Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study

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Abstract

Background

The occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated. The aim of the study was to characterize the cognitive profile and psychological symptoms (i.e. depression, anxiety and apathy) in drug-naïve migraine without aura (MwoA) patients.

Methods

Seventy-two consecutive MwoA patients, referred to the Italian University Headache Clinic and 72 healthy subjects (HCs) were enrolled. Patients, during an attack-free period, and HCs completed Montreal Cognitive Assessment (MoCA), Beck Depression Inventory-II (BDI-II), Self-version of Apathy Evaluation Scale (AES-S) and State and Trait Anxiety Inventory (STAI-Y-1 and 2). Clinical parameters of disease severity (i.e. disease duration, migraine attacks per month, mean pain intensity during migraine attacks, migraine disability and impact on daily life) were recorded.

Results

Although performance of MwoA patients on MoCA was above Italian cut-off threshold (<15.5) suggesting presence of cognitive impairment, MwoA patients achieved significantly lower scores than HCs on total MoCA scale (22.3 ± 2.7 versus 25.4 ± 2.3) and on its attention (4.9 ± 1.1 versus 5.6 ± 0.7), memory (1.8 ± 1.4 versus 3.1 ± 1.3), visuospatial (3.2 ± 0.9 versus 3.6 ± 0.6) and executive subscales (2.6 ± 1.1 versus 3.1 ± 0.8). In addition, we observed significant correlations between MoCA executive domain subscore and the attack-related disability score (MIDAS).

As for behavioral profile, the percentage of depressive symptoms (4.2 %), high state and trait anxiety (13.9 and 9.7 %, respectively), and apathy (11.1 %) in MwoA patients were similar to that of HCs. No significant associations of behavioural symptoms with cognitive performance and clinical parameters were found.

Conclusions

Drug-naïve MwoA patients are characterized by subtle cognitive dysfunctions and low percentage of behavioural symptoms. The results support the importance of searching for subclinical cognitive disturbances in patients with MwoA, who deserve to be followed-up to verify whether they develop clinically relevant disorders over time.

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Most cited references 33

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A six-item short-form survey for measuring headache impact: the HIT-6.

M Kosinski, M S Bayliss, J. Bjorner … (2003)

Migraine and other severe headaches can cause suffering and reduce functioning and productivity. Patients are the best source of information about such impact. To develop a new short form (HIT-6) for assessing the impact of headaches that has broad content coverage but is brief as well as reliable and valid enough to use in screening and monitoring patients in clinical research and practice. HIT-6 items were selected from an existing item pool of 54 items and from 35 items suggested by clinicians. Items were selected and modified based on content validity, item response theory (IRT) information functions, item internal consistency, distributions of scores, clinical validity, and linguistic analyses. The HIT-6 was evaluated in an Internet-based survey of headache sufferers (n = 1103) who were members of America Online (AOL). After 14 days, 540 participated in a follow-up survey. HIT-6 covers six content categories represented in widely used surveys of headache impact. Internal consistency, alternate forms, and test-retest reliability estimates of HIT-6 were 0.89, 0.90, and 0.80, respectively. Individual patient score confidence intervals (95%) of app. +/-5 were observed for 88% of all respondents. In tests of validity in discriminating across diagnostic and headache severity groups, relative validity (RV) coefficients of 0.82 and 1.00 were observed for HIT-6, in comparison with the Total Score. Patient-level classifications based in HIT-6 were accurate 88.7% of the time at the recommended cut-off score for a probability of migraine diagnosis. HIT-6 was responsive to self-reported changes in headache impact. The IRT model estimated for a 'pool' of items from widely used measures of headache impact was useful in constructing an efficient, reliable, and valid 'static' short form (HIT-6) for use in screening and monitoring patient outcomes.

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Normative data for the Montreal Cognitive Assessment in an Italian population sample.

Fabrizia Falco, Rossella Bisogno, Pietro Siano … (2015)

The Montreal Cognitive Assessment (MoCA) is a rapid screening battery, also including subtests to assess frontal functions such as set-shifting, abstraction and cognitive flexibility. MoCA seems to be useful to identify non-amnestic mild cognitive impairment (MCI) and subcortical dementia; it has high sensitivity and specificity in distinguishing MCI from mild Alzheimer's Disease. Previous studies revealed that certain items of MoCA may be culturally biased and highlighted the need for population-based norms for the MoCA. The aim of present study was to collect normative values in a sample of Italian healthy subjects. Four hundred and fifteen Italian healthy subjects (252 women and 163 men) of different ages (age range 21-95 years) and educational level (from primary to university) underwent MoCA and Mini Mental State Examination (MMSE). Multiple linear regression analysis revealed that age and education significantly influenced performance on MoCA. No significant effect of gender was found. From the derived linear equation, a correction grid for MoCA raw scores was built. Inferential cut-off score, estimated using a non-parametric technique, is 15.5 and equivalent scores were computed. Correlation analysis showed a significant but weak correlation between MoCA adjusted scores with MMSE adjusted scores (r = 0.43, p < 0.001). The present study provided normative data for the MoCA in an Italian population useful for both clinical and research purposes.

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Montreal Cognitive Assessment (MoCA): normative study for the Portuguese population.

Sandra Freitas, Mário R Simões, Lara Alves … (2011)

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument with good psychometric features and an excellent sensitivity in the early detection of mild cognitive decline. The MoCA was applied to a community-based sample of cognitively healthy adults (n = 650), stratified according to sociodemographic variables (age, gender, educational level, geographic region, geographic localization, and residence area), with a distribution similar to that observed in the Portuguese population. The normative data were determined according to age and education as these were the sociodemographic variables that most significantly contributed to the prediction of the MoCA scores, explaining 49% of their variance.

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Author and article information

Contributors

Luigi Trojano: luigi.trojano@unina2.it

Gioacchino Tedeschi: gioacchino.tedeschi@unina2.it

Journal

Journal ID (nlm-ta): J Headache Pain

Journal ID (iso-abbrev): J Headache Pain

Title: The Journal of Headache and Pain

Publisher: Springer Milan (Milan )

ISSN (Print): 1129-2369

ISSN (Electronic): 1129-2377

Publication date (Electronic): 27 August 2016

Publication date PMC-release: 27 August 2016

Publication date Collection: 2016

Volume: 17

Issue: 1

Electronic Location Identifier: 76

Affiliations

[1 ]Department of Psychology, Second University of Naples, Caserta, 81100 Italy

[2 ]Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138 Italy

[3 ]Institute for Diagnosis and Care “Hermitage Capodimonte”, Naples, 80100 Italy

[4 ]Salvatore Maugeri Foundation, Scientific Institute of Telese, Telese Terme, BN 82037 Italy

Article

Publisher ID: 667

DOI: 10.1186/s10194-016-0667-0

PMC ID: 5002274

PubMed ID: 27568039

SO-VID: daaca952-8537-4732-b6ec-753c1678c6cd

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 5 July 2016

Date accepted : 17 August 2016

Custom metadata

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: migraine,cognitive deficits,depression,apathy,moca,montreal cognitive assessment

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: migraine, cognitive deficits, depression, apathy, moca, montreal cognitive assessment

Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study

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Irish Journal of Paramedicine

Most cited references 33

A six-item short-form survey for measuring headache impact: the HIT-6.

Normative data for the Montreal Cognitive Assessment in an Italian population sample.

Montreal Cognitive Assessment (MoCA): normative study for the Portuguese population.

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