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Independence in everyday functioning has been associated with successful aging and declines in functioning may be indicative of pathological cognitive decline. Social determinants of health, like economic status and access to health care, a]lso play a role in everyday functioning. Understanding these factors are of particular importance for older Black adults who have had long-standing disparate access to care, education, and treatments. The current study aimed to evaluate social determinants of health, more specifically social engagement, as moderators of the association between cognition and everyday functioning.
Method:
A sample of 930 older Black adults from Rush University: The Memory and Aging Project, African American Clinical Core, and Minority Adult Research Study were used. Participants completed a battery of neuropsychological testing as well as questionnaires about their everyday functioning and social behaviors. Hierarchical linear regressions were utilized to determine to what extent social factors moderated the relationship between cognition and everyday functioning.
Results:
Late life social activity reduced the effect of global cognition on everyday functioning and was independently associated with everyday functioning. Social network size was associated with increased impairment.
Conclusion:
Results from the current study provide novel information regarding the role of social interaction on cognition in an older Black adult sample. Future interventions may benefit from an emphasis on increasing social engagement.
This study aims to investigate action language processing abilities in Parkinson’s disease (PD) compared to healthy controls (HCs), specifically examining whether the involvement of motor systems is influenced by task context. By focusing on implicit versus explicit task demands, the study evaluates how semantic processing differs in PD and whether these differences align with a flexible embodied cognition framework.
Methods:
The study analyzed the performance of participants on two tasks: an explicit task (semantic judgment task, SJ) and an implicit task (letter detection task, LD). PD outpatients (n = 31, mean age 64.58 years) referred to the Parkinson and Movement Disorders Unit of ICS Maugeri Hermitage were enrolled, along with a group of healthy controls (n = 31, mean age 64.19 years). Performance was measured through reaction times (RTs) and accuracy scores (Acc) during the processing of action verbs and abstract verbs.
Results:
PD patients exhibited slower RTs and lower accuracy when processing action verbs compared to abstract verbs, but only during the SJ task. Slower RTs in the SJ task were predicted by language and executive functioning (semantic fluency) and disease progression (Hoehn and Yahr stages) for both action and abstract verbs. In the LD task, slower RTs were predicted by executive functioning for action verbs and attention (measured by Trail Making Test Part B and Stroop task) for abstract verbs.
Conclusions:
The findings suggest a context-dependent involvement of the motor system in action language processing, supporting a flexible, embodied approach to conceptual semantic processing rather than an automatic one.
To assess for differences in low score frequency on cognitive testing amongst older adults with and without a self-reported history of traumatic brain injury (TBI) in the National Alzheimer’s Coordinating Center (NACC) dataset.
Method:
The sample included adults aged 65 or older who completed the Uniform Data Set 3.0 neuropsychological test battery (N = 7,363) and was divided by individuals with and without a history of TBI, as well as cognitive status as measured by the CDR. We compared TBI- and TBI + groups by the prevalence of low scores obtained across testing. Three scores falling at or below the 2nd percentile or four scores at or below the 5th percentile were criteria for an atypical number of low scores. Nonparametric tests assessed associations among low score prevalence and demographics, symptoms of depression, and TBI history.
Results:
Among cognitively normal participants (CDR = 0), older age, male sex and greater levels of depression were associated with low score frequency; among participants with mild cognitive impairment (CDR = 0.5-1), greater levels of depression, shorter duration of time since most recent TBI, and no prior history of TBI were associated with low score frequency.
Conclusions:
Participants with and without a history of TBI largely produced low scores on cognitive testing at similar frequencies. Cognitive status, sex, education, depression, and TBI recency showed variable associations with the number of low scores within subsamples. Future research that includes more comprehensive TBI history is indicated to characterize factors that may modify the association between low scores and TBI history.
Information on the time spent completing cognitive testing is often collected, but such data are not typically considered when quantifying cognition in large-scale community-based surveys. We sought to evaluate the added value of timing data over and above traditional cognitive scores for the measurement of cognition in older adults.
Method:
We used data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study (N = 4,091), to assess the added value of timing data over and above traditional cognitive scores, using item-specific regression models for 36 cognitive test items. Models were adjusted for age, gender, interviewer, and item score.
Results:
Compared to Quintile 3 (median time), taking longer to complete specific items was associated (p < 0.05) with lower cognitive performance for 67% (Quintile 5) and 28% (Quintile 4) of items. Responding quickly (Quintile 1) was associated with higher cognitive performance for 25% of simpler items (e.g., orientation for year), but with lower cognitive functioning for 63% of items requiring higher-order processing (e.g., digit span test). Results were consistent in a range of different analyses adjusting for factors including education, hearing impairment, and language of administration and in models using splines rather than quintiles.
Conclusions:
Response times from cognitive testing may contain important information on cognition not captured in traditional scoring. Incorporation of this information has the potential to improve existing estimates of cognitive functioning.
Altered reinforcement learning (RL) and decision-making have been implicated in the pathophysiology of anorexia nervosa. To determine whether deficits observed in symptomatic anorexia nervosa are also present in remission, we investigated RL in women remitted from anorexia nervosa (rAN).
Methods:
Participants performed a probabilistic associative learning task that involved learning from rewarding or punishing outcomes across consecutive sets of stimuli to examine generalization of learning to new stimuli over extended task exposure. We fit a hybrid RL and drift diffusion model of associative learning to model learning and decision-making processes in 24 rAN and 20 female community controls (cCN).
Results:
rAN showed better learning from negative outcomes than cCN and this was greater over extended task exposure (p < .001, ηp2 = .30). rAN demonstrated a reduction in accuracy of optimal choices (p = .007, ηp2 = .16) and rate of information extraction on reward trials from set 1 to set 2 (p = .012, ηp2 = .14), and a larger reduction of response threshold separation from set 1 to set 2 than cCN (p = .036, ηp2 = .10).
Conclusions:
rAN extracted less information from rewarding stimuli and their learning became increasingly sensitive to negative outcomes over learning trials. This suggests rAN shifted attention to learning from negative feedback while slowing down extraction of information from rewarding stimuli. Better learning from negative over positive feedback in rAN might reflect a marker of recovery.
This study compared cognitive flexibility (CF) and emotion recognition (ER) in adolescents with eating disorders (ED) to a healthy group.
Methods:
Forty healthy individuals aged 12–18 years with no psychiatric diagnosis and 46 patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) according to DSM-5 criteria participated. CF was assessed using the Cognitive Flexibility Scale (CFS), Stroop Test, and Berg Card Sorting Test (BCST), while ER was evaluated using the test of perception of affect via nonverbal cues.
Results:
CFS scores were lower in the ED group compared to the control group. Neuropsychological test results indicated similar BCST perseverative error percentages among ED patients and controls. However, while the BED group demonstrated greater difficulties with inhibitory control, as shown in the Stroop Test, the BN and AN groups performed similarly to the control group. ER performance was similar across groups, although the AN subgroup exhibited heightened recognition of negative emotions, particularly disgust and fear.
Conclusions:
This study highlights unique and shared neurocognitive patterns related to CF and ER profiles of ED patients. Despite self-reports of greater cognitive rigidity among ED patients, objective tests did not consistently confirm it. Notably, BED patients exhibited inhibitory control challenges, aligning with impulsive tendencies. ER abilities were similar to controls; however, the AN subgroup showed heightened sensitivity to certain negative emotions, such as disgust. These findings underscore the need for further research with larger, more balanced samples to explore how CF and ER vary across developmental stages and subtypes.
Despite advances in antiretroviral treatment (ART), human immunodeficiency virus (HIV) can detrimentally affect everyday functioning. Neurocognitive impairment (NCI) and current depression are common in people with HIV (PWH) and can contribute to poor functional outcomes, but potential synergies between the two conditions are less understood. Thus, the present study aimed to compare the independent and combined effects of NCI and depression on everyday functioning in PWH. We predicted worse functional outcomes with comorbid NCI and depression than either condition alone.
Methods:
PWH enrolled at the UCSD HIV Neurobehavioral Research Program were assessed for neuropsychological performance, depression severity (≤minimal, mild, moderate, or severe; Beck Depression Inventory-II), and self-reported everyday functioning.
Results:
Participants were 1,973 PWH (79% male; 66% racial/ethnic minority; Age: M = 48.6; Education: M = 13.0, 66% AIDS; 82% on ART; 42% with NCI; 35% BDI>13). ANCOVA models found effects of NCI and depression symptom severity on all functional outcomes (ps < .0001). With NCI and depression severity included in the same model, both remained significant (ps < .0001), although the effects of each were attenuated, and yielded better model fit parameters (i.e., lower AIC values) than models with only NCI or only depression.
Conclusions:
Consistent with prior literature, NCI and depression had independent effects on everyday functioning in PWH. There was also evidence for combined effects of NCI and depression, such that their comorbidity had a greater impact on functioning than either alone. Our results have implications for informing future interventions to target common, comorbid NCI and depressed mood in PWH and thus reduce HIV-related health disparities.
Mean levels of cognitive functioning typically do not show an association with self-reported cognitive fatigue in persons with multiple sclerosis (PwMS), but some studies indicate that cognitive variability has an association with cognitive fatigue. Additionally, coping has been shown to be a powerful moderator of some outcomes in multiple sclerosis (MS). To date, however, coping has not been considered as a possible moderator of the relationship between cognitive fatigue and cognitive variability in MS. The current study examined this relationship.
Method:
We examined 52 PwMS. All participants were administered the Fatigue Impact Scale, the Coping Orientation to Problems Experienced Questionnaire, and cognitive tests. Indices of variability for memory and attention/executive functioning tests were used as outcome variables. Avoidant coping, active coping, and composite coping indices were used as moderators.
Results:
The interaction analyses for the avoidant coping and composite coping indices were significant and accounted for 8 and 11% of the attention/executive functioning variability outcome, respectively. The interactions revealed that at low levels of cognitive fatigue, attention/executive functioning variability was comparable between the low and high avoidant and composite coping groups. However, at high levels of cognitive fatigue, PwMS using lower levels of avoidant coping (less maladaptive coping) showed less variable attention/executive functioning scores compared with those using higher levels of avoidant coping. We found a similar pattern for the composite coping groups.
Conclusion:
At high levels of cognitive fatigue, PwMS using adaptive coping showed less attention/executive functioning variability. These findings should be considered in the context of treatment implications.
Cognitive impairment is a common feature of multiple sclerosis (MS), and its severity may be influenced by several factors, such as biological sex and levels of cognitive reserve (CR). The relationship between sex, CR, and cognition has not yet been fully investigated. Therefore, the present study aimed to explore sex differences in CR building and the effect of sex and CR on cognitive performance in MS.
Method:
233 participants underwent the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), the Stroop test, and the Cognitive Reserve Scale. The t-test was performed to compare sociodemographic variables, Italian adaptation of the Cognitive Reserve Scale, and cognitive test scores between sexes. To evaluate the effect of CR and sex and their interaction on cognitive performance several models of multivariate analyses of covariance were performed (dependent variables: all subtests of Brief Repeatable Battery of Neuropsychological Tests and Stroop scores; independent variables: sex and CR). Covariates included age, Expanded Disability Status Scale, and BDI-II scores.
Results:
Women showed higher levels of CR, particularly in daily activities (t = −5.848, p<.001), hobbies (t = −2.591, p = .010), and social life (t = −2.362, p = .011). Sex differences were noted in verbal memory and fluency (with women outperforming men) and processing speed (with men performing better than women). Multivariate analyses revealed a nonsignificant interaction between CR and sex on cognition (Λ=.950, F(10,260)=.813, p = .617, ηp2 = .050).
Conclusions:
CR and sex seemed to affect cognitive performance independently in pwMS. This highlights the importance of considering both factors in cognitive assessment, and that both sexes may benefit from specific psychoeducational training aimed at increasing CR levels.
Cognitive impairment is prevalent, disabling, and poorly managed in multiple sclerosis (MS). Physical activity, often expressed as steps/day, has been associated with cognitive function in this population. This brief report examined the possibility of a (1) steps/day threshold associated with absence of cognitive impairment or (2) dose-response relationship between steps/day and cognitive function in MS.
Method:
The sample included 358 persons with MS who provided demographic (age, sex, race) and clinical (MS type, disease duration, disability status) information, and completed the Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test-Second Edition (CVLT-II). Participants wore an ActiGraph GT3X+ accelerometer above the non-dominant hip during waking hours of the day over a 7-day period for measuring steps/day.
Results:
The receiver operating characteristic (ROC) curve analysis did not identify a steps/day threshold associated with cognitive impairment on SDMT (area under the curve [AUC] ranged between 0.606 and 0.691). The ROC curve analysis further did not identify a threshold of steps/day associated with cognitive impairment based on CVLT-II (AUC range 0.606 to 0.691). The regression analysis indicated significant linear relationships between steps/day and SDMT (R2 = .06; β=.251; p < .001) and CVLT-II (R2 = .06; β=.247; p < .001) z-scores.
Conclusion:
The observed linear relationship suggests that focusing on increasing steps/day across all levels of physical activity might have benefits for cognitive function in MS.
Post-traumatic stress disorder (PTSD) and hypertension are highly prevalent among Veterans. Cognitive dispersion, indicating within-person variability across neuropsychological measures at one time point, is associated with increased risk of dementia. We examined interactive effects of PTSD symptom severity and hypertension on cognitive dispersion among older Veterans.
Methods:
We included 128 Vietnam-era Veterans from the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI) with a history of PTSD. Regression models examined interactions between PTSD symptom severity and hypertension on cognitive dispersion (defined as the intraindividual standard deviation across eight cognitive measures) adjusting for demographics and comorbid vascular risk factors.
Results:
There was an interaction between PTSD symptom severity and hypertension on cognitive dispersion (p = .026) but not on mean cognitive performance (p = .543). Greater PTSD symptom severity was associated with higher cognitive dispersion among those with hypertension (p = .002), but not among those without hypertension (p = .531). Results remained similar after adjusting for mean cognitive performance.
Conclusions:
Findings suggest, among older Veterans with PTSD, those with both hypertension and more severe PTSD symptoms may be at greater risk for cognitive difficulties. Further, cognitive dispersion may be a useful marker of subtle cognitive difficulties. Future research should examine these associations longitudinally and in a diverse sample.
Interoception is crucial for emotional processing. It relies on the bidirectional connections between the insula, a crucial structure in interoception, and the frontal lobe, which is implicated in emotional experiences. Acquired frontal brain injury often leads to emotional disorders. Our goal was to explore the interoceptive profiles of patients with frontal lesions with or without insular involvement.
Method:
Given the neuroanatomical links between interoception and emotions, we conducted a systematic Preferred Reporting Items for Systematic Reviews and Meta-analyses guided review of studies assessing at least one dimension of interoception in adults with acquired frontal injuries, with or without associated insular lesions.
Results:
Seven articles were included. The review indicated that interoceptive accuracy declines after frontal injuries. The two studies that investigated interoceptive sensitivity found lower scores in patient groups. Finally, inconsistent results were found for interoceptive metacognition after frontal damage.
Conclusions:
This review is the first to explore interoceptive disorders after acquired frontal brain injury. The findings reveal deficits in cardiac interoceptive accuracy and interoceptive sensitivity following frontal damage. Inconsistent results were observed for interoceptive metacognition. Further research is needed to confirm the presence of interoceptive deficits following a frontal lesion. Additionally, the relationship between interoceptive deficits and emotional disorders, often reported after frontal brain injury, should be investigated.