结果显示，眶额叶受损并没有影响大鼠的神经运动能力，但是降低了大鼠在旷场中的行走距离和直立次数以及降低了在Y-迷宫新异臂中的探索时间和穿梭次数。这些结果表明，眶额叶的完整性对大鼠探索新异环境行为是必要的，这可能与眶额叶参与记忆或行为决策功能有关。

中老年人工作记忆与血管性疾病及危险因素的相关分析

Background With the increasing of an elderly population, the number of both vascular disease and cognitive function is increasing. Recent study shown that there is close relationship between vascular disease or vascular risk factors and cognitive function, but many questions are unclear. Objective The aim of this study was to explore the status of cognitive function of midlife and elderly subjects and to evaluate association between vascular risk factors and cognitive function. Methods We selected 330(female,128,male,202) retire navy veterans aged between 55 and 87 years old in Beijing. The average age was 67 years old. Data about vascular risk factors, including: history of cerebral infarction, cardiovascular disease, hypertension, diabetes mellitus, carotid lesions, cigarette smoking, drinking, obesity, and so on. Cognitive functions were assessed by neuropsychological tests: the four tasks of working memory. Results The univariate analysis indicated that there were significant differences of working memory scores in aging, gender, education level, the history of stroke, hypertension with midlife and elderly subjects. Moderate levels of alcohol intake maybe better for cognition. Conclusion vascular disease and some vascular risk factors may lead to cognitive function decline, thus, intervention methods should be carried out in middle and elderly people with vascular risk fact should be under special supervision, with at least annual neuropsychological evaluation. Key words: cognitive function; vascular risk factor， working memory.

维持性血液透析患者认知功能特点研究

Objective: To study the episodic memory, semantic memory, cognitive planning ability and inhibition ability in MHD patients. Method: Neuropsychological research methods such as Action memory of verb-object phrase, Trail Making Test (A and B), Verbal Fluency Test, Go-No/Go test and Stroop Color Naming Task were used to investigate Episodic Memory 、Semantic Memory、Executive Function of 40 MHD and 40 NC. Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale(SDS), Social Support Scale, Life Satisfaction Scale, and biochemical examination were applied and their relationships with cognitive function were analized. The mean age and education level of MHD group and NC group have no significant difference. Result: 1.Action memory of verb-object phrase differed significantly between MHD group and NC group. 2.Two tests of Verbal Fluency differed significantly between MHD group and NC group. 3.Trail Making Test A, Trail Making Test B, the baseline condition of Go-No/Go Test and Stroop Color Naming Test differed significantly between MHD group and NC group. 4.There is no significant difference between MHD group and NC group on the correct rate of No/Go Test and the baseline condition. Both groups showed Stroop Effect in Go-No/Go test, but MHD group performed significantly worse. 5.In Stroop Color Naming Task Test, NC group showed Stroop Effect, significant Repeated Distraction Promotion Effect and significant Negative Priming Effect,while MHD group showed only Stroop Effect and no Repeated Distraction Promotion Effect and no Negative Priming Effect. There is significant difference in Stroop Effect between MHD group and NC group. Conclusion: 1.Comparing with NC group, episodic memory, semantic memory, cognitive planning ability, and inhibition ability of MHD group were impaired significantly. 2.The pathological aging of Executive Function in MHD group showed: executive Function should be a unitary system. 3.Cognitive impairment is negatively correlated with serum creatinine, blood pressure and anxiety score in MHD patients; and is related with hemoglobin, hematocrit, social support and life satisfaction. Keyword: maintenance hemodialysis, episodic memory, semantic memory, cognitive planning, inhibition ability.

2型糖尿病患者认知功能特点及相关影响因素研究

Objective: Type 2 diabetes patients’ performances of action memory , semantic memory and working memory and the related factors were explored. Methods: 60 Type 2 diabetes patients were compared with 60 age and gender and level of education matched non-diabetes controls. Mood were tested by SAS and SDS, MMSE was used to test the basic cognitive function, Trail Making Test A and B, Verbal fluency test, Go-No/Go test, and Stroop color-word test were used to investigate the executive function of Type 2 diabetes patients and normal controls (NC). Patients’ GLU, TG, TCH, HbA1c, insulin and Cp were tested and correlated with their action memory and working memory. Results: There was no difference between NC group and Type 2 diabetes patients in MMSE scores. There is depression and anxiety mood in Type 2 diabetes patients. Type 2 diabetes patients get lower score in action memory test. Comparing to NC group, Type 2 diabetes patients performed significantly worse in Trail Making Test A and B and verbal fluency test. In Stroop Test, NC group showed significant Stroop Effect and Repeated Distraction Promotion Effect and Negative Priming Effect. However, In Type 2 diabetes group, only the Stroop Effect appeared, but no Repeated Distraction Promotion Effect and Negative Priming Effect. There is no difference between Type 2 diabetes and NC in Stroop Effect. In Go-No/Go test, both of two groups showed significant Stroop Effect, however, there was no difference between them. And also there is no difference on error rate of all levels between them. The course of disease, GL, HbA1c, TG, TCH, INS and Cp affected action memory and working memory. Conclusion: Type 2 diabetes patients’ action memory, semantic memory and working memory were partially impaired. Controlling the levels of GLU, TG and TCH can delay these kinds of impairment.

中老年男性性激素水平与认知功能的关系

Abstract Objective: Study the relationship between sex hormones and cognitive function in aged male. Methods: The serum sex hormones including Free Testosterone(FT), Total Testosterone(TT), Estradiol(E2), Prolactin(PRL) and Luteotropic Hormone(LH) of 74 elderly men(47-75 years old, mean 58.73) were measured by radioimmunoassay. They were all applied the cognitive tests of episodic memory and verbal fluency. For the episodic memory, four experiments examined picture, digit and words memory separately. Four verbal fluency tests were performed in the middle of each episodic memory. The 74 men were divided into two groups according to the levels of their sex hormones respectively, with each group had 37 subjects. Data was analyzed by the software of SPSS 11.0. Results: Mean age and the mean years of formal education had no significant difference between the groups; Men in the group with higher levels of FT had significantly higher scores in the tests of picture memory and words memory；Men in the group with higher levels of TT had significantly higher scores in the tests of verbal fluency4, picture memory and words memory；Men in the group with higher levels of E2 had significantly higher scores in the tests of picture memory and verbal fluency3,4；There were no correlations between PRL or LH and the cognitive tests. Conclusions: 1 Sex hormones (especially FT, TT, E2) did have effect on the cognitive function in aged male, higher levels of hormones related with higher scores of some cognitive tests. 2 Among the cognitive functions, picture memory and words memory performance seemed being effected by the sex hormones most.

Aphasia rehabilitation and the strange neglect of speed.

Timing data is infrequently reported in aphasiological literature and time taken is only a minor factor, where it is considered at all, in existing aphasia assessments. This is not surprising because reaction times are difficult to obtain manually, but it is a pity, because speed data should be indispensable in assessing the severity of language processing disorders and in evaluating the effects of treatment. This paper argues that reporting accuracy data without discussing speed of performance gives an incomplete and potentially misleading picture of any cognitive function. Moreover, in deciding how to treat, when to continue treatment and when to cease therapy, clinicians should have regard to both parameters: Speed and accuracy of performance. Crerar, Ellis and Dean (1996) reported a study in which the written sentence comprehension of 14 long-term agrammatic subjects was assessed and treated using a computer-based microworld. Some statistically significant and durable treatment effects were obtained after a short amount of focused therapy. Only accuracy data were reported in that (already long) paper, and interestingly, although it has been a widely read study, neither referees nor subsequent readers seemed to miss "the other side of the coin": How these participants compared with controls for their speed of processing and what effect treatment had on speed. This paper considers both aspects of the data and presents a tentative way of combining treatment effects on both accuracy and speed of performance in a single indicator. Looking at rehabilitation this way gives us a rather different perspective on which individuals benefited most from the intervention. It also demonstrates that while some subjects are capable of utilising metalinguistic skills to achieve normal accuracy scores even many years post-stroke, there is little prospect of reducing the time taken to within the normal range. Without considering speed of processing, the extent of this residual functional impairment can be overlooked.

Biologically inspired automatic construction of cross-modal mapping in robotic eye/hand systems

Q. Meng and M.H. Lee, 'Biologically inspired automatic construction of cross-modal mapping in robotic eye/hand systems', IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2006,) ,4742-49, Beijing, 2006.

A study of diet and health in the elderly; the gut microbiota as a source of bioactive agents

The global proportion of older persons is increasing rapidly. Diet and the intestinal microbiota independently and jointly contribute to health in the elderly. The habitual dietary patterns and functional microbiota components of elderly subjects were investigated in order to identify specific effector mechanisms. A study of the dietary intake of Irish community-dwelling elderly subjects showed that the consumption of foods high in fat and/or sugar was excessive, while consumption of dairy foods was inadequate. Elderly females typically had a more nutrient- dense diet than males and a considerable proportion of subjects, particularly males, had inadequate intakes of calcium, magnesium, vitamin D, folate, zinc and vitamin C. The association between dietary patterns, glycaemic index and cognitive function was also investigated. Elderly subjects consuming ‘prudent’ dietary patterns had better cognitive function compared to those consuming ‘Western’ dietary patterns. Furthermore, fully-adjusted regression models revealed that a high glycaemic diet was associated with poor cognitive function, demonstrating a new link between nutrition and cognition. An extensive screening study of the elderly faecal-derived microbiota was also undertaken to examine the prevalence of antimicrobial production by intestinal bacteria. A number of previously characterised bacteriocins were isolated (gassericin T, ABP-118, mutacin II, enterocin L-50 and enterocin P) in this study. Interestingly, a Lactobacillus crispatus strain was found to produce a potentially novel antimicrobial compound. Full genome sequencing of this strain revealed the presence of three loci which exhibited varying degrees of homology with the genes responsible for helveticin J production in Lb. helveticus. An additional study comparing the immunomodulatory capacity of ‘viable’ and ‘non-viable’ Bifidobacterium strains found that Bifidobacterium-fermented milks (BFMs) containing ‘non-viable’ cells could stimulate levels of IL-10 and TNF-α in a manner similar to those stimulated by BFMs containing ‘viable’ cells in vitro.

Development of a decision aid to inform patients' and families' renal replacement therapy selection decisions.

BACKGROUND: Few educational resources have been developed to inform patients' renal replacement therapy (RRT) selection decisions. Patients progressing toward end stage renal disease (ESRD) must decide among multiple treatment options with varying characteristics. Complex information about treatments must be adequately conveyed to patients with different educational backgrounds and informational needs. Decisions about treatment options also require family input, as families often participate in patients' treatment and support patients' decisions. We describe the development, design, and preliminary evaluation of an informational, evidence-based, and patient-and family-centered decision aid for patients with ESRD and varying levels of health literacy, health numeracy, and cognitive function. METHODS: We designed a decision aid comprising a complementary video and informational handbook. We based our development process on data previously obtained from qualitative focus groups and systematic literature reviews. We simultaneously developed the video and handbook in "stages." For the video, stages included (1) directed interviews with culturally appropriate patients and families and preliminary script development, (2) video production, and (3) screening the video with patients and their families. For the handbook, stages comprised (1) preliminary content design, (2) a mixed-methods pilot study among diverse patients to assess comprehension of handbook material, and (3) screening the handbook with patients and their families. RESULTS: The video and handbook both addressed potential benefits and trade-offs of treatment selections. The 50-minute video consisted of demographically diverse patients and their families describing their positive and negative experiences with selecting a treatment option. The video also incorporated health professionals' testimonials regarding various considerations that might influence patients' and families' treatment selections. The handbook was comprised of written words, pictures of patients and health care providers, and diagrams describing the findings and quality of scientific studies comparing treatments. The handbook text was written at a 4th to 6th grade reading level. Pilot study results demonstrated that a majority of patients could understand information presented in the handbook. Patient and families screening the nearly completed video and handbook reviewed the materials favorably. CONCLUSIONS: This rigorously designed decision aid may help patients and families make informed decisions about their treatment options for RRT that are well aligned with their values.

An orally available compound prevents deficits in memory caused by the Alzheimer amyloid-B oligomers.

Despite progress in defining a pathogenic role for amyloid beta protein (Abeta) in Alzheimer's disease, orally bioavailable compounds that prevent its effects on hippocampal synaptic plasticity and cognitive function have not yet emerged. A particularly attractive therapeutic strategy is to selectively neutralize small, soluble Abeta oligomers that have recently been shown to mediate synaptic dysfunction. METHODS: Using electrophysiological, biochemical, and behavioral assays, we studied how scyllo-inositol (AZD-103; molecular weight, 180) neutralizes the acutely toxic effects of Abeta on synaptic function and memory recall. RESULTS: Scyllo-inositol, but not its stereoisomer, chiro-inositol, dose-dependently rescued long-term potentiation in mouse hippocampus from the inhibitory effects of soluble oligomers of cell-derived human Abeta. Cerebroventricular injection into rats of the soluble Abeta oligomers interfered with learned performance on a complex lever-pressing task, but administration of scyllo-inositol via the drinking water fully prevented oligomer-induced errors. INTERPRETATION: A small, orally available natural product penetrates into the brain in vivo to rescue the memory impairment produced by soluble Abeta oligomers through a mechanism that restores hippocampal synaptic plasticity.

Health status of children with cerebral palsy living in Europe: a multi-centre study

Aim The aim of this report is to describe the health status of 8–12-year-old children with cerebral palsy (CP) of all severities in Europe using the Child Health Questionnaire (CHQ).

Method A total of 818 children with CP from nine centres in defined geographical areas participated. CP type, gross and fine motor function, additional impairments were classified and family data were obtained. The CHQ was used to measure the parent's perception of their child's physical (PHY) and psychosocial (PSY) health.

Results PHY scores were lower than the reference samples with a median of 46. The severity of gross motor function influenced the CHQ scores significantly in the PHY scale with the lowest scores for children with least gross motor function. There were significant differences between the CP types in PHY with the higher scores for children with unilateral spastic and the lowest scores for children with bilateral spastic and dyskinetic CP type. Fine motor function severity significantly affected both the PHY and PSY scales. The severity of intellectual impairment was significantly associated with CHQ scores in most dimensions with higher scores for higher IQ level in PHY and PSY. Children with seizures during the last year had a significantly lower health compared with children without seizures. The results of the multivariate regression analyses (forward stepwise regression) of CHQ scores on CP subtype, gross and fine motor function, cognitive function, additional impairments, seizures, parental education and employment revealed gross motor function, cognitive level and type of school attended were significant prognostic factors.

Conclusion This report is based on the largest sample to date of children with CP. Health status as measured using the CHQ was affected in all children and was highly variable. Gross motor function level correlates with health from the PHY well-being perspective but the PSY and emotional aspects do not appear to follow the same pattern.

Interpersonal Aspects of Thinking Skills in an Intercultural Language Learning Context

Asking and answering certain types of questions are thought to develop thinking skills in all types of classrooms. Previous research has demonstrated that asking higher order questions and answering with elaborated responses are associated with high achievement in first, second, and foreign language contexts. Typically more attention is paid to question frequency or achievements inferred from individual performances than to the dialogues in which asking and answering occurs. This paper argues for a focus on the construction of responses in interaction as an alternative to the investigation of questions, effects of training or individual measurements of performance. Drawing on interactional data from an adult English as a Second Language classroom, it is argued that constructing an answer to a critical question appears to be a highly collaborative and evaluative affair. The thinking skills literature suggests that responding to higher order questions is an individual higher cognitive function, however it is argued in this paper that in attempting to construct evaluative answers language learners are involved not only in a cognitive task, which may or may not be helpful to language learning, but also in a complex social task in which perspectives need to be negotiated, stances taken and identities navigated. It is suggested that higher order thinking cannot be separated from the social and cultural knowledge through which it is brought into being. It is argued that any implementation of thinking skills in an English language teaching context ought to consider interpersonal and social aspects, particularly in intercultural settings.

Statins for the prevention of dementia

Background: This is an update of a Cochrane review first published in 2001. At that stage there was insufficient evidence to recommend statins for the prevention of Alzheimer's disease (AD). The scope of this review has been expanded to include all forms of dementia.
Objectives: To assess the effects of statins in the prevention of dementia.
Search strategy: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 10 October 2007 using the terms statin*, lovastatin*, pravastatin*, simvastatin*, fluvastatin*, atorvastatin* and rosuvastatin*. The CDCIG Register contains records from many healthcare databases, SIGLE, LILACS as well as many trials databases and is updated regularly.
Selection criteria: Double-blind randomized placebo-controlled trials of statins in people at risk of AD and dementia.
Data collection and analysis: Two independent reviewers extracted and assessed data independently and agreement was reached after discussion. Adverse effects were noted.
Main results: Two trials were identified with 26,340 participants; HPS 2002 and PROSPER 2002. Age range was 40-82 years across the two studies, PROSPER 2002 included 5804 patients aged 70-82 years and HPS included 20,536 patients with 5806 at least 70 years old at study entry. Mean total cholesterol 5.9 mmol/l, LDL cholesterol 3.4 mmol/l at study entry with mean reduction in LDL cholesterol of 1.0mmol/l in simvastatin treated patients compared to placebo in HPS 2002. Mean total cholesterol 5.7 mmol/l, LDL cholesterol 3.8 mmol/l at study entry with mean reduction in LDL cholesterol of 1.02 mmol/l in pravastatin treated patients compared to placebo in PROSPER 2002. Mean follow-up 3.2 years in PROSPER, 5 years in HPS 2002. Cognition was measured at different times and with different scales so could not be combined in a meta-analysis. There was no difference in incidence of dementia in HPS 2002 (31 cases in simvastatin group, 31 cases in placebo group) nor in performance on the modified Telephone Interview for Cognitive Status at final follow-up (23.7% simvastatin group cognitively impaired vs 24.2% in placebo group). There was no difference in cognition between groups either in relation to age at study entry or previous history of cerebrovascular disease. Cognitive function declined at the same rate in both treatment groups in PROSPER 2002, there was no significant difference between pravastatin treated and placebo groups in performance on letter digit codes, picture word learning test, Stroop and Mini Mental State Examination. There was no evidence that statins were detrimental to cognition.
Authors' conclusions : There is good evidence from RCTs that statins given in late life to individuals at risk of vascular disease have no effect in preventing AD or dementia. Biologically it seems feasible that statins could prevent dementia due to their role in cholesterol reduction and initial evidence from observational studies was very promising. Indication bias may have been a factor in these studies however and the evidence from subsequent RCTs has been negative.

mGluR5 Positive Allosteric Modulators Facilitate both Hippocampal LTP and LTD and Enhance Spatial Learning

Highly selective positive allosteric modulators (PAMs) of metabotropic glutamate receptor subtype 5 (mGluR5) have emerged as a potential approach to treat positive symptoms associated with schizophrenia. mGluR5 plays an important role in both long-term potentiation (LTP) and long-term depression (LTD), suggesting that mGluR5 PAMs may also have utility in improving impaired cognitive function. However, if mGluR5 PAMs shift the balance of LTP and LTD or induce a state in which afferent activity induces lasting changes in synaptic function that are not appropriate for a given pattern of activity, this could disrupt rather than enhance cognitive function. We determined the effect of selective mGluR5 PAMs on the induction of LTP and LTD at the Schaffer collateral-CA1 synapse in the hippocampus. mGluR5-selective PAMs significantly enhanced threshold theta-burst stimulation (TBS)-induced LTP. In addition, mGluR5 PAMs enhanced both DHPG-induced LTD and LTD induced by the delivery of paired-pulse low-frequency stimulation. Selective potentiation of mGluR5 had no effect on LTP induced by suprathreshold TBS or saturated LTP. The finding that potentiation of mGluR5-mediated responses to stimulation of glutamatergic afferents enhances both LTP and LTD and supports the hypothesis that the activation of mGluR5 by endogenous glutamate contributes to both forms of plasticity. Furthermore, two systemically active mGluR5 PAMs enhanced performance in the Morris water maze, a measure of hippocampus-dependent spatial learning. Discovery of small molecules that enhance both LTP and LTD in an activity-appropriate manner shows a unique action on synaptic plasticity that may provide a novel approach for the treatment of impaired cognitive function. Neuropsychopharmacology (2009) 34, 2057-2071; doi:10.1038/npp.2009.30; published online 18 March 2009

A nonsynonymous LNK polymorphism associated with idiopathic erythrocytosis

Anemia is a symptom associated with cognitive dysfunction and is diagnosed if the hemoglobin level of a blood sample is too low. The clinical impact of chronically low hemoglobin level may be insuf?cient
brain oxygenation, which may result in a decline in cognitive functioning. Previous studies have provided evidence of decrements in cognitive functioning associated with anemia across various disease processes, but few have investigated the association between cognitive dysfunction and hemoglobin level in patients with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS). As this population is inherently anemic, studying these patients allowed for an exploration of cognitive changes at mild, moderate, and severe levels of anemia. This investigation explored cutoff points for hemoglobin at which cognitive decline may occur. Findings showed decrements in cognitive functioning occurring at hemoglobin levels of 10 g/dL or below. Performance on measures of word retrieval, attention, and ?ne motor function was most affected which suggests fronto-temporal lobe dysfunction. Results provided evidence as to a hemoglobin cutoff point below which cognitive function may be affected in patients with AML and MDS. This cutoff value may provide a clinical marker at which cognitive testing and therapeutic interventions could be utilized to improve patients’ cognitive function, level of fatigue and overall quality of life.