The impact of executive cognitive functioning on rates of smoking cessation in the San Luis Valley Health and Aging Study

Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study

Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18-25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.

Emerging self-regulatory skills in childhood predict cardiometabolic risk in adolescence

Cardiometabolic risk (CMR) has increased among adolescents. A growing literature shows that childhood self-regulatory skills are associated with obesity and CMR. However, the developmental nature of self-regulation has not been considered in existing studies. Therefore, it is unclear how specific types of self-regulation (i.e., attentional, emotional, behavioral, cognitive) at different points in development, may differentially predict CMR. Using a multi-method longitudinal design, we assessed a sample of 117 children repeatedly between ages 2 and 16. At ages 2, 4, and 7 years, self-regulation (emotional, attentional, behavioral, and cognitive) skills that were hypothesized to have emerged were assessed. Adolescent CMR indicators were assessed at age 16. Latent profile analyses identified three profiles of adolescent CMR: Low Risk (41%), Dyslipidemia Risk (49.6%), and High Risk (9.4%). Distinct self-regulation skills at each childhood age predicted CMR during adolescence. Specifically, emotional regulation skills at ages 2 and 4, food-related behavioral regulation and attentional regulation at age 4, and attentional and cognitive regulation skills at age 7 predicted adolescent CMR. Self-regulation skills are modifiable, and thus, childhood interventions aimed at improving self-regulation could reduce CMR for decades to come. However, these results suggest that the multifaceted, developmental nature of self-regulation must be considered to most effectively inform preventive interventions aimed at lowering CMR. Additionally, our study highlights the need for additional research on adolescents who show elevations of CMR without meeting criteria for obesity.

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Three person-centered profiles of cardiometabolic risk were identified.

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Four domains of childhood self-regulation predicted adolescent cardiometabolic risk.

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Research is needed on adolescents with high cardiometabolic risk without obesity.

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Childhood self-regulation interventions could ultimately reduce cardiometabolic risk.

Impact of Depression and Nicotine Dependence on Executive Functioning in Rural Older Adult Smokers: A Brief Report (NCT02510716)

INTRODUCTION

Rural older adults are an underserved population with high rates of smoking and related morbidity and mortality. Age-related executive function deficits are common in older smokers; however, the association of depression and nicotine dependence on executive function has not been explored. This study addressed whether depression and nicotine dependence are related to executive dysfunction in rural older adult smokers.

METHODS

The sample included 40 rural older adults recruited from two primary care clinics in North Carolina. Executive function was evaluated with the Behavioral Regulation Index (BRI), Metacognition Index, and Global Executive Composite (GEC) T scores from the Behavior Rating Inventory of Executive Function-Adult. Nicotine dependence and depression symptoms were assessed using the Fagerstrom Test and Center for Epidemiologic Depression Scale-10, respectively. Analysis of variance was used to explore whether depression and/or nicotine dependence influences executive function. Nondirectional tests were performed with significance set at .10.

RESULTS

Smokers who screened positive for depression had significantly greater executive dysfunction than those who did not (BRI: p = .0003, Metacognition Index: p < .0001, GEC: p < .0001), and moderate/high dependence was associated with greater executive function deficits compared with those with mild dependence (BRI: p = .0942). Together, depression and nicotine dependence explained 50% of the variability of the GEC overall scores.

CONCLUSIONS

Executive dysfunction is common in rural older adult smokers and associated with depression and nicotine dependence severity. Futures studies should test the relationship of executive function and smoking cessation in the older adult population as it may have implications for cessation in this population.

Chronic versus recent expressive suppression burdens are differentially associated with cognitive performance among older adults

Introduction: Expressive suppression (ES; suppression of affective behavior) has been shown to have a deleterious impact on subsequently administered tests of executive functions (EF), threatening validity, and reliability of EF assessment. Past research has shown that recent ES (i.e., across 24 hours prior to testing) and chronic ES (i.e., across 2 weeks prior to testing) have differential impact on test performance. The present study compared the association of chronic vs. recent ES with speed vs. accuracy of performance on tests of EF and tests of lower-order processes.

METHOD

Participants were 255 community-dwelling older adults aged 60 and older. Participants completed timed subtests of the Delis-Kaplan Executive Function System and the Burden of State Emotion Regulation Questionnaire.

RESULTS

Hierarchical linear regressions examined the contributions of chronic vs. recent ES to test performance. Recent ES was related to scores of both speed and accuracy on EF tests. The association between recent ES and EF errors held beyond covariates (i.e., chronic ES, demographics, depression, and general cognitive status). In contrast, the association between recent ES and EF speed was fully explained by EF error scores. Chronic ES was associated only with speed of performance and only on lower-order tasks, but this relationship did not survive correction for cognitive, psychiatric, and demographic factors.

CONCLUSIONS

Recent ES appears to be a risk factor for EF lapses. Chronic ES, while related to performance speed, seems to also relate to several other cognitive, psychiatric, and demographic factors, which themselves explain slower information processing.

Association of self-reported executive function and mood with executive function task performance across adult populations

Executive function (EF) impacts behavior associated with health outcomes. EF can be measured using self-report and/or performance measures, but the correlations between these types of measures are mixed in the extant literature. This study examined self-report and performance-based measures of EF using data from 6 studies, including community and clinical populations (410 participants, ages 19-80, 71% female). Partial correlations revealed significant relationships between performance on the Trail making, Delay Discounting, and Stop Signal tasks with self-reported EF (p < .006 after controlling for age). Mood scores were significantly related to all self-reported domains of EF (p < .0001), and mood and EF scores were correlated over time. When also controlling for mood, correlations between delay discounting and stop signal tasks with self-reported EF remained significant (p < .006). Finally, examining EF scores in participants with and without clinically elevated mood scores showed a wider distribution of self-reported EF scores among those with clinically elevated mood symptoms than among those without. We conclude that self-reported EF is associated with tasks measuring delay discounting and response inhibition in our large, heterogenous population and that assessing EF may be particularly important for those with high levels of mood symptoms.

Mid-Term Effects of Pulmonary Rehabilitation on Cognitive Function in People with Severe Chronic Obstructive Pulmonary Disease

Purpose

Cognitive dysfunction is a common impairment associated with COPD. However, little is known about 1) its prevalence among those subjects referred for pulmonary rehabilitation (PR), 2) how it may affect the benefit of PR, 3) whether PR improves cognitive function and 4) whether cognitive dysfunction affects the usability of telehealth technology usually used to deliver in-home PR.

Patients and Methods

Fifty-six subjects with stable COPD (54% females, mean age 62 years (SD 9) and median FEV₁ 0.9 L (IQR 0.7 to 1.1)) participated in this multicenter observational study and performed 24 sessions of PR. The Montreal Cognitive Assessment tool (MoCA) was used to assess the occurrence of mild cognitive dysfunction (using a screening cutoff <26) at baseline, completion of PR and 3 months of follow-up.

Results

Mild cognitive dysfunction was found in 41 subjects (73% [95% CI: 60 to 83%]). The MoCA score significantly improved following PR for those people with baseline mild cognitive dysfunction (p<0.01). There was no significant difference in clinical outcomes between those people with or without mild cognitive dysfunction following PR nor in the proportion of subjects who were autonomous in using the telemonitoring system (83% compared with 71%, p=0.60).

Conclusion

Mild cognitive dysfunction is highly prevalent among those people with COPD referred for PR but does not affect the benefits of PR nor the usability of a telemonitoring system. PR may improve short- and mid-term cognitive function for those people who experience mild cognitive dysfunction at the time they are referred to PR.

Prevalence of Cognitive Impairment and Association With Survival Among Older Patients With Hematologic Cancers

Importance

As the population ages, cognitive impairment has promised to become increasingly common among patients with cancer. Little is known about how specific domains of cognitive impairment may be associated with survival among older patients with hematologic cancers.

Objective

To determine the prevalence of domain-specific cognitive impairment and its association with overall survival among older patients with blood cancer.

Design, Setting, and Participants

This prospective observational cohort study included all patients 75 years and older who presented for initial consultation in the leukemia, myeloma, or lymphoma clinics of a large tertiary hospital in Boston, Massachusetts, from February 1, 2015, to March 31, 2017. Patients underwent screening for frailty and cognitive dysfunction and were followed up for survival.

Exposures

The Clock-in-the-Box (CIB) test was used to screen for executive dysfunction. A 5-word delayed recall test was used to screen for impairment in working memory. The Fried frailty phenotype and Rockwood cumulative deficit model of frailty were also assessed to characterize participants as robust, prefrail, or frail.

Results

Among 420 consecutive patients approached, 360 (85.7%) agreed to undergo frailty assessment (232 men [64.4%] and 128 women [35.6%]; mean [SD] age, 79.8 [3.9] years), and 341 of those (94.7%) completed both cognitive screening tests. One hundred twenty-seven patients (35.3%) had probable executive dysfunction on the CIB, and 62 (17.2%) had probable impairment in working memory on the 5-word delayed recall. Impairment in either domain was modestly correlated with the Fried frailty phenotype (CIB, ρ = 0.177; delayed recall, ρ = 0.170; P = .01 for both), and many phenotypically robust patients also had probable cognitive impairment (24 of 104 [23.1%] on CIB and 9 of 104 [8.7%] on delayed recall). Patients with impaired working memory had worse median survival (10.9 [SD, 12.9] vs 12.2 [SD, 14.7] months; log-rank P < .001), including when stratified by indolent cancer (log-rank P = .01) and aggressive cancer (P < .001) and in multivariate analysis when adjusting for age, comorbidities, and disease aggressiveness (odds ratio, 0.26; 95% CI, 0.13-0.50). Impaired working memory was also associated with worse survival for those undergoing intensive treatment (log-rank P < .001). Executive dysfunction was associated with worse survival only among patients who underwent intensive treatment (log-rank P = .03).

Conclusions and Relevance

These data suggest that domains of cognitive dysfunction may be prevalent in older patients with blood cancer and may have differential predictive value for survival. Targeted interventions are needed for this vulnerable patient population.

A systematic review and meta-analysis of the executive function-health behaviour relationship

Objective

This study provides the first comprehensive meta-analysis of the relationship between executive function (EF) and performance of health behaviours in healthy populations.

Method

Electronic databases (MEDLINE, Embase, PsycINFO, Web of Science) were searched, and forward and backward citation tracking was undertaken to identify articles investigating the relationship between EF and health behaviour. Studies were eligible if they examined the direct correlational relationship between EF and health behaviour in healthy populations, were available in English and published in peer-reviewed journals in any year.

Results

Sixty-one articles covering 65 tests were included in a random effects meta-analysis. Several moderators were assessed, including: the type, and addictiveness of the health behaviour; the type of EF measure; study design, and sample characteristics. Overall EF had a significant, but small correlation with health behaviour; EF was significantly positively associated with health-protective behaviours and significantly negatively associated with health-damaging behaviours. There was considerable heterogeneity in the observed effect sizes, but this was not explained by the examined moderators.

Conclusions

Although the meta-analysis indicates a significant effect for EF on health behaviour, effect size is small. Due to the complex nature of EF, more research is required to further elucidate the relationship between EF and health behaviour in its entire conceptualization.

The Impacts of Sexual Arousal and Its Suppression on Executive Functioning

Suppression of certain types of reflexive emotional responses is thought to temporarily deplete executive functions (EF), as evidenced by poorer performance on measures of EF, but does not deplete other, lower-order cognitive processes. This study examined whether similar decrements in performance on EF tests would occur following suppression of sexual arousal. A sample of 44 male college students underwent baseline cognitive assessment (EF and lower-order cognitive processes), followed by experimental manipulation consisting of exposure to sexually explicit audiovisual stimuli. Sexual arousal was monitored using penile plethysmography. In this study, 21 participants were assigned to a suppression condition and were instructed to suppress sexual arousal during the video, while 23 were assigned to an arousal condition and were instructed to allow themselves to become aroused. Following experimental manipulation, cognition was reassessed. Unexpectedly, results showed EF decrements in the arousal group but not in the suppression group. As expected, only EF was affected by experimental manipulation, with no group differences in lower-order cognitive processes. Thus, the findings suggest that sexual arousal is associated with temporary decrements in EF performance, at least among young, primarily White, male college students. The results contribute to understanding why sexually charged situations are sometimes associated with poor decisions or unsafe/reckless sexual practices.

Cigarette use and smoking beliefs among older Americans: findings from a nationally representative survey

Background: Between 2005 and 2015, the prevalence of smoking among US adults has decreased for all age subgroups, except those aged 65 and older. Aim: In order to identify potential correlates of smoking behaviors in older adults, this research examined associations between age, smoking beliefs, and quitline utilization. Methods: Self-reported, nationally representative data from the Health Information National Trends Survey 2015 cycle (HINTS-FDA) were used (n = 3738). Multivariable logistic regression analyses examined associations between sociodemographic characteristics and beliefs about smoking behaviors. All analyses were conducted with jackknife estimation using sampling weights. Results: Among all survey respondents, 10.5% of those aged 65+ were current smokers (smoked 100 lifetime cigarettes and currently smoked every day or some days). These older adults, compared to those aged 18-29 years, had significantly higher odds of agreeing that smoking behavior is something one can do little to change (AOR = 1.89, 95% CI =1.08, 3.28) and agreeing that nicotine is the substance that causes cancer (AOR = 3.93, 95% CI = 2.17, 7.12). Post hoc analyses compared midlife adults (ages 50-64) with older adults (ages 65+), and indicated older adults had lower odds of having used a quitline/smoking cessation website (AOR = 0.36, 95% CI = 0.14, 0.94, p = 0.04) compared to their midlife peers. Discussion: US adults aged 65 and older hold erroneous beliefs about cigarette smoking behaviors and are less likely to utilize quitline supports. This may be contributing to the stagnant smoking rates among older adults. Smoking cessation efforts targeting older adult Americans are critical in order to stem tobacco use among all Americans.

The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: A systematic review

OBJECTIVE

To determine the characteristics of persons with cognitive impairment being able to self-manage in chronic obstructive pulmonary disease (COPD).

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance this systematic review examined all studies in English from 1st January 2000 to 20 February 2016, describing the relationship between cognition and COPD self-management domains in older community dwelling persons with dementia or cognitive impairment.

RESULTS

Of 4474 studies identified, thirteen studies were eligible for inclusion. No studies differentiated populations into recognized dementia subtypes. Study aims were variable; most (n = 7) examined inhaler competency alone. Studies identified a link between worsening cognition and the need for assistance in activities of daily living. Only one study evaluated the impact of cognition on overall self-management and found no association between cognitive impairment and self-rated self-management. Mild degrees of cognitive impairment were associated with reduced symptom recall. Cognitive impairment in COPD was associated with high degrees of inhaler incompetency. Basic cognitive screening tests were able to predict inhaler incompetence with reduced overall cognitive function, dyspraxia, and/or executive function identified as predictors of incompetency.

CONCLUSIONS

Multiple measures of disability consistently demonstrated that cognitive impairment in COPD significantly increased the need for assistance in many aspects of daily living, treatment adherence, and effective self-management. Given the nature of neuropsychological deficits seen in COPD, dedicated screening tools are required. Future research should investigate the impact of cognitive dysfunction in COPD and identify how to support those that lack capacity to self-manage.

Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit

BACKGROUND

Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation.

METHODS

Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26.

RESULTS

In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps>0.20).

CONCLUSIONS

Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.

Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease

We aimed to investigate (1) the relationship between cognitive impairment (CI) and disease severity and (2) the potential differences in exercise performance, daily activities, health status, and psychological well-being between patients with and without CI. Clinically stable chronic obstructive pulmonary disease (COPD) patients, referred for pulmonary rehabilitation, underwent a neuropsychological examination. Functional exercise capacity (6-minute walk test [6MWT]), daily activities (Canadian Occupational Performance Measure [COPM]), health status (COPD Assessment Test [CAT]) and St George’s Respiratory Questionnaire-COPD specific [SGRQ-C]), and psychological well-being (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory [BDI], and Symptom Checklist 90 [SCL-90]) were compared between patients with and without CI. Of 183 COPD patients (mean age 63.6 (9.4) years, FEV₁ 54.8 (23.0%) predicted), 76 (41.5%) patients had CI. The prevalence was comparable across Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1–4 (44.8%, 40.0%, 41.0%, 43.5%, respectively, p = 0.97) and GOLD groups A–D (50.0%, 44.7%, 33.3%, 40.2%, respectively, p = 0.91). Patients with and without CI were comparable for demographics, smoking status, FEV₁% predicted, mMRC, 6MWT, COPM, CAT, HADS, BDI, and SCL-90 scores. Clinical characteristics of COPD patients with and without CI are comparable. Assessment of CI in COPD, thus, requires an active case-finding approach.

Domain-specific cognitive impairment in patients with COPD and control subjects

Impaired cognitive function is increasingly recognized in COPD. Yet, the prevalence of cognitive impairment in specific cognitive domains in COPD has been poorly studied. The aim of this cross-sectional observational study was to compare the prevalence of domain-specific cognitive impairment between patients with COPD and non-COPD controls. A neuropsychological assessment was administered in 90 stable COPD patients and 90 non-COPD controls with comparable smoking status, age, and level of education. Six core tests from the Maastricht Aging Study were used to assess general cognitive impairment. By using Z-scores, compound scores were constructed for the following domains: psychomotor speed, planning, working memory, verbal memory, and cognitive flexibility. General cognitive impairment and domain-specific cognitive impairment were compared between COPD patients and controls after correction for comorbidities using multivariate linear and logistic regression models. General cognitive impairment was found in 56.7% of patients with COPD and in 13.3% of controls. Deficits in the following domains were more often present in patients with COPD after correction for comorbidities: psychomotor speed (17.8% vs 3.3%; P<0.001), planning (17.8% vs 1.1%; P<0.001), and cognitive flexibility (43.3% vs 12.2%; P<0.001). General cognitive impairment and impairments in the domains psychomotor speed, planning, and cognitive flexibility affect the COPD patients more than their matched controls.

A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions

Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.

Do Executive Function and Impulsivity Predict Adolescent Health Behaviour after Accounting for Intelligence? Findings from the ALSPAC Cohort

Objective

Executive function, impulsivity, and intelligence are correlated markers of cognitive resource that predict health-related behaviours. It is unknown whether executive function and impulsivity are unique predictors of these behaviours after accounting for intelligence.

Methods

Data from 6069 participants from the Avon Longitudinal Study of Parents and Children were analysed to investigate whether components of executive function (selective attention, attentional control, working memory, and response inhibition) and impulsivity (parent-rated) measured between ages 8 and 10, predicted having ever drunk alcohol, having ever smoked, fruit and vegetable consumption, physical activity, and overweight at age 13, after accounting for intelligence at age 8 and childhood socioeconomic characteristics.

Results

Higher intelligence predicted having drunk alcohol, not smoking, greater fruit and vegetable consumption, and not being overweight. After accounting for intelligence, impulsivity predicted alcohol use (odds ratio = 1.10; 99% confidence interval = 1.02, 1.19) and smoking (1.22; 1.11, 1.34). Working memory predicted not being overweight (0.90; 0.81, 0.99).

Conclusions

After accounting for intelligence, executive function predicts overweight status but not health-related behaviours in early adolescence, whilst impulsivity predicts the onset of alcohol and cigarette use, all with small effects. This suggests overlap between executive function and intelligence as predictors of health behaviour in this cohort, with trait impulsivity accounting for additional variance.

Predictors of Smoking Cessation in Old-Old Age

INTRODUCTION

There is a dearth of knowledge on smoking cessation in older adults. This study examined predictors of smoking cessation in persons over age 75.

METHODS

This study is a secondary analysis of a prospective longitudinal study. A sample of 619 older persons aged 75-94 was drawn from a representative cohort of older persons in Israel and was examined longitudinally. By means of interviews, we assessed smoking, health, Activities of Daily Living (ADL), Instrumental ADL, cognitive dysfunction, and well-being.

RESULTS

Continuing smokers tended to be lonelier. Participants who quit smoking took more medications and had greater cognitive dysfunction compared to those who continued smoking.

CONCLUSIONS

Greater cognitive dysfunction and high medication use or the physical causes for high medication use may precipitate smoking cessation in persons aged 75-94, potentially through a greater influence of caregivers on one's lifestyle.

IMPLICATIONS

Cognitive dysfunction and high medication use predicted smoking cessation. Smoking cessation for long time smokers may be influenced by greater ill health. Influence of caregivers may augment smoking cessation. Given these findings, for persistent smokers into old age, smoking cessation may occur at the time of physical and functional decline during the end of life period.

Cognitive Impairment in Hospitalized Seniors

Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization affects cognitive function and how cognitive impairment affects hospital outcomes. Possible interventions in cognitively impaired hospitalized seniors are reviewed.

Development of a Conceptual Model for Smoking Cessation: Physical Activity, Neurocognition, and Executive Functioning

PURPOSE

Considerable research has shown adverse neurobiological effects of chronic alcohol use, including long-term and potentially permanent changes in the structure and function of the brain; however, much less is known about the neurobiological consequences of chronic smoking, as it has largely been ignored until recently. In this article, we present a conceptual model proposing the effects of smoking on neurocognition and the role that physical activity may play in this relationship as well as its role in smoking cessation.

METHODS

Pertinent published peer-reviewed articles deposited in PubMed delineating the pathways in the proposed model were reviewed.

RESULTS

The proposed model, which is supported by emerging research, demonstrates a bidirectional relationship between smoking and executive functioning. In support of our conceptual model, physical activity may moderate this relationship and indirectly influence smoking behavior through physical activity-induced changes in executive functioning.

CONCLUSIONS

Our model may have implications for aiding smoking cessation efforts through the promotion of physical activity as a mechanism for preventing smoking-induced deficits in neurocognition and executive function.

Executive function in the context of chronic disease prevention: theory, research and practice

OBJECTIVE

To provide an overview of the nature, organization and measurement of executive function, and describe its significance for preventive medicine theory, research and practice.

METHOD

A conceptual and narrative review linking the operation of executive control systems to health behavior performance and health outcomes, within the context of chronic illness prevention.

RESULTS

Stronger executive function is linked with more consistent performance of a variety of health protective behaviors, less performance of health risk behaviors, and greater longevity in the existing observational research literature. These effects are not fully explained by demographic factors such as education, income and socioeconomic status, but may in some cases interact with them, or mediate their effects on other outcomes. Experimental manipulations of executive control suggest that the effect of executive function is causal, particularly in relation to the modulation of appetitive craving responses that may compete with healthy behaviors (or facilitate unhealthy behaviors).

CONCLUSION

Executive function is a potentially important variable in explanatory frameworks for health behavior and health outcomes. The size of effect and its endurance remain uncertain, though the causal status of its influence on some behaviors is becoming increasingly clear. Additional understanding of the relation between executive control and demand imposed by ecological context is an important frontier for research on changing behavior to prevent disease, and may be an explanatory factor in social patterning of these same conditions.

COgnitive-pulmonary disease

Over the past few decades, chronic obstructive lung disease (COPD) has been considered a disease of the lungs, often caused by smoking. Nowadays, COPD is regarded as a systemic disease. Both physical effects and effects on brains, including impaired psychological and cognitive functioning, have been demonstrated. Patients with COPD may have cognitive impairment, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning, and self-control. Possible causes are hypoxemia, hypercapnia, exacerbations, and decreased physical activity. Cognitive impairment in these patients may be related to structural brain abnormalities, such as gray-matter pathologic changes and the loss of white matter integrity which can be induced by smoking. Cognitive impairment can have a negative impact on health and daily life and may be associated with widespread consequences for disease management programs. It is important to assess cognitive functioning in patients with COPD in order to optimize patient-oriented treatment and to reduce personal discomfort, hospital admissions, and mortality. This paper will summarize the current knowledge about cognitive impairment as extrapulmonary feature of COPD. Hereby, the impact of smoking on cognitive functioning and the impact of cognitive impairment on smoking behaviour will be examined.

Executive dysfunction is independently associated with reduced functional independence in heart failure

AIMS AND OBJECTIVES

To examine the independent association between executive function with instrumental activities of daily living and health behaviours in older adults with heart failure.

BACKGROUND

Executive function is an important contributor to functional independence as it consists of cognitive processes needed for decision-making, planning, organising and behavioural monitoring. Impairment in this domain is common in heart failure patients and associated with reduced performance of instrumental activities of daily living in many medical and neurological populations. However, the contribution of executive functions to functional independence and healthy lifestyle choices in heart failure patients has not been fully examined.

DESIGN

Cross-sectional analyses.

METHODS

One hundred and seventy-five heart failure patients completed a neuropsychological battery and echocardiogram. Participants also completed the Lawton-Brody Instrumental Activities of Daily Living Scale and reported current cigarette use.

RESULTS

Hierarchical regressions revealed that reduced executive function was independently associated with worse instrumental activity of daily living performance with a specific association for decreased ability to manage medications. Partial correlations showed that executive dysfunction was associated with current cigarette use.

CONCLUSIONS

Our findings suggest that executive dysfunction is associated with poorer functional independence and contributes to unhealthy behaviours in heart failure. Future studies should examine whether heart failure patients benefit from formal organisation schema (i.e. pill organisers) to maintain independence.

RELEVANCE TO CLINICAL PRACTICE

Screening of executive function in heart failure patients may provide key insight into their ability to perform daily tasks, including the management of treatment recommendations.

Smoking-related prospective memory deficits observed on naturalistic everyday memory task

OBJECTIVE

This study assessed self-reported and objective prospective memory (PM) processes in smokers and a never-smoked comparison group. If persistent smoking does impair PM, then one would expect smokers recall being lower on a study that requires them to remember everyday activities when compared with a never-smoked group.

METHOD

An existing-groups design was used to compare a group of smokers with a never-smoked group on the self-report Prospective Memory Questionnaire (PMQ) and the Prospective Remembering Video Procedure (PRVP) measuring objective PM. An example of the location-action combination from the PRVP is 'At Thornton's shop' (location), 'Buy a bag of sweets' (action). Participants who reported using an illegal substance (e.g. ecstasy, cannabis), who drank excessively or were 'binge drinkers', or who reported suffering from a clinical condition, such as depression, were excluded from the study. Age, weekly 'safe levels' alcohol use, and strategy use were also measured and controlled for in the study. Each person was tested individually in a quiet laboratory setting on a university campus.

RESULTS

After controlling for variations in age, weekly alcohol use, and strategy use, smokers recalled significantly fewer location-action combinations on the PRVP when compared with a never-smoked group, with no between-group differences on self-reported PM as measured by the PMQ.

CONCLUSIONS

The findings suggest objective PM deficits are associated with persistent smoking - a relatively unexplored area of research. This cannot be attributed to other drug use, mood, or strategy use. The findings also suggest smokers lack self-awareness of such PM deficits. This study extends the area by utilising a more naturalistic object measure of PM and incorporating strict controls into the study.

Impairment of executive cognitive control in type 2 diabetes, and its effects on health-related behavior and use of health services

We evaluated whether, among persons with type 2 diabetes: (1) impaired executive cognitive functioning (ECF) is more common than among people without diabetes; (2) ECF is associated with the capacity to engage in instrumental health-related behaviors; and (3) worse ECF is associated with increased health services utilization. A population-based sample of 1,063 older people was interviewed regarding medical history and health services utilization; participants were administered the Mini Mental State Exam and the Behavioral Dyscontrol Scale, a measure of ECF. Participants with diabetes performed more poorly on cognitive measures than those without diabetes. Among those with diabetes, lower ECF was associated with more outpatient care and with ever having been in a nursing home. Impaired behavioral self-regulation may affect the capacity to engage in behaviors that could improve clinical status, resulting in greater health services use. The findings suggest the possibility of a positive feedback loop, with ECF deficits adversely affecting adherence, in turn leading to greater cognitive impairment-an issue for future research.

Smoking-related prospective memory deficits in a real-world task

BACKGROUND

Smokers, previous smokers and a never smoked group were compared on self-reported and real world prospective memory (PM - the cognitive ability of remembering to carry out particular actions at some future point in time).

METHODS

Twenty-seven current smokers, 24 people who had never smoked and 18 previous smokers were compared using an existing groups design. Scores on the long and short term PM subscales of the Prospective and Retrospective Memory Questionnaire (PRMQ) and scores on a Real World Prospective Memory Task (RWPMT) constituted the dependent measures. Smoking and other drug use were assessed by a Recreational Drug Use Questionnaire. The Hospital Anxiety and Depression Scale gauged levels of anxiety and depression. The National Adult Reading Test measured IQ, and retrospective memory was measured using the PRMQ. Gender, age, anxiety and depression, IQ, alcohol use and the retrospective memory scores, were measured as covariates and controlled for in the analysis.

RESULTS

A series of univariate ANCOVAs were applied to the main PM data across the three groups, controlling for variations in age, gender, mood, IQ, alcohol use and retrospective memory scores. These revealed no significant between-group differences on self-reported PM; however smokers recalled significantly fewer action-location combinations than the never smoked and previous smoker groups on the objective RWPMT.

CONCLUSIONS

Existing smokers showed reduced performance on RWPMT when compared to the never smoked group and previous smokers. Real-world PM impairments should be added to a growing list of neuropsychological sequelae associated with persistent smoking.

The role of nicotinic acetylcholine receptors in the medial prefrontal cortex and hippocampus in trace fear conditioning

Acute nicotine enhances multiple types of learning including trace fear conditioning but the underlying neural substrates of these effects are not well understood. Trace fear conditioning critically involves the medial prefrontal cortex and hippocampus, which both express nicotinic acetylcholine receptors (nAChRs). Therefore, nicotine could act in either or both areas to enhance trace fear conditioning. To identify the underlying neural areas and nAChR subtypes, we examined the effects of infusion of nicotine, or nicotinic antagonists dihydro-beta-erythroidine (DHβE: high-affinity nAChRs) or methyllycaconitine (MLA: low-affinity nAChRs) into the dorsal hippocampus, ventral hippocampus, and medial prefrontal cortex (mPFC) on trace and contextual fear conditioning. We found that the effects of nicotine on trace and contextual fear conditioning vary by brain region and nAChR subtype. The dorsal hippocampus was involved in the effects of nicotine on both trace and contextual fear conditioning but each task was sensitive to different doses of nicotine. Additionally, dorsal hippocampal infusion of the antagonist DHβE produced deficits in trace but not contextual fear conditioning. Nicotine infusion into the ventral hippocampus produced deficits in both trace and contextual fear conditioning. In the mPFC, nicotine enhanced trace but not contextual fear conditioning. Interestingly, infusion of the antagonists MLA or DHβE in the mPFC also enhanced trace fear conditioning. These findings suggest that nicotine acts on different substrates to enhance trace versus contextual fear conditioning, and that nicotine-induced desensitization of nAChRs in the mPFC may contribute to the effects of nicotine on trace fear conditioning.

Tobacco smoking in older people

Smoking remains prevalent in elderly people in the UK and similar countries. The adverse health effects of current smoking continue to accumulate in old age and stopping smoking in old age confers benefits on function, morbidity and mortality. Many elderly people wish to stop smoking and many are successful. Structured support from health and social care workers improves quit rates and nicotine replacement therapy can be an effective aid to smoking cessation in old age. Doctors and other healthcare staff should use the opportunities of patient contact to encourage older smokers to quit. Cognitive impairment is a barrier to successful smoking cessation.

Nicotine withdrawal-induced deficits in trace fear conditioning in C57BL/6 mice--a role for high-affinity beta2 subunit-containing nicotinic acetylcholine receptors

Nicotine alters cognitive processes that include working memory and long-term memory. Trace fear conditioning may involve working memory during acquisition while also allowing the assessment of long-term memory. The present study used trace fear conditioning in C57BL/6 mice to investigate the effects of acute nicotine, chronic nicotine and withdrawal of chronic nicotine on processes active during acquisition and recall 24 h later and to examine the nicotinic acetylcholine receptor subtypes (nAChRs) involved in withdrawal deficits in trace fear conditioning. During training, acute nicotine (0.09 mg/kg) enhanced, but chronic nicotine (6.3 mg/kg/day, 13 days) and withdrawal of chronic nicotine (6.3 mg/kg/day, 12 days) had no significant effect on, acquisition of trace conditioning. At recall, acute treatment enhanced conditioning while chronic nicotine had no effect and withdrawal of chronic nicotine resulted in deficits. Antagonist-precipitated withdrawal was used to characterize the nAChRs involved in the withdrawal deficits. The low-affinity nAChR antagonist MLA (1.5, 3 or 9 mg/kg) had no effect on trace fear conditioning, but the high-affinity nAChR antagonist DHbetaE (3 mg/kg) precipitated deficits in trace fear conditioning if administered at training or training and testing, but not if administered at testing alone. The beta2 nAChR subunit is involved in the withdrawal effects as withdrawal of chronic nicotine produced deficits in trace fear conditioning in wildtype but not in beta2-knockout mice. Thus, nicotine alters processes involved in both acquisition and long-term memory of trace fear conditioning, and high-affinity beta2 subunit-containing nAChRs are critically involved in the effects of nicotine withdrawal on trace fear conditioning.

Executive cognitive function and cessation of smoking among older smokers

Evaluation of: Brega AG, Grigsby J, Kooken R, Hamman RF, Baxter J: The impact of executive cognitive functioning on rates of smoking cessation in the San Luis Valley Health and Aging Study. Age Ageing 37, 521–525 (2008). The prevalence of smoking among the elderly is lower than in the general population, but aging populations in many countries mean that smoking-related diseases will increase as a health burden in the future. Executive cognitive functioning (ECF) allows people to plan and regulate behavior in order to achieve future goals. Impaired ECF is prevalent in those aged over 65 years and may be a factor in continued smoking among the elderly. Initial studies suggest that current ECF predicts successful cessation of smoking. Among ever smokers, 74% of those with unimpaired ECF had successfully quit compared with 65% of those with some level of ECF impairment. However, a general measure of cognition did not predict cessation. These findings have implications for how cessation of smoking programs can be improved in order to help older smokers quit smoking by providing more social support as well as the removal of smoking cues.