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Yayın Neuropsychiatric outcomes and caregiver distress in primary progressive aphasia(Wiley, 2023-01) Seçkin, Mustafa; Yıldırım, Elif; Demir, İlayda; Orhun, Ömer; Bülbül, Ezgi; Velioğlu, H. Aziz; Öget, Öktem; Yeşilot, Nilüfer; Çoban, Oğuzhan; Gürvit, HakanBackground: In this study, we aimed to outline the neuropsychiatric consequences of primary progressive aphasia (PPA) and to understand how neuropsychiatric symptomatology affects distress in caregivers. Methods: The Neuropsychiatric Inventory (NPI) including the distress index (NPI-Distress) was used. Additional information about the caregiver burden was obtained using Zarit Burden Interview (ZBI). NPI, NPI-Distress, and ZBI data from 17 patients with a clinical diagnosis of PPA were compared with 10 stroke aphasia patients. Neuropsychiatric symptomatology was investigated based on three clusters; Mood, Frontal/Comportmental, and Psychotic/Disruptive. Additionally, the Activities of Daily Living Questionnaire (ADLQ) was used to outline the functional impairment. Twelve healthy controls were included to compare the neurocognitive test scores with PPA and stroke aphasia groups. Results: A greater number of neuropsychiatric symptoms were observed in the PPA group compared to the stroke aphasia group. The number of symptoms in Mood, and Frontal/Comportmental clusters were greater than the number of symptoms in Psychotic/Disruptive clusters in the PPA group, whereas no significant relationship between the number of symptoms and symptom clusters was found in the stroke aphasia group. In the PPA group, a strong correlation was found between the NPI-Frequency × Severity scores and the NPI-Distress scores. Moreover, the NPI-Distress scores in the PPA group strongly correlated with the ZBI scores. Scores for anxiety, irritability/lability, and apathy had a stronger correlation with the NPI-Distress scores compared to the other NPI symptoms. The Communication subscale was the most impaired domain in the PPA group. Travel, and Employment and Recreation subscales showed greater functional impairment in the stroke aphasia group compared to the PPA group. Conclusions: Neuropsychiatric symptoms in PPA in our study were more frequent than previously reported. Furthermore, the distress index of the NPI was not only correlated with the severity of the neuropsychiatric symptoms but also reflected the overall burden on the caregivers in the PPA group.Yayın An investigation of affective theory of mind ability and its relation to neuropsychological functions in Alzheimer's disease(John Wiley and Sons Ltd., 2020-09) Yıldırım, Elif; Soncu Büyükişcan, Ezgi; Demirtaş Tatlıdede, Aslı; Bilgiç, Başar; Gürvit, İbrahim HakanAlthough cognitive theory of mind (ToM) has been largely studied within neurodegenerative disorders including Alzheimer's disease (AD), studies focusing on affective ToM are relatively limited, yielding inconsistent findings. The current study aimed at investigating affective ToM abilities within different stages of AD (mild AD dementia [ADD], mild cognitive impairment [MCI], and subjective cognitive impairment [SCI]), together with its relationship with neuropsychological functioning. Eighty-one participants were tested with two different ToM tasks (Faux Pas Recognition Test [FPR] and Reading Mind in the Eyes Test [RMET]) and tests of attention, executive functions, episodic memory, and facial recognition. Our results showed two different affective ToM profiles in AD continuum: while ADD group performed poorly on both tasks of ToM, MCI group displayed deteriorated performance on RMET but not on FPR. In addition, ToM performance was significantly related to episodic memory and verbal fluency within the overall sample. These findings suggest that impairment in the decoding process of emotional cues could begin even in the prodromal stage of AD. In contrast, the reasoning process of emotional information, as measured with FPR, could be preserved until the dementia stage. Moreover, the relation of affective ToM with amnestic functions and verbal abilities could provide evidence of a domain-general ToM impairment in AD.Yayın An investigation of affective personality traits in Alzheimer’s disease: seeking as a possible predictor for early-stage Alzheimer’s dementia(Routledge, 2023-09) Soncu Büyükişcan, Ezgi; Yıldırım, Elif; Demirtaş Tatlıdede, Aslı; Bilgiç, Başar; Gürvit, HakanObjective: The aim of the current study was to investigate affective personality traits in Alzheimer’s disease, a neurodegenerative condition mainly characterized by episodic memory impairment. Method: The sample included 69 participants from 3 diagnostic categories. Twenty-five participants were diagnosed with subjective cognitive impairment (SCI), 26 participants were diagnosed with mild cognitive impairment of the amnestic type (aMCI), and the remaining 18 participants were diagnosed with early-stage Alzheimer’s dementia (ADD). Diagnostic labels were given as a result of detailed neurological, neuropsychological, and neuroradiological assessment. Affective personality traits were assessed via Affective Neuroscience Personality Scales (ANPS). Results: The only significant intergroup difference was obtained for the SEEKING subscale of ANPS. Here, ADD group scored significantly lower compared to the SCI group. The results of logistic regression analysis also indicated that SEEKING score successfully predicted early-stage ADD diagnosis. Conclusion: The results suggest that a specific personality constellation characterized by reduced investment in the outside world might be associated with Alzheimer’s disease, either as a risk factor or a byproduct of the neurodegenerative process initiated by AD pathology.Yayın White-matter changes in early and late stages of mild cognitive impairment(Churchill Livingstone, 2020-08) Femir Gürtuna, Banu; Kurt, Elif; Ulaşoğlu Yıldız, Çiğdem; Bayram, Ali; Yıldırım, Elif; Soncu Büyükişcan, Ezgi; Bilgiç, BaşarMild Cognitive Impairment (MCI) is characterized by cognitive deficits that exceed age-related decline, but not interfering with daily living activities. Amnestic type of the disorder (aMCI) is known to have a high risk to progress to Alzheimer's Disease (AD), the most common type of dementia. Identification of very early structural changes in the brain related to the cognitive decline in MCI patients would further contribute to the understanding of the dementias. In the current study, we target to investigate whether the white-matter changes are related to structural changes, as well as the cognitive performance of MCI patients. Forty-nine MCI patients were classified as Early MCI (E-MCI, n = 24) and Late MCI (L-MCI, n = 25) due to their performance on The Free and Cued Selective Reminding Test (FCSRT). Age-Related White-Matter Changes (ARWMC) scale was used to evaluate the white-matter changes in the brain. Volumes of specific brain regions were calculated with the FreeSurfer program. Both group and correlation analyses were conducted to show if there was any association between white-matter hyperintensities (WMHs) and structural changes and cognitive performance. Our results indicate that, L-MCI patients had significantly more WMHs not in all but only in the frontal regions compared to E-MCI patients. Besides, ARWMC scores were not correlated with total hippocampal and white-matter volumes. It can be concluded that WMHs play an important role in MCI and cognitive functions are affected by white-matter changes of MCI patients, especially in the frontal regions.Yayın Decision-making and impulse-control disorders in parkinson’s disease: Influence of dopaminergic treatment(AVES, 2020-05-08) Yıldırım, Elif; Altınayar, Sibel; Çakmur, RaifObjective: Dopaminergic treatment is proved to ameliorate motor deficits in Parkinson’s disease (PD); however, it could have negative effects on behavior and cognition, including impulse controlling and decision-making. We aimed (1) to investigate the decision-making and impulse-control disorders (ICDs) of PD patients and their correlations with sociodemographical and clinical variables, dopaminergic treatment in particular, and (2) to determine the relation of decision-making with ICDs. Methods: The sample of 39 patients with PD and 37 healthy controls underwent cognitive tests and the task which analyzed decision-making (Iowa Gambling Task [IGT]). Besides assessing motor and nonmotor symptoms of patients with PD, ICDs were also scanned using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease. Results: Although patients with PD performed similarly to healthy controls on IGT, decision-making profile in PD related to clinical variables: dopaminergic treatment and duration of illness. In addition to this younger age of onset, higher dose of dopamine agonists, longer duration of illness, and impaired decision-making were together accounted for a substantial amount of variance in impulsive behaviors. Conclusions: Dopaminergic medication likely contributes to the impairment in decision-making, which may be the underlying mechanism of ICDs. Further studies will be necessary to understand the potential implications of this finding.Yayın Cognitive functions among healthy older adults using online social networking(Routledge, 2023-07-04) Yıldırım, Elif; Ögel Balaban, HaleOnline social network sites provide possibilities to enhance social relationships and engage in cognitive activities for older adults. The present study aimed to investigate the relationship between the use of one social network site, Facebook, and cognitive functions in older adults considering different dimensions of Facebook use together with different cognitive functions. Seventy healthy older adults completed the use of Facebook form, Multidimensional Scale of Perceived Social Support, and Social Network Index. Their cognitive functions were measured with Digit Span Tasks, Free and Cued Selective Reminding Test, Letter and Category Fluency Tests, Stroop Test, Digit Symbol Substitution Test, and Trail Making Test (TMT-A and TMT-B). After controlling for age, gender, education level, we found that Facebook users performed better on TMT-A compared to non-users. Among Facebook users, the length of having an account, the network size, the daily duration of use, and the frequency of active and passive use correlated with cognitive performance after controlling offline sociality. These findings, which need confirmation by experimental and longitudinal studies, suggested that being connected to a larger network via more prolonged and active use of social media might be associated with higher cognitive functioning.Yayın Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy(Taylor & Francis, 2023-03-04) Orhun, Günseli; Esen, Figen; Yılmaz, Vuslat; Ulusoy, Canan; Şanlı, Elif; Yıldırım, Elif; Gürvit, İbrahim Hakan; Ergin Özcan, Perihan; Sencer, Serra; Bebek, Nerses; Tüzün, ErdemPurpose: Sepsis-associated encephalopathy (SAE) is a common manifestation of sepsis that may lead to cognitive decline. Our aim was to investigate whether the neurofilament light chain (NFL) and soluble triggering receptor expressed on myeloid cells 2 (sTREM2) could be utilized as prognostic biomarkers in SAE. Materials and methods: In this prospective observational study, baseline serum levels of sTREM2 and cerebrospinal fluid (CSF) levels of sTREM2 and NFL were measured by ELISA in 11 SAE patients and controls. Patients underwent daily neurological examination. Brain magnetic resonance imaging (MRI) and standard electroencephalography (EEG) were performed. Cognitive dysfunction was longitudinally assessed after discharge in 4 SAE patients using the Mini-Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) tests. Results: SAE patients showed higher CSF sTREM2 and NFL levels than controls. sTREM2 and NFL levels were not correlated with the severity measures of sepsis. Three months after discharge, 2 SAE patients displayed ACE-R scores congruent with mild cognitive impairment (MCI), persisting in one patient 12 months after discharge. SAE patients with MCI showed higher CSF NFL levels, bacteremia, and abnormal brain MRI. Patients with increased serum/CSF sTREM2 levels showed trends towards displaying poorer attention/orientation and visuo-spatial skills. Conclusions: sTREM2 and NFL levels may serve as a prognostic biomarker for cognitive decline in SAE. These results lend further support for the involvement of glial activation and neuroaxonal degeneration in the physiopathology of SAE.Yayın Uzaktan nöropsikolojik değerlendirme: telenöropsikoloji(BAYT Yayıncılık, 2024-05-25) Yıldırım, Elif; Soncu Büyükişcan, Ezgi; Akça Kalem, Şükriye; Gürvit, İ. HakanAmaç: Nöropsikolojik testlerin hastalara uzaktan, telefon ve videokonferans aracılığı ile yapılan uygulamalarını içeren telenöropsikoloji, uzakta yaşayan ya da hareket kısıtlılığı bulunan hastaların sağlık hizmetlerine ulaşım imkânını genişletebilmektedir. Covid-19 pandemisinin ortaya çıkması ile kognitif değerlendirmelerde telenöropsikoloji kullanımı önemli bir artış göstermiştir. Bu derlemede telenöropsikoloji ile ilgili yapılan çalışmaların sonuçlarının ve telenöropsikolojik değerlendirme ile ilgili temel esasların eleştirel bir şekilde gözden geçirilmesi amaçlanmıştır. Buna ek olarak, bu derlemede Türkiye uygulamaları için geliştirilmiş “ev temelli telenöropsikoloji uygulama rehberi” genel hatları ile paylaşılmıştır. Yöntem: Web of Science ve Pubmed veri tabanları kullanılarak konu ile ilgili erişilebilen tüm makale türlerini kapsayan bir şekilde literatür taraması yapılmıştır. Bulgular: Klinik temelli ve ev temelli telenöropsikolojik değerlendirme ile ilgili çalışmaların sonuçları dikkat, bellek, yürütücü işlevler ve dil gibi kognitif işlevleri değerlendiren ve özellikle sözel uygulamaya dayanan nöropsikolojik testlerin telenöropsikolojik değerlendirmede güvenilir bir şekilde uygulanabileceğini göstermektedir. Fakat telenöropsikolojik değerlendirmeye alınacak hastaların yönlendirilmesinde, değerlendirmede kullanılacak testlerin seçiminde ve etik konularda dikkat edilmesi gereken unsurlar bulunmaktadır. Buna ek olarak, telenöropsikolojik değerlendirmenin etkili bir şekilde yürütülmesi için görüşme öncesinde ve sırasında hem klinisyenin hem de hasta ve/veya hasta yakınının uygulanması önerilen adımların takip edilmesi önemlidir. Sonuç: Her ne kadar klinik nöropsikoloji pratiğinde hasta ile doğrudan temas kurmak önemli bir unsur olsa da gerekli durumlarda ve yetkin uzmanlar tarafından uygun uygulama prosedürleri takip edilerek yapılan telenöropsikolojik değerlendirmeler yüz yüze değerlendirmeler için iyi bir alternatif olabilir.Yayın Cognitive reserve and aging: impacts on theory of mind and executive functions(Routledge, 2025-03) Şandor, Serra; Hıdıroğlu Ongun, Ceren; Yıldırım, ElifAim: This study examines the effects of cognitive reserve (CR) on Executive Functions (EF) and Theory of Mind (ToM). While CR is suggested to mitigate age-related cognitive decline, its relationship with social cognition remains limited and inconsistent in the literature. It was hypothesized that the effect of CR on ToM might be indirect, mediated by EF and working memory. Methods: 225 cognitively healthy participants were included. CR was measured with the Cognitive Reserve Index Questionnaire, EF with verbal fluency and the Stroop Test, and WM using digit span tasks. Structural Equation Modeling was used to analyze the relationships among CR, EF, WM, and SC, controlling for age and gender. Results: CR was significantly associated with both RMET and FPRT performances. Mediation analysis revealed the direct effects of CR on RMET performance, while the effects on FPRT performance were mediated by executive functions. WM had a partial mediating effect on EF and ToM, but did not directly influence FPRT. Education was most strongly associated with RMET performance, while leisure activities were linked to FPRT performance. Conclusion: These findings suggest that CR indirectly supports ToM by enhancing EF and highlight the importance of interventions aimed at strengthening executive control to support social cognition in aging.Yayın Decision making, emotion recognition and childhood traumatic experiences in murder convicts ımprisoned with aggravated life sentence: a prison study(Turkish Neuropsychiatric Society, 2025-03) Çıkrıkçılı, Uğur; Yıldırım, Elif; Buker, Seda; Ger, Can; Erözden, Ozan; Gürvit, Hakan; Saydam, BilginIntroduction: Decision-making and emotion recognition are two fundamental themes in social cognition. Disorders in these areas can lead to interpersonal, psychosocial, and legal problems for the individual and society. The likelihood of consequent aggression and crime makes them foci of forensic psychiatry over time. In this study, two developmental disorders that have a clear relationship with crime, that are antisocial personality disorder (ASPD), and psychopathy are investigated for their relationship with these social cognitive deficits.Methods: The present study involved 23 male prison inmates who were diagnosed with both antisocial personality disorder and psychopathy, as well as 23 control participants who were matched for age, gender, and level of education. Following the psychiatric interview, Reading the Mind in the Eyes Test (RMET), the Iowa Gambling Test (IGT), Toronto Alexithymia Scale (TAS), Defense Styles Questionnaire (DSQ), Childhood Psychic Trauma Scale (CTQ), Hare Psychopathy Checklist (PCL-R) were administered to all participants. Results: The results of the study showed that ASPD group performed statistically worse than healthy controls in TAS, CTQ, all items of DSQ, PCL-R Factor 1 and 2, and all the IGT scores (p<0.05). There were no statistically significant difference between in the RMET test performancesConclusion: These results suggest that ASPD and psychopathy lead to impaired decision-making behaviors due to the inability to recognize one’s own emotions and impulsivity, and that these characteristics play a critical role in the criminal behavior of individuals. In addition, contrary to expectations, the results of affective theory of mind assessed with the RMET showed similar characteristics in homicide convicts and healthy controls. These data indicate the need for further research in the field of forensic psychiatry.
