Deconstructing the nature of episodic foresight deficits associated with chronic opiate use

OBJECTIVES

Episodic foresight refers to the capacity to mentally travel forward in time and has been linked to a wide variety of important functional behaviours. Evidence has recently emerged that chronic opiate use is associated with deficits in this critical capacity and that these difficulties are not simply a secondary consequence of broader cognitive dysfunction. The current study aimed to better understand the circumstances in which chronic opiate users might be expected to have problems with episodic foresight, by addressing whether deficits reflect compromised scene construction, self-projection, or narrative ability.

METHODS

Thirty-five chronic opiate users and 35 demographically matched controls completed an imagination task in which they were instructed to imagine and provide descriptions of an atemporal event, a plausible, self-relevant future event, as well as complete a narrative task. These three imagination conditions systematically varied in their demands on scene construction, self-projection, and narrative ability.

RESULTS

Consistent with prior literature, chronic opiate users exhibited reduced capacity for episodic foresight relative to controls. However, this study was the first to show that these difficulties were independent of capacity for scene construction and narration. Instead, a specific impairment in self-projection into the future appears to contribute to the problems with episodic foresight seen in this clinical group.

CONCLUSIONS

Deficits in self-projection into the future may have important implications in therapeutic environments given that many relapse prevention strategies rely heavily on the ability to project oneself into an unfamiliar future, free of problem substance use.

PRACTITIONER POINTS

A reduced capacity for episodic foresight highlights the importance of refining current relapse prevention protocols that place significant demands for mental time travel into the future. Psychosocial treatments should focus on the attainment of more immediate or short-term goals. It is difficult to delineate the effects of specific substances given long-standing drug use history common to chronic opiate users. Conclusions relating to neurological functioning are speculative given the absence of neuroimaging data.

The relationship between prospective memory and episodic future thinking in younger and older adulthood

Episodic future thinking (EFT), the ability to project into the future to “preexperience” an event, and prospective memory (PM), remembering to perform an intended action, are both examples of future-oriented cognition. Recently it has been suggested that EFT might contribute to PM performance but to date few studies have examined the relationship between these two capacities. The aim of the present study was to investigate the nature and specificity of this relationship, as well as whether it varies with age. Participants were 125 younger and 125 older adults who completed measures of EFT and PM. Significant, positive correlations between EFT and PM were identified in both age groups. Furthermore, EFT ability accounted for significant unique variance in the young adults, suggesting that it may make a specific contribution to PM function. Within the older adult group, EFT did not uniquely contribute to PM, possibly indicating a reduced capacity to utilize EFT, or the use of compensatory strategies. This study is the first to provide systematic evidence for an association between variation in EFT and PM abilities in both younger and older adulthood and shows that the nature of this association varies as a function of age.

Trust and trustworthiness in young and older adults

In a series of 1-shot economic trust games in which participants could make real monetary profits, but also risked losing money, 2 studies compared young and older adults' trust (amount invested with trustees) and trustworthiness (amount returned to investors by trustees). In Study 1, young (n = 35) and older (n = 32) participants acted as investors, and the age of simulated trustees (young, older) was manipulated. In Study 2, young (n = 61) and older (n = 67) participants acted in real life as both investors and trustees. They completed 2 face-to-face trust games with same- and other-age partners, and 3 anonymous trust games with same-, other-, and unknown-age partners. Study 1 found that young and older participants rate older trustees as appearing more trustworthy than young trustees, but neither group invest more with older than young trustees. Rather, older participants were more likely than young participants to invest money averaged across trustee age. In Study 2, there were no age-related differences in trust, but older adults were more trustworthy than young adults in anonymous games with same- and unknown-age partners. It was also found that young adults demonstrate greater reputational concerns than older adults by reciprocating more trust when face-to-face than anonymous. We discuss the complex influences of age on trust game investing and reciprocation, as well as the implications for older adults' wellbeing and financial security.

Age-related similarities and differences in first impressions of trustworthiness

Trust is a particularly under-studied aspect of social relationships in older age. In the current study, young (n = 35) and older adults (n = 35) completed a series of one-shot social economic trust games in which they invested real money with trustees. There were potential gains with each investment and also a risk of losing everything if the trustee was untrustworthy. The reputation and facial appearance of each trustee were manipulated to make them appear more or less trustworthy. Results revealed that young and older adults invest more money with trustees whose facial appearance and reputation indicate that they are trustworthy rather than untrustworthy. However, older adults were more likely than young to invest with trustees who had a reputation for being untrustworthy. We discuss whether age-related differences in responding to negative information may account for an age-related increase in trust, particularly when trusting someone with a reputation for being uncooperative.

Episodic foresight deficits in long-term opiate users

RATIONALE

There is considerable literature showing that opiate use is associated with a range of neurocognitive deficits, including deficits in executive control and episodic memory. However, no study to date has assessed whether these neurocognitive difficulties extend to the ability to mentally time travel into one's personal future. This is a surprising omission given that executive control and episodic memory are considered to be critical for episodic foresight. In addition, opiate-related brain changes have been identified in the neural regions that underlie the capacity for episodic foresight.

OBJECTIVE

In the present study, we assessed how episodic foresight is affected in the context of chronic opiate use, as well as the degree to which any deficits are related to difficulties with executive control and episodic memory.

METHODS AND RESULTS

Forty-eight long-term heroin users enrolled in an opiate substitution program and 48 controls were tested. The results showed that, relative to controls, the clinical group exhibited significant impairment in episodic foresight but not episodic memory (as indexed by an adapted version of the Autobiographical Interview). For executive function, the clinical group was impaired on only one of three measures (Inhibition).

CONCLUSIONS

These data provide important preliminary evidence that episodic foresight might be particularly susceptible to the neurocognitive effects of opiate use, as the difficulties identified were not secondary to more general executive control or episodic memory impairment. Because a number of widely used relapse prevention protocols require the ability to mentally project into the future, these data have potentially important practical implications in relation to the treatment of substance dependence disorders.

Adiposity estimated using dual energy X-ray absorptiometry and body mass index and its association with cognition in elderly adults

OBJECTIVES

To determine whether obesity, estimated according to body mass index (BMI), waist circumference, and body fat and abdominal fat assessed using dual-energy X-ray absorptiometry (DEXA), was associated with cognitive performance.

DESIGN

Cross-sectional.

SETTING

Community based.

PARTICIPANTS

Individuals aged 74-94 (N = 406).

MEASUREMENTS

BMI, waist circumference, body fat, and abdominal fat were assessed using DEXA. Cognitive performance was assessed using a comprehensive neuropsychological battery.

RESULTS

When categorized using BMI, overweight individuals had higher global cognitive function and executive function scores than normal-weight individuals. This relationship did not differ according to sex. When categorized according to DEXA, there were no relationships between body fat and cognitive function in the whole group, but women in the middle and highest tertiles of DEXA body fat had better executive function than those in the lowest tertile. Men in the middle tertile of DEXA body fat had significantly better executive function and memory than those in the lowest tertile. BMI had greater power to predict executive function than DEXA body fat. No significant associations were found between cognition and estimates of abdominal adiposity.

CONCLUSION

This study found an association between being overweight and better executive function in elderly adults; this association was stronger for the simpler BMI than the more-elaborate DEXA measures.

Future thinking improves prospective memory performance and plan enactment in older adults

Efficient intention formation might improve prospective memory by reducing the need for resource-demanding strategic processes during the delayed performance interval. The present study set out to test this assumption and provides the first empirical assessment of whether imagining a future action improves prospective memory performance equivalently at different stages of the adult lifespan. Thus, younger ( n = 40) and older ( n = 40) adults were asked to complete the Dresden Breakfast Task, which required them to prepare breakfast in accordance with a set of rules and time restrictions. All participants began by generating a plan for later enactment; however, after making this plan, half of the participants were required to imagine themselves completing the task in the future (future thinking condition), while the other half received standard instructions (control condition). As expected, overall younger adults outperformed older adults. Moreover, both older and younger adults benefited equally from future thinking instructions, as reflected in a higher proportion of prospective memory responses and more accurate plan execution. Thus, for both younger and older adults, imagining the specific visual–spatial context in which an intention will later be executed may serve as an easy-to-implement strategy that enhances prospective memory function in everyday life.

Age differences in conscious versus subconscious social perception: the influence of face age and valence on gaze following

Gaze following is the primary means of establishing joint attention with others and is subject to age-related decline. In addition, young but not older adults experience an own-age bias in gaze following. The current research assessed the effects of subconscious processing on these age-related differences. Participants responded to targets that were either congruent or incongruent with the direction of gaze displayed in supraliminal and subliminal images of young and older faces. These faces displayed either neutral (Study 1) or happy and fearful (Study 2) expressions. In Studies 1 and 2, both age groups demonstrated gaze-directed attention by responding faster to targets that were congruent as opposed to incongruent with gaze-cues. In Study 1, subliminal stimuli did not attenuate the age-related decline in gaze-cuing, but did result in an own-age bias among older participants. In Study 2, gaze-cuing was reduced for older relative to young adults in response to supraliminal stimuli, and this could not be attributed to reduced visual acuity or age group differences in the perceived emotional intensity of the gaze-cue faces. Moreover, there were no age differences in gaze-cuing when responding to subliminal faces that were emotionally arousing. In addition, older adults demonstrated an own-age bias for both conscious and subconscious gaze-cuing when faces expressed happiness but not fear. We discuss growing evidence for age-related preservation of subconscious relative to conscious social perception, as well as an interaction between face age and valence in social perception.

Examining the time course of young and older adults' mimicry of enjoyment and nonenjoyment smiles

Electromyographic (EMG) research suggests that implicit mimicry of happy facial expressions remains intact with age. However, age-related differences in EMG responses to enjoyment and nonenjoyment smiles have not been explored. The present study assessed younger and older adults' orbicularis oculi (O.oculi; eye) and zygomaticus major (Z.major; cheek) reactions to images of individuals displaying enjoyment and nonenjoyment smiles. Both age groups mimicked displays of enjoyment smiles, and there were no age differences in O.oculi and Z.major activity to these expressions. However, compared with younger participants, older adults showed extended O.oculi activity to nonenjoyment smiles. In an explicit ratings task, older adults were also more likely than younger participants to attribute feelings of happiness to individuals displaying both nonenjoyment and enjoyment smiles. However, participants' ratings of the happiness expressed in images of enjoyment and nonenjoyment smiles were independent of their O.oculi responding to these expressions, suggesting that mimicry and emotion recognition may reflect separate processes. Potential mechanisms underlying these findings, as well as implications for social affiliation in older adulthood, are considered.

Exploring own-age biases in deception detection

The present study explored own-age biases in deception detection, investigating whether individuals were more likely to trust those in their own-age group. Younger and older participants were asked to detect deceit from videos of younger and older speakers, rating their confidence in each decision. Older participants showed an own-age bias: they were more likely to think that deceptive speakers of their own age, relative to younger speakers, were telling the truth. Older participants were also more confident in their judgements of own-age, relative to other-age, speakers. There were no own-age biases for younger participants. In a subsequent (apparently unrelated) task, participants were asked to rate the trustworthiness of the speakers. Both age groups of participants trusted younger speakers who had previously told the truth more compared to those who had lied. This effect was not found for older speakers. These findings are considered in relation to the in-group/out-group model of social cognition and common stereotypical beliefs held about younger and older adults.

Older adults have greater difficulty imagining future rather than atemporal experiences

Episodic future thinking refers to mentally traveling forward in time to preexperience an event, and emerging research suggests that this is more difficult for older adults. The current study was designed to better understand the effect of aging on separate component processes of age differences in episodic future thinking. Young (n = 24) and older (n = 25) adults were asked to construct a) atemporal scenarios, b) future scenarios, and c) a narrative that involved navigation. Each of these conditions assesses the capacity to construct and describe a scene, but only the future scenario requires a subjective sense of self in time (autonoetic consciousness). The composite measure of performance showed that relative to young adults, older adults have substantially reduced capacity for all three types of construction, suggesting that age-related difficulty imagining future episodic events may reflect a more general cognitive decline with age. In addition, older adults were worse at imagining future experiences than atemporal experiences, indicating limited capacity for autonoetic consciousness. Further, this difference between imagining atemporal and future experiences was not as evident among younger adults. These deficits in episodic future thinking have implications for the daily lives of older adults in terms of anticipating and planning for the future.

Age-related differences in social economic decision making: the ultimatum game

OBJECTIVES

Despite recognition of the increasing influence of emotion on decision making with age, there are few studies that have assessed older adults' financial choices in a socioemotional context. Thus, social economic decision making between same- versus other-aged partners was assessed.

METHOD

Young (n = 35) and older (n = 34) adults participated in two Ultimatum Games. In the first, they proposed divisions of money between themselves and future young and older participants. In the second, they accepted or rejected fair and unfair divisions of money proposed by past young and older participants. Lastly, participants reported their anger in response to the offers that were proposed to them in the second game.

RESULTS

In the first game, older participants divided the money more generously than did young participants. In the second game, young, but not older, participants rejected more unfair offers proposed by young relative to older adults. However, both participant age groups reported being angrier at unfair offers proposed by young adults compared with when receiving the same offer from an older adult.

DISCUSSION

These findings are discussed in the context of evidence for improved anger regulation and increased prosocial behavior with age.

Right frontal cortical lesions disrupt anger mimicry

The current study investigates the neural substrates of facial expression mimicry by assessing individuals with right and left lateralised frontal cortical lesions. Electromyography was used to measure spontaneous changes in electrical activity over the corrugator supercilii (brow) and zygomaticus major (cheek) muscle regions in response to happy and angry facial expressions. Individuals with right (n=4) and left (n=5) frontal cortical lesions and demographically matched controls (n=9) were compared. It was shown that while all three groups mimic happy facial expressions, only controls and individuals with left frontal lesions mimic angry expressions. These data are consistent with evidence for right frontal cortical specialisation for the processing of anger.

Dismantling the “age–prospective memory paradox”: The classic laboratory paradigm simulated in a naturalistic setting

Previous research has identified “the age–prospective memory paradox”—that adult ageing results in reliably poorer performance on laboratory-based tasks of prospective memory (PM), but improved performance on such tasks carried out in real-life settings. We hypothesized that even in their everyday environment, older adults might be worse at PM tasks that are triggered during an experimenter-generated ongoing activity. The present study used a task that captured the key features of the classic laboratory paradigm, but which was completed in a setting that met key criteria to be considered naturalistic. In their everyday setting, participants’ PM was assessed, with the cue to remember occurring either (a) during their day-to-day activities, or (b) during an experimenter-generated ongoing task. The results confirmed previous naturalistic findings, in showing that older adults ( n = 28) exhibited better PM than their younger counterparts ( n = 65) when prompted during their everyday activities. However, older adults were also then subsequently less likely to show effective PM during experimenter-generated ongoing activity. Reproducing the paradox within a single dataset, these data indicate that older adults can effectively act on intentions during everyday activities, but have difficulty in prospective remembering during experimenter-generated ongoing tasks.

Promoting accountability in obstetric care: use of criteria-based audit in Viet Nam

Audits can improve clinical and managerial practices, enhance the rational use of limited resources, and improve staff morale and motivation. Staff at five hospitals in Thanh Hoa and Quang Tri provinces (Viet Nam) used criteria-based audit (CBA) as a tool to improve the quality of emergency obstetric and newborn care. CBA compares current practice with standards based on the best available evidence and the local context. The audit cycle begins with a known problem, proceeds with an initial assessment and data collection, analysis of those data, formulation and implementation of an action plan, and a re-evaluation of the topic initially assessed. Teams found that clinical protocols for treating major obstetric complications were not followed, although, national guidelines had been issued in 2002. In an audit of facility organisation, staff addressed obstacles to the timely treatment of obstetric emergencies during off hours. In each audit, teams devised mechanisms to correct problems that resulted in significant improvements when the audit cycle was repeated. CBA improved adherence to national guidelines, improved record-keeping, heightened teamwork, and showed staff that they could identify and solve many of their own problems.

Socioemotional deficits associated with obsessive-compulsive symptomatology

Increasing emphasis has been placed on the role of socioemotional functioning in models of obsessive-compulsive disorder (OCD). The present study investigated whether OCD symptoms were associated with capacity for theory of mind (ToM) and basic affect recognition. Non-clinical volunteers (N=204) completed self report measures of OCD and general psychopathology, in addition to behavioral measures of ToM and affect recognition. The results indicated that higher OCD symptoms were associated with reduced ToM, as well as reduced accuracy decoding the specific emotion of disgust. Importantly, these relationships could not be attributed to other, more general features of psychopathology. The findings of the current study therefore further our understanding of how the processing and interpretation of social and emotional information is affected in the context of OCD symptomatology, and are discussed in relation to neuropsychological models of OCD.

Separating component processes of theory of mind in schizophrenia

OBJECTIVE

It has been argued that in order to take the perspective of another the 'default' self-perspective must first be inhibited. Thus, executive function failures (and specifically, reduced inhibitory control of the self-perspective) may contribute to the theory of mind (ToM) difficulties that have been observed in schizophrenia.

METHOD

Participants with schizophrenia (N=28) and demographically matched controls (N=30) were administered a behavioural measure of ToM that directly manipulates inhibitory demands by involving either high- or low-levels of self-perspective inhibition.

RESULTS

Relative to controls, participants with schizophrenia demonstrated impaired ToM, but did not have particular difficulty on the task that placed high demands on self-perspective inhibition.

CONCLUSION

Disruption of other-perspective taking, rather than self-perspective inhibition, appears to be the more important determinant of ToM impairment in schizophrenia. This finding is discussed in relation to competing perspectives of ToM.

Empathy, social functioning and schizotypy

Whilst affective empathy is concerned with one's emotional response to the affective state of another, cognitive empathy refers to one's understanding of another's mental state, and deficits in both are believed to contribute to the social behavioral abnormalities associated with schizophrenia. The present study aimed to test whether individual differences in normally distributed schizotypal personality traits are related to cognitive and affective empathy, and whether any observed association between schizotypy and empathy mediates the relationship between schizotypy and (reduced) social functioning. Non-clinical volunteers (N=223) completed measures of schizotypal personality, cognitive and affective empathy, social functioning and negative affect. The results indicated that higher schizotypy was associated with reduced empathy, poorer social functioning and increased negative affect. Of the specific schizotypal dimensions (positive, negative and disorganized), only negative schizotypy was significantly associated with social functioning, and this relationship persisted even after controlling for negative affect. Further, affective empathy functioned as a partial mediator in this relationship. These data show that the relationship between negative schizotypy and social functioning is at least partially attributable to deficits in affective empathy.

Empathy and social functioning in late adulthood

OBJECTIVES

Both cognitive and affective empathy are regarded as essential prerequisites for successful social functioning, and recent studies have suggested that cognitive, but not affective, empathy may be adversely affected as a consequence of normal adult aging. This decline in cognitive empathy is of concern, as older adults are particularly susceptible to the negative physical and mental health consequences of loneliness and social isolation.

METHOD

The present study compared younger (N = 80) and older (N = 49) adults on measures of cognitive empathy, affective empathy, and social functioning.

RESULTS

Whilst older adults' self-reported and performance-based cognitive empathy was significantly reduced relative to younger adults, there were no age-related differences in affective empathy. Older adults also reported involvement in significantly fewer social activities than younger adults, and cognitive empathy functioned as a partial mediator of this relationship.

CONCLUSION

These findings are consistent with theoretical models that regard cognitive empathy as an essential prerequisite for good interpersonal functioning. However, the cross-sectional nature of the study leaves open the question of causality for future studies.