Structure of executive functions in young and in older persons

French adult normative data for a Standard Executive Neuropsychological Test Battery

OBJECTIVE

Executive impairments are frequent and may concern a large spectrum of health conditions throughout life. Given the complexity of the executive functions, their assessment requires the administration of multiple tests. There is only one source of French-language normative data for seven traditional executive tests for adults under age 50. The aim of the present study was to establish demographically adjusted normative data of four executive tests commonly used during the neuropsychological assessment in France for adults aged 18-65.

METHOD

The following tools were administered to 518 community adults aged from 18 to 65: Digit Span, Trail Making Test, Color Word Interference Test, and Verbal Fluency Test. An Overall Test Battery Mean was computed. Multiple regressions were computed for normally distributed scores and percentiles were established for non-normally distributed scores.

RESULTS

Multiple regression analyses indicated that younger age and higher education were both associated with better performance. Age did not predict the number of correct responses on the Verbal Fluency Test. Gender did not have any effect on executive performances. Regression equations to calculate Z-scores are presented. Percentiles are presented for the number of recorded errors on the Trail Making Test, Color Word Interference Test, and Verbal Fluency Test.

CONCLUSIONS

We provide reliable and updated norms for four executive tests that are among the most used by clinical neuropsychologists in France. Our work represents a valuable addition to the limited norms currently available for the assessment of executive functions in French young and middle-aged adults.

The validity of studying healthy aging with cognitive tests measuring different constructs

A clinically useful characterization of the cognitive aging process requires the development of valid and robust behavioral tests, with an emphasis on explaining and understanding typical inter-individual variability in cognition. Here, using a dataset that includes behavioral scores collected with the National Institute of Health Toolbox Cognition Battery (NIHTB-CB) and other auxiliary tests, we examined (1) the differences between young and old adults across different cognitive domains, (2) the strength of across-subject correlations in behavioral test scores, (3) the consistency of low-dimensional behavioral representations across age using factor analysis, and (4) the accuracy of behavioral scores in predicting participants' age. Our results revealed that (1) elderly females had better verbal episodic memory scores than elderly males, (2) across-subject correlations between behavioral tests varied with age group, (3) although a three-factor model explained the behavioral data in both age groups, some tasks loaded to different factors between the two groups, and (4) age-performance relationship (i.e. a regression model linking age to cognitive scores) in one group cannot be extrapolated to predict age in the other group, indicating an inconsistency in age-performance relationships across groups. These findings suggest that executive function tests might tap into different cognitive processes in different age groups, which might ultimately suggest that a statistically significant between-group difference in test performance might not always reflect differences in the same underlying cognitive processes. Overall, this study calls for more caution when interpreting age-related differences and similarities between age groups with different cognitive abilities even when the same tests are used.

Development of working memory and inhibitory control in early childhood: Cross-sectional analysis by age intervals and gender in Ecuadorian preschoolers

Working memory (WM) and inhibitory control (IC) play a crucial role in learning during early childhood. The literature suggests a non-linear developmental trajectory of executive functions (EFs) with varied results according to gender, usually attributed to environmental factors. However, there is insufficient and inconclusive data on whether this pattern is reproduced in the Latin American preschool population since most studies have been conducted in English-speaking, European, and Asian environments. Thus, objectively comparing children's executive performance across diverse international geographical contexts becomes challenging. This study aimed to conduct a cross-sectional analysis of the performance in WM and IC of 982 Ecuadorian preschoolers aged between 42 and 65 months (M = 53.71; SD = 5.714) and belonging to medium-high, medium, and low-medium socioeconomic strata. The participants consisted of 496 boys (M = 53.77; SD = 5.598) and 486 girls (M = 53.65; SD = 5.834), representing nine cities in Ecuador. To assess the effect of age and gender on performance in these two domains, the sample was divided into four 6-month age intervals. Two tests were administered to the participants, and a survey was conducted with 799 of their usual caregivers. Viewing the cross-sectional mean scores of the WM and IC tests as a temporal continuum reveals an upward trend in each age interval studied. Girls outperformed boys on the IC test, showing statistically significant differences in the earliest age interval. The gender differences in executive performance reported in the literature emphasize the need to explore the modulating effect of environmental variables on early childhood development. This information could offer valuable insights for adapting and optimizing cognitive and didactic strategies in early childhood tailored to the characteristics and needs of the preschool population.

Executive function abilities in cognitively healthy young and older adults-A cross-sectional study

A prominent feature of cognitive aging is the decline of executive function (EF) abilities. Numerous studies have reported that older adults perform poorer than younger adults in such tasks. In this cross-sectional study, the effect of age on four EFs, inhibition, shifting, updating, and dual-tasking, was examined in 26 young adults (mean 21.18  years) and 25 older adults (mean 71.56  years) with the utilization of a pair of tasks for each EF. The tasks employed for DT were the Psychological Refractory Period paradigm (PRP) and a modified test for everyday attention, for inhibition the Stroop and Hayling sentence completion test (HSCT), for shifting a task switching paradigm and the trail making test (TMT), and for updating the backward digit span (BDS) task and a n-back paradigm. As all participants performed all tasks, a further aim was to compare the size of the age-related cognitive decline among the four EFs. Age-related decline was observed in all four EFs in one or both of the tasks employed. The results revealed significantly poorer performance in the older adults in the response times (RTs) of the PRP effect, interference score of the Stroop, RT inhibition costs of the HSCT, RT and error-rate shifting costs of the task switching paradigm, and the error-rate updating costs of the n-back paradigm. A comparison between the rates of decline revealed numerical and statistically significant differences between the four EFs, with inhibition showing the greatest decline, followed by shifting, updating, and dual-tasking. Thus, we conclude that with age, these four EFs decline at different rates.

The association of executive functions and physical fitness with cognitive-motor multitasking in a street crossing scenario

Age-related decline in cognitive-motor multitasking performance has been attributed to declines in executive functions and physical fitness (motor coordinative fitness and cardiovascular fitness). It has been suggested that those cognitive and physical resources strongly depend on lifestyle factors such as long-term regular physical activity and cognitive engagement. Although research suggests that there is covariation between components of executive functions and physical fitness, the interdependence between these components for cognitive-motor multitasking performance is not yet clear. The aim of the study was to examine the contribution and interrelationship between executive functions, motor coordinative fitness, and cardiovascular fitness on street crossing while multitasking. We used the more ecologically valid scenario to obtain results that might be directly transferable to daily life situation. Data from 50 healthy older adults (65-75 years, 17 females, recruited in two different cities in Germany) were analyzed. Participants' executive functions (composite score including six tests), motor coordinative fitness (composite score including five tests), and cardiovascular fitness (spiroergometry), as well as their street crossing performance while multitasking were assessed. Street crossing was tested under single-task (crossing a two-line road), and multitask conditions (crossing a two-line road while typing numbers on a keypad as simulation of mobile phone use). Street crossing performance was assessed by use of cognitive outcomes (typing, crossing failures) and motor outcomes (stay time, crossing speed). Linear mixed-effects models showed beneficial main effects of executive functions for typing (p = 0.004) and crossing failures (p = 0.023), and a beneficial main effect of motor coordinative fitness for stay time (p = 0.043). Commonality analysis revealed that the proportion of variance commonly explained by executive functions, motor coordinative fitness, and cardiovascular fitness was small for all street crossing outcomes. For typing and crossing failures (cognitive outcomes), the results further showed a higher relative contribution of executive functions compared to motor coordinative fitness and cardiovascular fitness. For stay time (motor outcome), the results correspondingly revealed a higher relative contribution of motor coordinative fitness compared to executive functions and cardiovascular fitness. The findings suggest that during cognitive-motor multitasking in everyday life, task performance is determined by the components of executive functions and physical fitness related to the specific task demands. Since multitasking in everyday life includes cognitive and motor tasks, it seems to be important to maintain both executive functions and physical fitness for independent living up to old age.

Cognitive-motor multitasking in older adults: a randomized controlled study on the effects of individual differences on training success

Background

Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor training on multitasking performance in older adults. Previous work, however, has not regarded interindividual differences in cognitive functioning and motor fitness that may affect training benefits. The current study aims to identify whether different training programs may have differential effects on multitasking performance depending on the initial level of cognitive functioning and motor fitness.

Methods

We conduct a 12-week single-blinded randomized controlled trial. A total of N = 150 healthy older adults are assigned to either a single cognitive, a single motor, or a simultaneous cognitive-motor training. Participants are trained twice per week for 45 min. A comprehensive test battery assesses cognitive functions, motor and cardiovascular fitness, and realistic multitasking during walking and driving in two virtual environments. We evaluate how multitasking performance is related not only to the training program, but also to participants’ initial levels of cognitive functioning and motor fitness.

Discussion

We expect that multitasking performance in participants with lower initial competence in either one or both domains (cognitive functioning, motor fitness) benefits more from single-task training (cognitive training and/or motor training). In contrast, multitasking performance in participants with higher competence in both domains should benefit more from multitask training (simultaneous cognitive-motor training). The results may help to identify whether tailored training is favorable over standardized one-size-fits all training approaches to improve multitasking in older adults. In addition, our findings will advance the understanding of factors that influence training effects on multitasking.

Trial registration

DRKS (German Clinical Trials Register), DRKS00022407. Registered 26/08/2020 - Retrospectively registered at https://www.drks.de/drks_web/setLocale_EN.do

Neurocognitive factorial structure of executive functions: Evidence from neurotypicals and frontotemporal dementia

The latent structure of executive functions (EFs) remains controversial. Confirmatory factorial analysis (CFA) has provided support for both multidimensional (assumes EFs to be functionally separable but related components) and bifactor (proposes all components are nested within a common factor) models. However, these CFA models have never been compared in patient samples, nor regarding their neuroanatomical correlates. Here, we systematically contrast both approaches in neurotypicals and in a neurodegenerative lesion model (patients with the behavioral variant frontotemporal dementia, bvFTD), characterized by executive deficits associated with frontal neurodegeneration. First, CFA was used to test the models' fit in a sample of 341 neurotypicals and 29 bvFTD patients based on performance in an executive frontal screening battery which assesses working memory, motor inhibition, verbal inhibition, and abstraction capacity. Second, we compared EFs factor and observed scores between patients and matched controls. Finally, we used voxel-based morphometry (VBM) to compare the grey matter correlates of factor and observed scores. CFA results showed that both models fit the data well. The multidimensional model, however, was more sensitive than the bifactor model and the observed scores to detect EFs impairments in bvFTD patients. VBM results for the multidimensional model revealed common and unique grey matter correlates for EFs components across prefrontal-insular, posterior, and temporal cortices. Regarding the bifactor model, only the common factor was associated with prefrontal-insular hubs. Observed scores presented scant, non-frontal grey matter associations. Converging behavioral and neuroanatomical evidence from healthy populations and a neurodegenerative model of EFs supports an underlying multidimensional structure.

Data-driven approaches to executive function performance and structure in aging: Integrating person-centered analyses and machine learning risk prediction

Objective: Executive function (EF) performance and structure in nondemented aging are frequently examined with variable-centered approaches. Person-centered analytics can contribute unique information about classes of persons by simultaneously considering EF performance and structure. The risk predictors of these classes can then be determined by machine learning technology. Using data from the Victoria Longitudinal Study we examined two goals: (a) detect different underlying subgroups (or classes) of EF performance and structure and (b) test multiple risk predictors for best discrimination of these detected subgroups. Method: We used a classification sample (n = 778; M_age = 71.42) for the first goal and a prediction subsample (n = 570; M_age = 70.10) for the second goal. Eight neuropsychological measures represented three EF dimensions (inhibition, updating, shifting). Fifteen predictors represented five domains (genetic, functional, lifestyle, mobility, demographic). Results: First, we observed two distinct classes: (a) lower EF performance and unidimensional structure (Class 1) and (b) higher EF performance and multidimensional structure (Class 2). Second, Class 2 was predicted by younger age, more novel cognitive activity, more education, lower body mass index, lower pulse pressure, female sex, faster balance, and more physical activity. Conclusions: Data-driven modeling approaches tested the possibility of an EF aging class that displayed both preserved EF performance levels and sustained multidimensional structure. The two observed classes differed in both performance level (lower, higher) and structure (unidimensional, multidimensional). Machine learning prediction analyses showed that the higher performing and multidimensional class was associated with multiple brain health-related protective factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Distracting tasks have persisting effects on young and older drivers' braking performance

It is well established that car driving performance suffers when the driver concurrently engages in a distracting activity, such as talking on a cell phone. The present study investigates whether the effects of driver distraction are short-lived, or rather persist for some time. Age-related differences are evaluated as well. Sixty-three young and 61 older adults were tested in a driving simulator. They were asked to follow a lead car that drove at a constant speed, and to concurrently engage in a pseudorandom sequence of distracting tasks (typing, reasoning, memorizing). When the lead car braked, participants had to brake as well to prevent a collision. The stimulus onset asynchrony between the braking task and the last preceding distraction was 11.49 ± 1.99 s. Each person was tested once in a multitasking condition (as described above), and once in a control condition without distracting tasks. Outcome measures quantified distance keeping and lane keeping while participants braked to the lead car. We found that braking responses differed significantly between conditions; this difference could be interpreted as a combination of performance deficits and compensatory strategies in the multitasking condition compared to the control condition. We also found significant differences between age groups, which could be interpreted similarly. Differences between age groups were less pronounced in the multitasking than in the control condition. All observed effects were associated with participants' executive functioning. Our findings confirm that distractions have an impact on braking responses, and they document for the first time that this impact can persist for about 11.5 s. We attribute this persistence to a task set effect, and discuss the practical relevance of our findings.

Toward Predicting Human Performance Outcomes From Wearable Technologies: A Computational Modeling Approach

Wearable technologies for measuring digital and chemical physiology are pervading the consumer market and hold potential to reliably classify states of relevance to human performance including stress, sleep deprivation, and physical exertion. The ability to efficiently and accurately classify physiological states based on wearable devices is improving. However, the inherent variability of human behavior within and across individuals makes it challenging to predict how identified states influence human performance outcomes of relevance to military operations and other high-stakes domains. We describe a computational modeling approach to address this challenge, seeking to translate user states obtained from a variety of sources including wearable devices into relevant and actionable insights across the cognitive and physical domains. Three status predictors were considered: stress level, sleep status, and extent of physical exertion; these independent variables were used to predict three human performance outcomes: reaction time, executive function, and perceptuo-motor control. The approach provides a complete, conditional probabilistic model of the performance variables given the status predictors. Construction of the model leverages diverse raw data sources to estimate marginal probability density functions for each of six independent and dependent variables of interest using parametric modeling and maximum likelihood estimation. The joint distributions among variables were optimized using an adaptive LASSO approach based on the strength and directionality of conditional relationships (effect sizes) derived from meta-analyses of extant research. The model optimization process converged on solutions that maintain the integrity of the original marginal distributions and the directionality and robustness of conditional relationships. The modeling framework described provides a flexible and extensible solution for human performance prediction, affording efficient expansion with additional independent and dependent variables of interest, ingestion of new raw data, and extension to two- and three-way interactions among independent variables. Continuing work includes model expansion to multiple independent and dependent variables, real-time model stimulation by wearable devices, individualized and small-group prediction, and laboratory and field validation.

Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis

Driving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.

Cognitive dedifferentiation as a function of cognitive impairment in the ADNI and MemClin cohorts

The cause of cognitive dedifferentiation has been suggested as specific to late-life abnormal cognitive decline rather than a general feature of aging. This hypothesis was tested in two large cohorts with different characteristics. Individuals (n = 2710) were identified in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) research database (n = 1282) in North America, and in the naturalistic multi-site MemClin Project database (n = 1223), the latter recruiting from 9 out of 10 memory clinics in the greater Stockholm catchment area in Sweden. Comprehensive neuropsychological testing informed diagnosis of dementia, mild cognitive impairment (MCI), or subjective cognitive impairment (SCI). Diagnosis was further collapsed into cognitive impairment (CI: MCI or dementia) vs no cognitive impairment (NCI). After matching, loadings on the first principal component were higher in the CI vs NCI group in both ADNI (53.1% versus 38.3%) and MemClin (33.3% vs 30.8%). Correlations of all paired combinations of individual tests by diagnostic group were also stronger in the CI group in both ADNI (mean inter-test r = 0.51 vs r = 0.33, p < 0.001) and MemClin (r = 0.31 vs r = 0.27, p = 0.042). Dedifferentiation was explained by cognitive impairment when controlling for age, sex, and education. This finding replicated across two separate, large cohorts of older individuals. Knowledge that the structure of human cognition becomes less diversified and more dependent on general intelligence as a function of cognitive impairment should inform clinical assessment and care for these patients as their neurodegeneration progresses.

Are There Extended Cognitive Improvements from Different Kinds of Acute Bouts of Physical Activity?

Acute bouts of physical activity of at least moderate intensity have shown to enhance cognition in young as well as older adults. This effect has been observed for different kinds of activities such as aerobic or strength and coordination training. However, only few studies have directly compared these activities regarding their effectiveness. Further, most previous studies have mainly focused on inhibition and have not examined other important core executive functions (i.e., updating, switching) which are essential for our behavior in daily life (e.g., staying focused, resisting temptations, thinking before acting), as well. Therefore, this study aimed to directly compare two kinds of activities, aerobic and coordinative, and examine how they might affect executive functions (i.e., inhibition, updating, and switching) in a test-retest protocol. It is interesting for practical implications, as coordinative exercises, for example, require little space and would be preferable in settings such as an office or a classroom. Furthermore, we designed our experiment in such a way that learning effects were controlled. Then, we tested the influence of acute bouts of physical activity on the executive functioning in both young and older adults (young 16–22 years, old 65–80 years). Overall, we found no differences between aerobic and coordinative activities and, in fact, benefits from physical activities occurred only in the updating tasks in young adults. Additionally, we also showed some learning effects that might influence the results. Thus, it is important to control cognitive tests for learning effects in test-retest studies as well as to analyze effects from physical activity on a construct level of executive functions.

Shedding Light on the Effects of Moderate Acute Exercise on Working Memory Performance in Healthy Older Adults: An fNIRS Study

Numerous studies have reported the beneficial effects of acute exercise on executive functions. Less is known, however, about the effects of exercise on working memory as one subcomponent of executive functions and about its effects on older adults. We investigated the effects of acute moderate-intensity exercise on working memory performance, the respective cortical hemodynamic activation patterns, and the development and persistence of such effects in healthy older adults. Forty-four participants (M: 69.18 years ± 3.92; 21 females) performed a letter 2-back task before and at three time points after (post 15 min, post 30 min, and post 45 min) either listening to an audiobook or exercising (15 min; 50% VO2-peak). Functional near-infrared spectroscopy (fNIRS) was used to assess cortical hemodynamic activation and brain-behavior correlations in the fronto-parietal working memory network. Overall, we found no group differences for working memory performance. However, only within the experimental group, 2-back performance was enhanced 15 min and 45 min post-exercise. Furthermore, 15 min post-exercise frontal activation predicted working memory performance, regardless of group. In sum, our results indicate slight beneficial effects of acute moderate-intensity exercise on working memory performance in healthy older adults. Findings are discussed in light of the cognitive aging process and moderators affecting the exercise-cognition relationship.

Strategic prioritisation enhances young and older adults' visual feature binding in working memory

Visual working memory for features and bindings is susceptible to age-related decline. Two experiments were used to examine whether older adults are able to strategically prioritise more valuable information in working memory and whether this could reduce age-related impairments. Younger (18–33 years) and older (60–90 years) adults were presented with coloured shapes and, following a brief delay, asked to recall the feature that had accompanied the probe item. In Experiment 1, participants were either asked to prioritise a more valuable object in the array (serial position 1, 2, or 3) or to treat them all equally. Older adults exhibited worse overall memory performance but were as able as younger adults to prioritise objects. In both groups, this ability was particularly apparent at the middle serial position. Experiment 2 then explored whether younger and older adults’ prioritisation is affected by presentation time. Replicating Experiment 1, older adults were able to prioritise the more valuable object in working memory, showing equivalent benefits and costs as younger adults. However, processing speed, as indexed by presentation time, was shown not to limit strategic prioritisation in either age group. Taken together, these findings demonstrate that, although older adults have poorer visual working memory overall, the ability to strategically direct attention to more valuable items in working memory is preserved across ageing.

Depression, social support, executive functioning, functionality, and quality of life in institutionalized elderly people

Aim

Our aim was to study the executive functioning, functionality, and quality of life of institutionalized old aged persons and to determine the potential roles of self-reported depression and satisfaction with social support on these domains.

Method

The sample comprised 36 volunteers (13 males and 23 females) aged between 71 and 94 years. The measures used consisted of well-established battery of neuropsychological tests. A comparative study was performed.

Results

Participants with depressive symptoms shown impaired executive functioning. Cognitive flexibility, functionality in instrumental activities of daily living, and quality of life are more affected in participants with higher levels of depression that also report higher levels of satisfaction with social support.

Conclusion

This result is intriguing and may highlight the relevance of considering not only depression, but also factors related to social isolation and loneliness in the explanation of cognitive performance, functionality, and quality of life.

Executive functions and memory in bipolar disorders I and II: new insights from meta-analytic results

OBJECTIVE

To perform a systematic review and meta-analysis of executive functions (EF) and episodic memory in bipolar disorder (BD).

METHODS

A literature search was conducted on three electronic databases. Results were combined using random-effects meta-analysis.

RESULTS

A total of 126 studies (6424 patients with BDI, 702 with BDII, and 8276 controls) were included. BDI was associated with moderate to large impairments across all cognitive functions and BDII with small-to-medium impairments. Small significant differences were identified between BDI and BDII on all cognitive functions except inhibition. The Trail Making Test (TMT) (g = 0.74, 95% CI: 0.67-0.80), Hayling Test (g = 0.58, 95% CI: 0.34-0.81), Digit Span Total (g = 0.79, 95% CI: 0.57-1.01), and Category Fluency (g = 0.59, 95% CI: 0.45-0.72) tasks were most sensitive to cognitive impairment in BDI. The TMT (g = 0.65, 95% CI: 0.50-0.80) and Category Fluency (g = 0.56, 95% CI: 0.37-0.75) were also sensitive to cognitive alterations in patients with BDII.

CONCLUSION

BD type I was associated with more severe and widespread impairments than BDII, which showed smaller impairments on all functions except inhibition, where impairments were larger. Education and (hypo)manic symptoms should be further investigated in future studies due to their possible influence on the neuropsychological profile of BD. The instruments identified in this review should be considered for inclusion in cognitive assessment batteries in BD.