Domains of cognition and their assessment

Assessing neurocognitive outcomes in PTSD: a multilevel meta-analytical approach

Background: Evidence supporting the association between posttraumatic stress disorder (PTSD) and cognitive impairment is accumulating. However, less is known about which factors influence this association.Objective: The aims of this meta-analysis were to (1) elucidate the association between PTSD and a broad spectrum of cognitive impairment, including the risk of developing neurocognitive disorder (NCD) later in life, using a multilevel meta-analytic approach, and (2) identify potential moderating factors of this association by examining the effects of age (20-39, 40-59, 60+), study design (cross-sectional or longitudinal), study population (war-exposed populations/veterans or the general population), neurocognitive outcome assessed (i.e. a diagnosis of NCD or type of cognitive domain as classified according to A Compendium of Neuropsychological tests), gender (≥50% women or <50% women), study quality (high vs low), type of PTSD measure (self-report or clinical diagnosis), as well as the presence of comorbidities such as traumatic brain injury (TBI), depression, and substance use (all coded as either present or absent).Method: Peer-reviewed studies on this topic were extracted from PubMed and Web of Science with predetermined keywords and criteria. In total, 53 articles met the criteria. Hedge's g effect sizes were calculated for each study and a three-level random effect meta-analysis conducted.Results: After accounting for publication bias, the results suggested a significant association between PTSD and cognitive impairment, g = 0.13 (95% CI: 0.10-0.17), indicating a small effect. This association was consistent across all examined moderators, including various neurocognitive outcomes, age, gender, study design, study population, study quality, type of PTSD measure, and comorbidities such as depression, substance use, and TBI.Conclusions: These findings collectively suggest that PTSD is associated with both cognitive impairment and NCD. This emphasizes the need for early intervention (including prevention strategies) of PTSD, alongside monitoring cognitive function in affected individuals.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021219189, date of registration: 02.01.2021.

Lower- versus higher-order suicide-related attentional processing measures as predictors of adolescent suicide ideation and attempt

Cognitive theories suggest that biased suicide-related attentional processing confers risk for suicide ideation (SI) and attempts (SAs), but studies to date, which have been mixed, have not compared lower- and higher-order measures of attentional processes. The present study examined attention fixation, attention disengagement, and semantic interference as predictors of future SI and SA among adolescents, a high-risk age group for onset of SI and SAs. Adolescents (N = 135) (75 % female), ages 12-19 (M = 15.4, SD = 1.9), who presented to emergency or outpatient departments with SI (n = 84) or a SA (n = 51) completed an attention disengagement task (ADT), Suicide Stroop task, and the Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ). A subsample of adolescents completed 3-month (n = 98) and 12-month follow-up assessments (n = 96) of SI severity and SA (n = 118) (based on adolescent or caregiver report). AFSEQ score predicted SI severity at 3- and 12-months, respectively, b = 0.47, p < .05; b = 0.44, p < .01, adjusting for ADT and relevant covariates, and also predicted SA at follow up, OR = 1.06, 95 % CI = 1.00-1.12, p < .05, adjusting for SA history, but not after adjusting for SI. Greater suicide-related attention disengagement difficulty predicted greater SI severity at 12 months, b = 0.03, p < .05, but not at 3 months. Self-reported, higher-order, attentional fixation may better predict future suicide-related risk among diverse adolescents than lower-order cognitive tasks assessing suicide-related attention disengagement or semantic interference.

Different language profiles on neuropsychological tests in dementia with Lewy bodies and Alzheimer's disease

Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) may lead to different cognitive profiles. The performance on single language tests have been investigated in these patient-groups, but few studies have compared DLB and AD patients' language performances on different types of tests. The aim was to compare performances for patients with DLB, AD and healthy controls on different aspects of language function. Boston Naming Test, Naming of famous faces and verbal fluency (both semantic and lexical) were investigated in 90 DLB patients, 77 matched AD patients (MMSE score ≥ 21), and in a control group (N = 61). The patients had significantly lower scores on all tests compared to controls. The AD patients scored significantly lower than DLB patients on naming measures whereas the lexical fluency score was significantly lower in DLB. No significant differences were found for the semantic fluency. The frequency of impairment on the Boston Naming Test was higher in AD as compared to DLB, whereas the frequency of impairment on the lexical fluency test was significantly higher in DLB. In conclusion, DLB may lead to a different language profile than AD, and performance on language-based tests may help to differentiate patients with AD and DLB.

Effect of cariprazine on attention and quality of life in patients with predominant negative symptoms of schizophrenia: A post-hoc analysis

Background

Cariprazine, a potent dopamine D3-preferring D3/D2 receptor partial agonist, has demonstrated benefits on negative symptoms among patients with schizophrenia. Secondary endpoint and post-hoc analyses have also suggested a benefit of cariprazine on quality of life (QoL) and attention.

Methods

Data for this post-hoc analysis were pooled from two 6-week, placebo-controlled phase 3 trials evaluating cariprazine among patients with acute exacerbations of schizophrenia. One study included an aripiprazole active-control arm for assay sensitivity.Two populations were analyzed: pooled intention-to-treat (ITT) population (N = 1043), and the pooled subgroup with predominant negative symptoms (PNS, n = 215), as defined by the Positive and Negative Syndrome Scale (PANSS) subscale and item cut-off criteria at baseline. Analyses of interest were: Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) total score; Cognitive Drug Research (CDR) power of attention (PoA), and continuity of attention (CoA).

Results

Among study completers, cariprazine and aripiprazole were associated with significant SQLS-R4 improvements in the ITT and PNS populations. Differences in CDR-PoA scores were significant for cariprazine vs. placebo in the ITT and PNS populations, but not for aripiprazole in the ITT or PNS analyses. Differences in CDR-CoA scores were significant for cariprazine vs. placebo in the ITT and PNS analyses; and was significant for aripiprazole vs. placebo in the PNS analysis, but not in the ITT analysis.

Conclusions

This post-hoc analysis suggests that cariprazine may be associated with beneficial effects on measures of attention and QoL among patients with schizophrenia, and these effects could be more pronounced among individuals with PNS.

Impact of artificial colored lights on performance in working memory task

The contemporary lifestyle obligates exposure to artificially illuminated environments often with a variation in spectral composition of light. The wavelength of light, perceived as the color, differentially stimulates the short, medium, and long wavelength cones. Through the non-image-forming pathways, light possibly affects cognitive functions including working memory. Commensurately, this warrants an evaluation of the effects of exposure to colored lights of specific wavelength, on the performance in cognitive task. A within-subject approach was planned to ascertain the impact of light in white, red, green, and blue wavelengths (corresponding to the retinal cone cells) on performance in the Forward Digit Span Task (FDST) and Backward Digit Span Task (BDST) in four randomized sessions. Each light exposure session was preceded by 15 min of dark state and performances were assessed using percent accuracy. The mean age of participants (N = 50) was 28.8 years. A statistically significant difference was found in performance in FDST (P < 0.0005) and BDST (P < 0.0005) with exposure to different colored light (specific wavelengths) when compared to white light (broad-spectrum). Performance in FDST was better than the performance in BDST in all light conditions. The results suggest that working memory performance was affected by the color of light and performance in DST was better under red light than other lights. Therefore, the color of light plays an important role in cognitive performance and ambient light color needs to be adjusted while testing cognitive functions. Red lights may enhance memory recall compared to blue and green lights.

Life course socioeconomic position and cognitive aging in later life: A scoping review

BACKGROUND AND OBJECTIVES

Low socioeconomic position (SEP) throughout the life course is related to poorer cognitive health in later life, but debate ensues on the life course models for this association. To advance inquiry on the topic, we conducted a scoping review.

RESEARCH DESIGN AND METHODS

We examined the association between life course SEP and cognitive function in later life in observational studies-considering cognition both as a cross-sectional level and as a longitudinal trajectory across cognitive domains-and assessed whether the empirical evidence supported life course models. We focused on studies in the general population with cognition measured in the second half of life (45 +). Forty-two studies (21 datasets) were included representing 595,276 participants (201,375 across unique datasets) from 46 countries.

RESULTS

For cognitive level, studies consistently found associations between SEP at various stages of the life course, both in overall cognition and across specific cognitive domains. These associations were generally robust to confounding and mediating factors. For cognitive trajectory, studies showed inconclusive associations with SEP across life course and across cognitive domains. Results supported the sensitive period, pathway, and accumulation models, but not the critical period model. Results supported that education acts as a pathway (and potential mediator) in the association between early-life SEP and later-life cognition.

DISCUSSION AND IMPLICATIONS

SEP throughout the life course has a robust association with later-life cognitive level, but not decline. Early-life cognitive enrichment for young people raised in socioeconomically disadvantaged households may reduce the SEP gap in cognitive functioning during later life.

Chinese validation of "subjective motoric cognitive risk syndrome" screening tool in patients with coronary artery disease using Rasch analysis

Objective

Subjective motoric cognitive risk syndrome (MCR-S) is a well-established screening tool that has been validated for objective motoric cognitive risk syndrome (MCR-O) and predicted risk of incident dementia. MCR is associated with cardiovascular factors and coronary artery disease (CAD). MCR-S is crucial for remote cognitive screening but has only been validated in community settings so far. Our study aimed to validate a Chinese version of the MCR-S in CAD patients.

Method

The Chinese version of the MCR-S was obtained through a standardized forward-backward translation and cultural adaptation. 338 CAD patients were recruited. Traditional analysis based on classical test theory and Rasch analysis based on latent trait theory were performed on the MCR-S for validation. Receiver operating characteristic analysis was applied to determine the discriminative ability of MCR-S for the MCR-O in CAD patients.

Results

The MCR-S met the unidimensionality, lack of local dependency or disordered thresholds, and good fit value for each item of the Rasch model, the item-person map shows that the item's estimate of capacity is appropriate. MCR-S has good content validity, criterion-related validity, and test-retest reliability. An optimal cut-score of 4.6 on the MCR-S score was determined to have good sensitivity (79.2%) and specificity (71.3%) for MCR-O in CAD patients.

Conclusion

The Chinese version of MCR-S meets the requirements of the Rasch model and has good validity in CAD patients. The validated MCR-S cutoff can support long-term monitoring and early intervention for CAD patients at risk of MCR-O.

Cognitive Impairments in Patients with Rheumatoid Arthritis and Comorbid Anxiety and Depressive Disorders: Outcomes of the Five-Year Prospective Study

The aim of this study was to assess the baseline rates and five-years outcomes of mild cognitive impairments (MCIs) in patients with rheumatoid arthritis (RA) and comorbid anxiety and depressive disorders (ADDs) receiving traditional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or adequate psychopharmacotherapy (PPT), as well as to assess the factors associated with MCI after five years. A total of 128 RA patients were enrolled, ADDs were diagnosed in 123 (96.1%) patients by a licensed psychiatrist. Severity of depression and anxiety was evaluated with Montgomery-Asberg and Hamilton Anxiety scales. CIs were diagnosed during clinical and psychological examination using the battery of pathopsychological and projective techniques. CI outcomes were considered favourable in cases with no CI diagnosed throughout the study and in cases of CI reversal. PPT was offered, 52 (42.3%) patients agreed. Patients were  divided into the following treatment groups: сsDMARDs (n = 39), сsDMARDs + PPT (n = 43), сsDMARDs + bDMARDs (n = 32), and сsDMARDs + bDMARDs + PPT (n = 9). Multivariable logistic regression was performed to determine factors associated with CI after five years. MCIs were diagnosed in the majority of RA patients (73.2%), including logical thinking impairments (51.2%) and memory deficit (67.5%). At a 5-year endpoint, 74 patients were included. Total CI rates in no-PPT groups increased from 69 to 85.7% (p = 0.024) and was higher compared to PPT groups (р = 0.021, 85.7% vs 62.5%, RR 1.37). Patients with favourable CI outcomes had lower major depression prevalence and baseline Montgomery-Asberg scores, major improvement in depression symptoms, and higher rates of ADD remission after five years. Baseline DAS28 (OR 1.29, p < 0.001) was positively associated and remission of ADD negatively associated with MCI after five years (OR 0.25, p = 0.03), R2 = 0.48, p < 0.001. ADDs and MCIs are highly prevalent in RA patients. While CIs tend to persist and worsen over time, PPT is associated with lower CI rates in long-term perspective. Personalized PPT with antidepressants and neuroleptics may show potential to lessen the rates of MCIs in RA patients with ADDs.

Effects of Tea (Camellia sinensis) or its Bioactive Compounds l-Theanine or l-Theanine plus Caffeine on Cognition, Sleep, and Mood in Healthy Participants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

CONTEXT

The bioactive compounds found in tea from Camellia sinensis, namely theanine, caffeine, and polyphenols, can potentially improve short-term and long-term health outcomes.

OBJECTIVE

The aim of this study was to assess the effects of tea, theanine alone, or theanine plus caffeine on cognition, mood, and sleep outcomes, using data from randomized controlled trials (RCTs) in healthy participants.

DATA SOURCES

The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, and Ovid Medline were searched up to and including August 2023.

DATA EXTRACTION

Data relevant to the participants, interventions, comparisons, outcomes (ie, cognition, mood, and sleep), and study design were extracted.

DATA ANALYSIS

Fifty RCTs were included in the review, of which 15 were eligible for at least 1 meta-analysis, most commonly performed by use of standardized mean differences (SMD), in random effects models. After intake of theanine plus caffeine, and of placebo, small-to-moderate differences were found between these interventions in the first hour (h1) and second hour (h2), that favoured theanine plus caffeine, with regard to cognition and mood outcomes such as choice reaction time (h1: SMD, -0.48; 95% CI, -1.01, 0.05), digit vigilance task accuracy (h2: SMD, 0.20; 95% CI, 0.02, 0.38), attention switching task accuracy (h2: SMD, 0.33; 95% CI, 0.13, 0.54), and overall mood (h2: SMD, 0.26; 95% CI,-0.10, 0.63). There was a small-to-moderate difference between the effects of theanine and placebo that favored theanine on choice reaction time (h1: SMD, -0.35; 95% CI,-0.61, -0.10). The CIs frequently highlighted the uncertainty surrounding the direction and magnitude of these differences.

CONCLUSIONS

This meta-analysis provides evidence that theanine plus caffeine, and theanine alone, could be beneficial for cognitive and mood outcomes. More research using tea beverages or tea-equivalent bioactive doses and research in free-living participants is needed.

PROSPERO REGISTRATION NO

CRD42022351601.

Experimental Investigation of the Efficacy of Preemptive Tilting Seats in mitigating Carsickness

Carsickness (CS) experienced by vehicle passengers is a critical unsolved challenge that impacts existing human-driven vehicles and may limit the adoption of future autonomous vehicles. If CS is reduced, then passengers can perform productive tasks during their commutes. Prior research has demonstrated that a preemptively triggered tilting seat system (TSS), i.e., a seat that tilts the passenger in the direction of the vehicle's turn, can reduce CS response. However, no previous investigations have studied the impact of TSS on passengers performing representative productive tasks when riding a real vehicle under realistic driving conditions. This paper addresses this gap by presenting a human subject study to quantify passenger CS response and assess their task performance in the presence of a preemptively triggered TSS. Twenty-nine healthy adults with varying levels of self-reported motion sickness susceptibility participated in the study across two test conditions. This is the first in-vehicle study that assessed both CS response and passenger task performance for a diverse sample of passengers under realistic driving conditions emulated on a closed test track. The results from this study demonstrated that a preemptively triggered TSS reduces CS scores for male passengers and has no negative influence on their productive task performance. The results also demonstrated that a preemptively triggered TSS did not have an effect on CS scores for female passengers but had a small positive influence on their productive task performance. In addition, the majority of the study participants (∼70%) indicated via a qualitative questionnaire that they would want a preemptively triggered TSS in their car.

Challenges and perspectives with understanding the concept of mental fatigue

Mental fatigue is referred to as a psychophysiological or neurobiological state caused by prolonged periods of demanding cognitive activity. Sport and exercise science research studies have investigated the effects of experimentally induced mental fatigue on cognitive performance, with mixed results. It has been suggested that negative effects of mental fatigue on cognition performance in laboratory studies could translate to impaired sport performance. However, it remains unclear if impairments in sport performance are due to mental fatigue and how mental fatigue may differ from physical fatigue. Fatigue is well understood as a complex multifactorial construct involving interactions between physiological and neuropsychological responses across brain regions. It may be prudent for researchers to return to the origins of fatigue and cognition before attempting to connect mental fatigue and sport cognition. This article reviews the concept of mental fatigue, its mechanisms and neuroanatomical basis, models of cognition relevant to sports science, investigates how mental fatigue may influence cognition, and suggests future research directions. Mental fatigue as a construct separated from fatigue could be an oversight that has hindered the development of our understanding of mental fatigue. Future sports science research could work to enhance our knowledge of our definitions of fatigue.

The impact of pituitary adenomas on cognitive performance: a systematic review

Purpose

Increasing evidence suggests that beyond classical endocrine and visual symptoms, patients with pituitary adenoma (PA) may experience neurocognitive impairment, potentially resulting in reduced productivity and diminished quality of life. Prior studies have used diverse cognitive assessment tools across heterogeneous populations, leading to inconsistent findings. To address the variability, our study systematically analyzes the assessment batteries used in previous research, clarifying their corresponding cognitive domains. We seek to provide a more consistent and comprehensive understanding of the neurocognitive implications associated with PAs.

Methods

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Individual patient-level data, including clinical characteristics, tumor subtype, treatment interventions, hormonal status, and psychological outcomes, were systematically collected. Cognitive assessment tools were categorized according to their corresponding cognitive domains to facilitate domain-specific analyses.

Results

This systematic review included 70 studies encompassing a total of 3,842 patients with PA. Of these, 60 studies employed either objective neuropsychological tests or subjective questionnaires to evaluate cognitive function. The most frequently utilized assessment was the Digit Span test, with 42.9% of studies reporting significant impairments in complex attention and executive functioning among patients with PA. Twelve studies focused on structural brain changes as assessed by magnetic resonance imaging, with half documenting volumetric reductions in gray matter. Across the various PA subtypes, a consistent decline in discrete cognitive domains was observed, most notably in memory and executive function. Treatment-related data were provided in 59 studies. Perioperative changes in cognitive performance were described in 14 studies, of which 11 reported post-surgical improvement in at least one cognitive domain. Twenty studies investigated the potential adverse effects of radiotherapy on cognitive function; among them, 16 found no significant differences following treatment. Eight studies examined the association between tumor size and cognitive impairment; seven reported no statistically significant correlation. In contrast, 24 studies identified a significant relationship between hormonal dysregulation and cognitive decline.

Conclusions

The literature contains heterogeneous findings about the cognitive performance, nature of cognitive impairment, and subsequent effects of treatment. Patients with PA may experience cognitive decline in specific areas and are notably affected by hormone levels, while treatment may lead to cognitive recovery. The proposed tiered cognitive evaluation approach can improve assessment consistency in future practice.

Peak alpha frequency and alpha power spectral density as vulnerability markers of cognitive impairment in Parkinson's disease: an exploratory EEG study

Background

Cognitive impairment substantially impacts quality of life in Parkinson's disease (PD), yet current biomarker frameworks lack sensitivity for detecting early-stage cognitive decline. While peak alpha frequency (PAF) and alpha power spectral density (PSD) have emerged as potential electrophysiological markers, prior studies primarily focused on global cortical measures, neglecting region-specific variations that may better reflect the heterogeneous nature of PD-related cognitive impairment (PDCOG). To address this gap, we conducted the first multiregional comparative analysis of PAF and alpha PSD between PDCOG and PD with normal cognition patients (PDNC).

Methods

Data from 76 participants (44 PD, 32 healthy controls) at The Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (March-July 2024) were analyzed. PAF and alpha PSD were computed across brain regions; cognitive function was assessed via MoCA.

Results

Global PAF was reduced in PD vs. controls (p < 0.05) and correlated with cognition. PDCOG showed lower alpha PSD in parieto-occipital/posterior temporal regions (P3, P4, O1, T5, T6, PZ) vs. PDNC (p < 0.05), with these regions positively correlating with MoCA scores. ROC analysis identified P3, PZ, and T6 alpha PSD as optimal discriminators (AUC: 0.77-0.758). Executive function inversely correlated with alpha PSD in right posterior temporal/left occipital regions.

Conclusion

PAF differentiates PD from controls and links to global cognition, while regional alpha PSD (notably P3, PZ, T6) effectively distinguishes PDCOG from PDNC. These findings underscore regional QEEG's utility in PD cognitive assessment, though sensitivity limitations warrant optimization.

Impact of depression on cognitive function among women in a psychiatric hospital: Analysis via the Beck Scale Short Version and the Moroccan Version of the Montreal Cognitive Assessment (MoCA) test

AIM

This study assessed the impact of depression on cognitive function in newly diagnosed women presenting to psychiatric emergency services through the cold track.

METHODS

A cross-sectional study was conducted at Ar-Razi Psychiatric Hospital in Salé, Morocco, involving 86 women aged 18-58 years, newly diagnosed with depression. Depression severity was measured using the 13-item Beck Depression Inventory Short Version, and cognitive functions were assessed with the Moroccan version of the Montreal Cognitive Assessment (MoCA) test. Data analysis used SPSS v.26, employing correlation tests and one-way analysis of variance (ANOVA) to explore relationships and group differences. A confidence level of 95% and a significance threshold of 0.05 were applied.

RESULTS

Among the participants, severe depression was prevalent, particularly among women aged 38-48 years. Depression scores were significantly higher in women with only primary education, while widowed women exhibited the highest overall scores. Students and unemployed participants were the most severely affected. A negative correlation was observed between depression symptoms and cognitive function, with higher depression levels associated with lower cognitive scores. Feelings of sadness and concentration deficits were negatively correlated, as were feelings of discouragement and executive functions. Positive correlations emerged between feelings of guilt and verbal fluency.

CONCLUSION

This study underscores the relationship between depression and cognitive impairment in women, emphasizing the need for comprehensive evaluations of cognitive deficits in depressed patients. Tailored interventions should be prioritized to improve their quality of life.

A meta-analysis of the influence of traditional Chinese exercises on cognitive function in the elderly

Background

This study seeks to assess the impact of traditional Chinese exercises (Tai Chi, Baduanjin, Yijinjing, Wuqinxi, and Liuzijue) on cognitive function in older adults through a systematic review and meta-analysis. It examines their effects on global cognitive performance, as well as specific cognitive domains, providing robust evidence to support the enhancement of cognitive function in the elderly.

Methods

A thorough search was executed across eight key databases, including PubMed, Embase, Cochrane Library, EBSCO, Web of Science, Wanfang Data, the Chinese Science and Technology Journal Database, and China National Knowledge Infrastructure. The quality of the studies that met the inclusion criteria was assessed using the Cochrane Collaboration tool for evaluating risk of bias. Data synthesis was performed using Review Manager 5.4, where pooled intervention outcomes were expressed as mean differences (MD) alongside their 95% confidence intervals (CI). Additional sub-group analysis was conducted to explore potential factors contributing to heterogeneity.

Results

This systematic review and meta-analysis evaluated data from 29 randomized controlled trials, encompassing a total of 2,489 participants. The results demonstrate that traditional Chinese exercises substantially improve language abilities (Category Verbal Fluency: MD = 0.90, 95% CI: 0.38 to 1.41), executive function (TMT B: MD = -13.70, 95% CI: -16.06 to -11.35), short-term memory (MD = 0.85, 95% CI: 0.42 to 1.29), and long-term delayed recall (MD = 1.39, 95% CI: 0.72 to 2.06). Sub-group analysis indicated that baseline cognitive function plays a critical role in determining the effectiveness of the intervention. Patients with cognitive impairment derive significantly greater benefits from traditional Chinese exercise interventions than those with normal cognitive function.

Conclusion

This study found that the traditional Chinese exercises can enhance cognitive function in the elderly, particularly in those with mild cognitive impairment. The effects of traditional Chinese exercises differed across various cognitive domains, indicating that when utilizing traditional Chinese exercise as an intervention, it is crucial to consider the specific cognitive status of the patient to design precisely tailored intervention strategies.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42024535287, identifier [CRD42024535287].

Psychosocial Phenotypes of Older Adults With Pain and Their Associated Clinical Outcomes

A comprehensive understanding of the patterns of psychosocial characteristics in older adults with pain is needed. Our objectives were to (1) identify psychosocial phenotypes (comprising depression, anxiety, affect, self-realization, resilience, and social participation) among older adults with pain and (2) compare pain characteristics, physical health, and cognition among the identified phenotypes. Using cross-sectional 2021 data from the National Health and Aging Trends Study, we performed latent class analysis to identify four psychosocial phenotypes of older adults with pain (N = 1903): Favorable (best psychosocial characteristics, 67.7%), Adverse (worst psychosocial characteristics, 4.9%), Intermediate (moderate scores on psychosocial variables, 12.6%), and Compensated (moderate scores with relatively high self-realization and resilience, 14.9%). Phenotypes with less psychosocial adversity had generally better clinical outcomes. Future research should explore precision pain management interventions in older adults based on their psychosocial phenotypes, longitudinal trajectories of phenotypes, and technology-based, point-of-care clinical insights for pain management.

Multicomponent exercise improved cognitive flexibility and muscular fitness in community-dwelling older adults

ObjectiveCognitive flexibility is the ability to transition between various tasks flexibly, which declines in aging. The purpose of this quasi-experimental study was to investigate the effect of a 12-week multicomponent exercise intervention on cognitive flexibility and attention, measured by color trail test (CTT)-1, CTT-2, and CTT 2-1 difference, in community-dwelling older adults. The relationship between cognitive flexibility and muscular fitness was also examined.MethodsThe participants were assigned to either the exercise group (n = 41, aged 70.6 ± 5.9 years) or the control group (n = 18, aged 67.9 ± 4.9 years). The exercise group participated in a 90-minute multicomponent exercise session, including endurance, resistance, and stretching training, twice a week for 12 weeks. Participants in the control group maintained their sedentary lifestyle. CTT and muscular fitness, including 30-second arm curl, 30-second chair stand, and 2-minute step tests, were measured before and after the intervention.ResultsA significant group×time interaction effect was found in CTT-2, CTT 2-1 difference, chair stand, and step test. After the intervention, the exercise group showed a significantly better cognitive flexibility, indicated by faster completion time in CTT-2 (before: 140.3 ± 60.1 seconds, after: 127.0 ± 60.6 seconds) and improved CTT 2-1 difference (before: 82.8 ± 49.5 seconds, after: 72.2 ± 49.0 seconds). The exercise group also improved the number of repetitions in chair stand (before: 18.5 ± 5.0, after: 22.8 ± 5.5) and step test (before: 108.9 ± 16.2, after: 126.2 ± 19.0). The cognitive and muscular performance remained unchanged in the control group. Moreover, better performance in the 30-second chair stand test was associated with faster completion time in CTT-1 at baseline (r = -0.296).ConclusionsThe amelioration in cognitive flexibility coincided with improvements in muscular fitness after a 12-week multicomponent exercise intervention in older adults. Better muscular strength was associated with higher cognitive flexibility at the baseline.

Efficacy of Action Observation Therapy on Cognitive Function in Stroke: A Systematic Review and Meta-Analysis

INTRODUCTION

Action Observation Therapy (AOT) is a rehabilitation method believed to activate the mirror neuron system, which may contribute to cognitive recovery. Previous studies have shown varying results due to different intervention characteristics. This review will examine the efficacy of AOT on clinical cognitive function in stroke.

METHODS

Randomized controlled trials (RCTs) comparing AOT with non-AOT interventions in cognitive function were included. Databases searched included PubMed, Cochrane Library, Embase, Web of Science, EBSCO, CNKI, WanFang, and VIP database from inception to May 6, 2024. The risk of bias was assessed using Cochrane's Risk of Bias Assessment Tool 2.0, and the quality of evidence was evaluated with the GRADE approach. RevMan 5.4 and Stata 18.0 were used for the meta-analysis. After the analysis of cognitive function, meta-regression was performed to explore the possible sources of heterogeneity. A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates and 95% confidence interval (CI) values. We examined the funnel plot and used Egger's regression test to assess for publication bias. This study was conducted by PRISMA reporting guidelines (Appendix S1). The search protocol was prospectively registered in PROSPERO (CRD42024571694).

RESULTS

A total of 6 RCTs with 400 participants were included. All the included articles were rated as having B-level quality. Meta-analysis showed that AOT significantly improved cognitive function in stroke. Meta-regression did not find the source of heterogeneity. The GRADE result indicated that the finding was of very low certainty.

CONCLUSIONS

Cognitive interventions based on AOT can improve cognitive function in stroke patients. However, it should be interpreted cautiously due to heterogeneity and low certainty. To strengthen evidence-based practices, we advocate for higher-quality and more homogeneous RCTs, including strict randomization procedures, large sample sizes, extended follow-up periods, and studies focused on specific disease subtypes.

Paternity analysis reveals sexual selection on cognitive performance in mosquitofish

In many animal species, cognitive abilities are under strong natural selection because decisions about foraging, habitat choice and predator avoidance affect fecundity and survival. But how has sexual selection, which is usually stronger on males than females, shaped the evolution of cognitive abilities that influence success when competing for mates or fertilizations? We aimed to investigate potential links between individual differences in male cognitive performance to variation in paternity arising solely from sexual selection. We therefore ran four standard cognitive assays to quantify five measures of cognitive performance by male mosquitofish (Gambusia holbrooki). Males were then assigned to 11 outdoor ponds where they could compete for females. Females mate many times, which leads to intense sperm competition and broods with mixed paternity. We genotyped 2,430 offspring to identify their fathers. Males with greater inhibitory control and better spatial learning abilities sired significantly more offspring, while males with better initial impulse control sired significantly fewer offspring. Associative and reversal learning did not predict a male's share of paternity. In sum, there was sexual selection on several, but not all, aspects of male cognitive performance.

Developmental change of prefrontal cortex activity during handwriting tasks in children and adults

BACKGROUND

The relationship between handwriting and executive function has been explored in numerous studies. However, limited research has focused on the relationship between handwriting and prefrontal cortex (PFC) activity, which underpins executive function and writing processes. Additionally, differences in frontal lobe activity during writing between adults and children remain inadequately understood. This study aimed to investigate developmental changes in the prefrontal cortex and their neural basis during writing activities in children and adults.

METHODS

In this study, a pen tablet and functional near-infrared spectroscopy (fNIRS) were used to compare adult and pediatric writing dynamics and PFC function during two writing activities. The stimuli consisted of two line-drawing tasks designed to minimize linguistic influence, with two conditions (trace and predict) applied to each task. PFC activation was examined across the right, middle, and left regions. Oxygenated brain activity was quantified by converting oxygenated hemoglobin values obtained from fNIRS to z-scores.

RESULTS

The line length, an index of writing dynamics, was consistently shorter in children compared to adults across all tasks and conditions. Regarding brain function, the right PFC exhibited greater activation in adults during the predictive periodic line pattern drawing condition.

CONCLUSION

These findings suggest that the lateralization of the right PFC plays a critical role in the development of executive function, which is integral to writing development.

Hypotensive Episodes on 24-Hour Ambulatory Blood Pressure and Cognitive Function: Insights From the SPRINT Study

BACKGROUND

Hypotensive episodes detected by 24-hour ambulatory blood pressure (BP) monitoring capture daily cumulative hypotensive stress and could be clinically relevant to cognitive impairment, but this relationship remains unclear.

METHODS

We included participants from the Systolic Blood Pressure Intervention Trial (receiving intensive or standard BP treatment) who had 24-hour ambulatory BP monitoring measured near the 27-month visit and subsequent biannual cognitive assessments. We evaluated the associations of hypotensive episodes (defined as systolic BP drops of ≥20 mm Hg between 2 consecutive measurements that reached <100 mm Hg) and hypotensive duration (cumulative time of systolic BP <100 mm Hg) with subsequent cognitive function using adjusted linear mixed models. We further assessed 24-hour average BP and variability.

RESULTS

Among 842 participants with treated hypertension (mean age, 71±9 years; 29% women), the presence (versus absence) of recurrent hypotensive episodes (11%) was associated with lower digit symbol coding scores (difference in Z scores, -0.249 [95% CI, -0.380 to -0.119]) and their faster declines (difference in Z score changes, -0.128 [95% CI, -0.231 to -0.026]). A consistent dose-response association was also observed for longer hypotensive duration with worse Montreal Cognitive Assessment and digit symbol coding scores. The association with digit symbol coding scores remained significant after further adjusting for 24-hour average BP and variability and was not observed for hypotension defined by clinic, orthostatic, or 24-hour average BP. Intensive BP treatment increased 24-hour hypotensive episodes and modified its association with the decline in digit symbol coding score.

CONCLUSION

Twenty-four-hour hypotensive episodes were associated with worse cognitive function, especially in processing speed, and could be a novel marker for optimal BP control and dementia prevention.

Association between Fear of Falling and Visuospatial and Executive Functions in Older Adults with Subjective Cognitive Decline: A Cross-Sectional Study

OBJECTIVES

Fear of falling (FOF) is a common health concern among older adults. Although cognitive impairment (CI) is a risk factor for FOF, the specific cognitive domains associated with FOF remain unclear. This study examined the association between FOF and domain-specific cognitive functions in older adults. We also analyzed whether this association varied based on CI, recent fall experience, or engagement in physical activity.

DESIGN

This was a cross-sectional study analyzing the relationship between FOF and cognitive performance across various domains, with stratifications by CI status, fall history, and physical activity levels.

SETTING AND PARTICIPANTS

The study included 591 older adults with mild CI who visited the Veterans Health Service Medical Center in Korea.

METHODS

Cognitive performance in attention, language, visuospatial, memory, and frontal or executive domains was assessed using the Seoul Neuropsychological Screening Battery-Core. FOF was measured using the Activities-specific Balance Confidence Scale. Covariates, including demographics, physical health, and activity levels, were adjusted in the analyses.

RESULTS

Higher FOF was significantly associated with lower performance in the visuospatial domain [Rey Complex Figure Test (β = 0.04, P = .002)] and the frontal or executive domain [Digit Symbol Coding (β = 0.05, P < .001), Controlled Oral Word Association Test (β = 0.02, P = .041), Trail Making Test (β = 0.06, P < .001), and Color Word Stroop Test (β = 0.04, P < .001)] after adjusting for covariates. The observed association was particularly evident in older adults with CI or those not engaging in moderate physical activity. The association was consistent regardless of fall history in the past year.

CONCLUSIONS AND IMPLICATIONS

High FOF was associated with poor visuospatial and frontal or executive functions. These findings underscore the link between FOF and cognitive function, suggesting that specific cognition in visuospatial and frontal or executive domains may contribute to FOF development.

Acute exercise impacts heart rate variability but not cognitive flexibility during subsequent simulated firefighter occupational tasks

PURPOSE

Acute exercise can transiently enhance cognitive flexibility. The cognitive demand of firefighters makes it relevant to understand if on-shift exercise could produce similar improvements in cognitive performance during subsequent occupational tasks. Metrics of heart rate variability (HRV), such as time- and frequency-domain outcomes, may shed light upon the influence exercise has on cognition, as they discern information related to cardiac autonomic (sympathetic/parasympathetic) function. We aimed to determine if acute resistance and aerobic exercise impact cognitive flexibility during occupational tasks and its relation to HRV.

METHODS

32 participants completed a baseline Wisconsin Card Sorting Task (WCST) and three experimental trials: resistance exercise (RE), aerobic exercise (AE), or a rested control (CON). An occupational task assessment (OTA) including four rounds of 10 deadlifts and a 0.15-mile sandbag carry in an environmental chamber (35 °C/50% humidity) was completed after each trial. The second round was followed by the WCST. Repeated measures ANOVAs were used to analyze differences by condition.

RESULTS

For the WCST, total, perseverative, and non-perseverative errors did not differ (ps > 0.39). Time-domain HRV metrics were not different (ps > 0.05). All frequency-domain metrics, other than low-frequency power, were not different (ps > 0.24). Low-frequency power was lower based on condition (p = 0.03). Post hoc analysis showed low-frequency power was lower following AE compared to RE and CON.

CONCLUSION

Results suggest an acute bout of on-shift aerobic or resistance exercise may not impact cognitive flexibility during subsequent simulated occupational tasks, despite depressed metrics of heart rate variability following aerobic exercise.

Cognitive abilities and psychosocial functioning in bipolar disorder: findings from the BIPLONG study

Background

Bipolar disorder is associated with impairments in cognition and psychosocial functioning. Although these impairments occur frequently, often persist during euthymic times, and worsen quality of life, the impact of cognitive abilities on functioning has not yet been fully elucidated.

Methods

The current study investigated the effects of cognitive domains (attention/psychomotor speed, verbal learning/memory, executive function) on psychosocial functioning cross-sectionally. Data from 210 euthymic individuals with bipolar disorder [101 female, 109 male; M (age) = 44.47; SD (age) = 14.25] were included into the analysis. A neurocognitive test battery was administered and the Global Assessment of Functioning was used to depict psychosocial functioning. Correlation analyses were conducted to observe the associations between functioning and the cognitive domains. Moreover, three hierarchical regression analyses were applied to predict functioning by each of the cognitive domains, while considering age, sex, and education as control variables.

Results

Correlation analyses revealed that functioning was positively associated with attention/psychomotor speed and verbal learning/memory. However, the consecutive hierarchical regression analyses found that none of the cognitive domains were able predict functioning beyond the control variables age, sex, and education.

Conclusion

Our findings indicate that greater abilities in the domains of attention/psychomotor speed and verbal learning/memory are associated with better functioning. However, this association can be explained by other relevant variables such as age or education, indicating that cognitive abilities are not the sole contributor of psychosocial functioning. Investigating other measurements of functioning or cognitive abilities could lead to different results. Nevertheless, promoting cognitive abilities and autonomy in daily life remains an important aspect of therapy in bipolar disorder.

Extracted step parameters during the timed up and go test discriminate between groups with different levels of cognitive ability-a cross-sectional study

BACKGROUND

Identifying cognitive impairment at an early stage is important to enable preventive treatment and lifestyle changes. As gait deviations precede cognitive impairment, the aim of this study was to investigate if step parameters during different Timed Up and Go (TUG) conditions could discriminate between people with different cognitive ability.

METHODS

Participants (N = 304) were divided into the following groups: (1) controls, n = 50, mean age:73, 44% women; (2) Subjective cognitive Impairment (SCI), n = 71, mean age:67, 45% women; (3) Mild Cognitive Impairment (MCI), n = 126, mean age: 73, 42% women; and (4) dementia disorders, n = 57, mean age: 78, 51% women. Participants conducted TUG and two motor-cognitive TUG-conditions: TUG while naming animals (TUGdt-NA) and reciting months in reverse order (TUGdt-MB). Tests were video recorded for data extraction of valid spatiotemporal parameters: step length, step width, step duration, single step duration and double step duration. Step length was investigated with the step length/body height ratio (step length divided by body height). Logistic regression models (adjusted for age, sex and education) investigated associations between step parameters and dichotomous variables of groups adjacent in cognitive ability: dementia disorders vs. MCI, MCI vs. SCI, and SCI vs. controls. Results were presented as standardized odds ratios (sORs), with 95% confidence intervals (CI95) and p-values (significance level: p < 0.05). The areas under the Receiver Operating Characteristic curves were presented for the step parameters/conditions with the highest sORs and, where relevant, optimal cutoff values were calculated.

RESULTS

Step length showed greatest overall ability to significantly discriminate between adjacent groups (sOR ≤ . 67, CI95: .45-.99, p = ≤ . 047) during all group comparisons/conditions except three. The highest sOR for step-length was obtained when discriminating between SCI vs controls during TUGdt-MB (sOR = .51, CI95:.29- .87, p = .014), whereby the area under the curve was calculated (c-statistics = .700). The optimal cut-off indicated a step length of less than 32.9% (CI95 = 22.1-43.0) of body height to identify SCI compared with controls.

CONCLUSIONS

The results indicate that step length may be important to assess during TUG, for discrimination between groups with different cognitive ability; and that the presented cut-off has potential to aid early detection of cognitive impairment.

TRIAL REGISTRATION NUMBER

NCT05893524 (retrospectively registered 08/06/23).

Relations between 24-h movement behaviors, declarative memory, and hippocampal volume in early childhood

This study aimed to determine if 24-h movement behaviors (sedentary time, physical activity, and sleep), considered independently and together, were associated with declarative memory and hippocampal volume in late early childhood. Observational data were obtained from preschool-aged children (timepoint 1: n = 35 children, 3.9 ± 0.5 years; 6 months later: n = 28 children, 4.5 ± 0.5 years). Movement behaviors were measured with actigraphy. Outcomes were declarative memory and hippocampal subregion volumes. Multilevel models explored movement behaviors independently as absolute values, and with both absolute total activity, 24-h sleep duration, and night sleep efficiency. Movement behaviors were also explored as compositions in linear regression models. In independent models, sleep duration and moderate to vigorous physical activity were positively associated with total and right hippocampal volumes, respectively. When examined together, children meeting sleep recommendations were more likely to have larger total, right and left hemisphere, body, and tail hippocampal volumes. In our sample of preschool children, we observed positive associations between sleep duration and hippocampal volume, independent of age. To improve our understanding of the connections between 24-h behaviors and brain health in early childhood, larger samples that also consider the context and subcomponents of movement behaviors may be warranted.

Association between periodontal disease and age-related cognitive impairment: a narrative review

BACKGROUND

Previous studies have shown associations between periodontal disease and age-related cognitive impairment. However, little is known about the different cognitive functions that may be affected in patients with periodontal disease.

METHODS

We reviewed the recent literature to better understand the bidirectional relationship between cognitive function and periodontal disease, and to explore the cognitive assessments that may be useful when investigating this relationship. We also reviewed the literature around improving periodontal health in older adults presenting with cognitive impairment, which may improve their cognition.

RESULTS

There is a bidirectional relationship between periodontal disease and cognitive impairment. We also found that visuospatial function, attention, memory, and language are important cognitive domains that may be impaired in older people with periodontal disease, possibly because these factors are associated with the ability to adequately brush one's teeth. Furthermore, we noted that the choice of cognitive assessment may be particularly important when studying cognitive function in relation to periodontal health. To improve periodontal health in older people with cognitive impairment, partner-assisted interventions, adequate toothbrushing, and the use of a powered toothbrush have all been proposed. The early initiation of regular oral care visits, education for individuals, improving cooking skills, and dietary/caloric restrictions may also contribute to improving periodontal health.

CONCLUSIONS

The bidirectional nature of the relationship between periodontal health and cognitive function is important for older adults presenting with cognitive impairment. Furthermore, improvements in periodontal health may help to improve cognitive impairment. The appropriate assessment of cognitive function will contribute to preserving and improving oral health in older people with periodontal disease.

Assessing the Impact of Neurofeedback on Cognitive Function in Individuals with Autism Spectrum Disorder: A Systematic Review

Objectives

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by qualitative deficits in behavior and social interaction patterns. Recently, cognitive impairments commonly associated with ASD have been well-documented. Neurofeedback (NFB) has been proposed as a potential treatment for individuals with autism, but its effectiveness in improving cognitive issues remains uncertain despite multiple trials. This review aims to summarize the estate of documents regarding the cognitive efficacy of NFB for participants with ASD.

Materials & Methods

Conducting a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study scrutinized NFB studies specific to ASD treatment. Its inclusion criteria focused on studies involving individuals with ASD without comorbidities, employing JBI checklists to assess study quality. Utilizing PubMed, Embase, Web of Science, PsycINFO, and Scopus, supplemented by manual paper reviews, we initially identified 474 papers. After deduplication and full-text review, 12 studies were selected for analysis.

Results

Findings revealed that 83% of the chosen studies highlighted a positive impact of NFB on cognition in individuals with ASD. The findings suggest NFB as a promising alternative treatment, demonstrating efficacy in addressing attention, memory, executive function, and speech difficulties. Additionally, six studies indicated sustained long-term effectiveness of NFB in improving cognitive functioning among ASD patients.

Conclusion

This review supports the potential of NFB as a viable intervention for cognitive challenges in ASD. Furthermore, the results hint at broader applications of NFB beyond ASD, suggesting efficacy in addressing conditions like Attention Deficit/Hyperactivity Disorder (ADHD), sleep apnea, depression, and epilepsy.

Cognition in cerebellar disorders: What's in the profile? A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aim to examine the profile and extent of cognitive deficits in patients with cerebellar disorders, and to provide a complete overview of the cognitive domains that might be affected in the Cerebellar Cognitive Affective Syndrome (CCAS).

METHODS

MEDLINE, Embase, PsycINFO, and Web of Science were systematically searched to 17-07-2024. Studies were considered if the participants were adult patients with a clinical diagnosis of cerebellar disorder and were neuropsychological assessed. Outcomes were grouped into the domains of processing speed, language, social cognition, executive function, visuospatial skills, episodic memory, verbal intelligence, attention, and working memory. All aetiologies were included for first evaluation and patients were assigned to one of two groups (focal vs. degenerative) for secondary evaluation. Random-effects models were employed for the meta-analyses.

RESULTS

129 studies with a total of 3140 patients with cerebellar disorders were included. Patients performed significantly worse compared to control/standardized data in all domains. Deficits were most pronounced in processing speed, ES [95% CI] = - 0.83 [- 1.04, - 0.63], language, ES [95% CI] = - 0.81 [- 0.94, - 0.67], and social cognition, ES [95% CI] = - 0.81 [- 1.19, - 0.42]. Cognitive impairment varied between patients with focal cerebellar lesions and degenerative cerebellar disorders, but was overall worse in the degenerative group.

DISCUSSION

Cerebellar disorders can impact many cognitive domains, extending beyond executive functioning, visuospatial skills, and language. These outcomes contribute to a broader understanding of the cerebellum's role in cognition and sheds light on the cognitive deficits associated with cerebellar disorders.

A systematic review of neurocognition and social cognition in body dysmorphic disorder

OBJECTIVE

Neurocognitive underpinnings are implicated in the aetiology and maintenance of body dysmorphic disorder (BDD); however, inconsistent findings across a range of neurocognitive domains suggest that a comprehensive synthesis of the literature using a hierarchical framework of neurocognition is needed.

METHODS

A final search across OVID Medline, PsycNET, Scopus and Web of Science databases was conducted on 20 June 2024 to identify research that examined performance on behavioural tasks of objective neurocognition in BDD. Risk of bias was assessed using the Newcastle-Ottawa Scale. Fifty-four studies aligned with the following inclusion criteria: (1) full-text; (2) peer-reviewed; (3) published in English; (4) employed a neurocognitive task with an objective outcome and (5) involved a case-controlled paradigm consisting of BDD and healthy control samples. Findings were synthesised according to neurocognitive sub-domains viewed as a hierarchy from basic to higher-level domains.

RESULTS

Neurocognitive differences in BDD relative to controls were identified at almost all levels of the hierarchy, most consistently in the upper domains of executive function and social cognition. Vulnerabilities were also demonstrated in the sub-domains of visual perception of faces, Gestalt processing, selective attention to faces and verbal memory. Methodological limitations or the influence of neurocognitive sub-groups may contribute to inconsistencies across the literature.

CONCLUSIONS

Although neurocognitive differences appear central to BDD, a picture of neurocognitive heterogeneity emerged with the salience of stimuli important and a likely bias to local-over-global processing demonstrated across the domains.

Assessing patient-reported outcomes in primary sclerosing cholangitis: an update

PURPOSE OF REVIEW

Patient-reported outcome (PRO) measures validated in primary sclerosing cholangitis (PSC) are needed for clinical trials. This review describes the recent US Food & Drug Administration (FDA) Patient-Focused Drug Development (PFDD) guidelines, existing PRO measures used in PSC studies, and the design of PSC-specific symptom measures adherent with the guidelines.

RECENT FINDINGS

FDA released updated guidance reflecting best practices for the design and evaluation of clinical outcome assessments (including PROs) and the design of trial endpoints. Two recent systematic reviews (2018, 2020) identified multiple PRO measures used in PSC studies, with two additional measures published since. Of these, four were developed in samples inclusive of PSC patients and six have been psychometrically evaluated in PSC. Published evidence to sufficiently support alignment with the recent guidance is sparse. We review the design of three symptom measures for PSC to illustrate alignment with FDA guidance, including qualitative and quantitative studies to provide evidence for their validity for use in adult PSC trials.

SUMMARY

Investigators planning to use PRO measures as study endpoints for PSC need to be adherent with the recent FDA guidelines and build the evidence base to support the measure as fit-for-purpose as an endpoint for clinical trials.

Social factors associated with everyday functioning in older Black adults

OBJECTIVE

Independence in everyday functioning has been associated with successful aging and declines in functioning may be indicative of pathological cognitive decline. Social determinants of health, like economic status and access to health care, a]lso play a role in everyday functioning. Understanding these factors are of particular importance for older Black adults who have had long-standing disparate access to care, education, and treatments. The current study aimed to evaluate social determinants of health, more specifically social engagement, as moderators of the association between cognition and everyday functioning.

METHOD

A sample of 930 older Black adults from Rush University: The Memory and Aging Project, African American Clinical Core, and Minority Adult Research Study were used. Participants completed a battery of neuropsychological testing as well as questionnaires about their everyday functioning and social behaviors. Hierarchical linear regressions were utilized to determine to what extent social factors moderated the relationship between cognition and everyday functioning.

RESULTS

Late life social activity reduced the effect of global cognition on everyday functioning and was independently associated with everyday functioning. Social network size was associated with increased impairment.

CONCLUSION

Results from the current study provide novel information regarding the role of social interaction on cognition in an older Black adult sample. Future interventions may benefit from an emphasis on increasing social engagement.

Altered angular gyrus activation during the digit symbol substitution test in people living with HIV: beyond information processing speed deficits

Speed-of-information processing (SIP) is often impaired in people living with HIV (PLWH), typically assessed through tests such as the digit symbol (DS) and symbol search, which also rely on motor and executive functions. This study aims to disentangle SIP deficits from other cognitive impairments in PLWH using an MRI-adapted digit symbol substitution test (mDSST). Fifty-seven PLWH (34.7 ± 11.2 years) and 50 age-matched people living without HIV (PLWoH, 31.8 ± 9.9 years) completed standardized neuropsychological tests and the mDSST. Behavioral performances and brain activations were compared, with correlations drawn between group-differentiating brain activations and clinical ratings of cognitive domains. Results showed that PLWH performed worse in DS and symbol search, made fewer responses, and was slower in mDSST, with performances correlating to SIP and motor ratings. Notably, PLWH showed greater deficits in attention compared to PLWoH, rather than in SIP or motor. PLWH also exhibited greater primary motor cortex activation and reduced right angular gyrus activation. These findings suggest that slower performances on SIP-related tests in PLWH may be partially linked to abnormal visuospatial attention, as reflected by reduced angular gyrus activation, with higher motor cortex activation potentially serving as a compensatory mechanism. Future studies should explore whether prefrontal regions implicated in SIP are impaired in more severely affected PLWH.

Executive function deficit in patients with long COVID syndrome: A systematic review

Background

Post-COVID-19 condition (Long COVID) refers to a condition in which patients endure persistent symptoms for more than 12 weeks, typically occurring at least 3 months after the onset of Coronavirus disease 2019 (COVID-19) infection. It occurs when a constellation of symptoms persists following the initial illness, and this may obstruct a daily routine and impose difficulty in life. Therefore, this study aimed to systematically review published articles assessing the neurocognitive profile of long COVID patients, with a specific emphasis on executive function (EF), and to determine the correlation between EF deficits and brain alterations through the utilisation of neuroimaging modalities.

Methods

A thorough search was conducted using the PubMed/MEDLINE and Web of Science online databases following the PICOS and PRISMA 2020 guidelines. All included studies were deemed to be of high quality according to the Newcastle-Ottawa Scale (NOS).

Results

A total of 31 out of 3268 articles were included in the present study. The main outcome is the proportion of individuals with cognitive deficits, particularly in the EF domain, as detected by neuropsychological assessments. The present study also revealed that EF deficits in long COVID patients are correlated with disruptions in the frontal and cerebellar regions, affecting processes such as nonverbal reasoning, executive aspects of language, and recall. This consistent disturbance also emphasised the correlation between EF deficits and brain alterations in patients with long COVID.

Conclusion

The present study highlights the importance of evaluating EF deficits in long COVID patients. This insight has the potential to improve future treatments and interventions.

Creating dementia-friendly travel: enhancing accessibility and inclusion

The growing participation of older adults in travel is reshaping this industry and highlighting the need for inclusive travel experiences, particularly for people living with dementia (PLwD). While travel provides substantial physical, psychological, cognitive and social benefits that promote active and healthy ageing, it also presents significant challenges. Although physical disabilities are generally proactively addressed, more "hidden" cognitive difficulties often remain unrecognised and unaddressed. These include navigating complex environments, making timely decisions and relying on working memory-tasks that are further challenged by dynamic settings such as airports, train stations and bus terminals. Although efforts to create dementia-friendly travel experiences are underway, their implementation across travel infrastructure remains inconsistent. There is still much to be done to ensure this activity is accessible and inclusive for this population, and there is a need to advocate for a comprehensive, person-centred approach to dementia-friendly travel environments, emphasising the integration of tailored assessments, innovative technologies and coordinated global policies.

Neuropsychological functioning after COVID-19: Minor differences between individuals with and without persistent complaints after SARS-CoV-2 infection

Objective: It is unclear how self-reported severe fatigue and difficulty concentrating after SARS-CoV-2 infection relate to objective neuropsychological functioning. The study aimed to compare neuropsychological functioning between individuals with and without these persistent subjective complaints. Method: Individuals with and without persistent severe fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months after SARS-CoV-2 infection were included. Neuropsychological assessment was performed on overall cognitive functioning, attention, processing speed, executive functioning, memory, visuo-construction, and language (18 tests). T-scores -1.5 SD below population normative data (T ≤ 35) were classified as "impaired". Results: 230 participants were included in the study, of whom 22 were excluded from the analysis due to invalid performance. Of the participants included in the analysis, 111 reported persistent complaints of severe fatigue and difficulty concentrating and 97 did not. Median age was 54 years, 59% (n = 126) were female, and participants were assessed a median of 23 months after first infection (IQR: 16-28). With bivariate logistic regression, individuals with persistent complaints had an increased likelihood of slower information processing speed performance on the Stroop word reading (OR = 2.45, 95%CI = 1.02-5.84) compared to those without persistent complaints. Demographic or clinical covariates (e.g. hospitalization) did not influence this association. With linear regression techniques, persistent complaints were associated with lower t-scores on the D2 CP, TMT B, and TMT B|A. There were no differences in performance on the other neuropsychological tests. Conclusions: Individuals with subjective severe fatigue and difficulty concentrating after COVID-19 do not typically demonstrate cognitive impairment on extensive neuropsychological testing.

Topical review: Ocular surface abnormalities in neurodegenerative disorders

SIGNIFICANCE

In an aging population, the number of people living with neurodegenerative disease is projected to increase. It is vital to develop reliable, noninvasive biomarkers to detect disease onset and monitor progression, and there is a growing body of research into the ocular surface as a potential source of such biomarkers.

BACKGROUND

This article reviews the potential of in vivo corneal confocal microscopy and tear fluid analysis as tools for biomarker development. Corneal confocal microscopy, traditionally used for studying corneal health, offers high-resolution imaging of corneal nerves and has shown promise for examining systemic diseases such as Alzheimer disease and Parkinson's disease. Complementarily, tear fluid analysis, known for its ease of collection, reflects systemic changes in neurodegenerative conditions.

CONCLUSION

Together, these noninvasive techniques provide insights into disease onset and progression and hold potential for advancing diagnostic and treatment strategies.

The Effect of Anthocyanins on Cognition: A Systematic Review and Meta-analysis of Randomized Clinical Trial Studies in Cognitively Impaired and Healthy Adults

PURPOSE OF THE REVIEW

Clinical trials suggest that dietary anthocyanins may enhance cognitive function. This systematic literature review and meta-analysis aimed to identify the effect of anthocyanin on cognition and mood in adults.

RECENT FINDINGS

Using a random-effects model, Hedge's g scores were calculated to estimate the effect size. Across 30 randomized controlled trials, fourteen (n = 733 participants) met the criteria for meta-analysis following PRISMA guidelines (Registration number: CRD42021279470). Qualitative synthesis showed improvements in multiple domains after anthocyanin intake: short-term memory, verbal learning and working memory, executive function, visual-spatial function, psychomotor skills, attention and semantic memory. Four of 15 studies reported significant mood improvements, including anti-fatigue and reduced anxiety and depression scores. However, there were no significant effects for working memory (Hedges's g = -0.183, 95% CI = -0.407 to 0.041, P = 0.110), verbal learning (Hedges's g = 0.054, 95% CI = -0.215 to 0.324, P = 0.69), immediate memory (Hedges's g = 0.196, 95% CI = -0.242 to 0.633, P = 0.38) and delayed memory (Hedges's g = -0.188, 95% CI = -0.629 to -0.252, P = 0.402) according to the meta-analysis. This review suggests potential benefits of anthocyanin intake on cognition and mood. However, in meta-analysis of 14 eligible studies, effects on working, immediate, delayed memory and verbal learning were not significant, likely due to study heterogeneity. Recommendations for future study designs are discussed.

Effects of movement behaviors on preschoolers' cognition: a systematic review of randomized controlled trials

BACKGROUND

Movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are fundamental to early childhood development. These behaviors interact dynamically within a 24-hour period, creating a complex balance that influences not only physical health but also cognitive and emotional well-being in young children. While the physical health benefits of movement behaviors are well-documented, systematic evaluations of how interventions targeting these behaviors affect cognitive development in preschool-aged children remain limited.

METHODS

This review was guided through PRISMA 2020 guidelines. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the impact of interventions targeting PA, SB, and sleep on cognitive outcomes in preschool-aged children. A comprehensive search was performed across five databases: PubMed, PsycInfo, Web of Science, Embase, and CINAHL, covering studies published between January 2000 and December 2023. Eligible studies were those that focused on at least one movement behavior, had a minimum intervention duration of four weeks, and assessed cognitive development as a primary outcome. The cognitive outcomes evaluated included executive function, attention, memory, and other key domains critical to early childhood development, such as language, processing speed, and social cognition.

RESULTS

Twenty-two RCTs (14 individual, 8 cluster) met the inclusion criteria. Of these, 21 studies focused on PA, while only one targeted SB, and none specifically addressed sleep or combined movement behaviors. PA interventions, particularly those involving cognitively engaging activities, significantly improved cognitive domains such as executive function, inhibition, and attention, with effect sizes ranging from moderate to large (Cohen's d > 0.5). The SB-focused study did not report significant cognitive improvements. A clear gap exists in understanding the effects of sleep and multi-behavior interventions on cognitive outcomes.

CONCLUSIONS

Cognitively engaging PA interventions demonstrated the largest effects, while motor skill-focused and general PA programs produced moderate to smaller gains. Evidence on SB and sleep interventions remains limited, with no studies exploring the combined effects of these three movement behaviors. Future research should focus on integrated interventions that address PA, SB, and sleep to achieve a more comprehensive understanding of their collective impact on cognitive development in early childhood.

TRIAL REGISTRATION

This study was registered with PROSPERO under the registration number CRD42023479156.

Measuring working memory span with WAIS-IV: Digit sequence is the superior span test

The Digit Span test has been part of the Wechsler tests from the first version. In the WAIS-IV the Digit Span Sequencing subtest (DSS) was introduced and in the forthcoming WAIS-5 working memory span will also be measured in the visual modality. The present study analyzes WAIS-IV Digit Span, Letter- Number Span (LNS) and WMS-III Spatial Span (SS) performance in a mixed clinical sample, expecting to find that Digit Span Forwards (DSF) lacks sensitivity to the Working Memory impairment evident in D-KEFS Trail Making Test-4 (TMT-4) scores ≤1 SD below normative means in the sample. The results showed DSF score above normative means, Digit Span Backwards (DSB) around mean, while SS and LNS was slightly impaired and DSS impaired at the same level as TMT- 4. A double dissociation was observed in DSF and SS performance between subjects with Language- and Non-verbal learning disorders. Most subjects scored in the average range on the LNS-span and high kurtosis reduced sensitivity. Taking LNS and TMT-4 as criterion measures of WM, regression analyses showed no unique contribution of DSF to the variance in these tests. The study supports prior critiques regarding the composite Digit Span measure and demonstrates that the DSS are more effective than the current version of LNS in identifying reduced Working Memory capacity.

Cognitive Domains in the National Social Life, Health, and Aging Project

OBJECTIVES

Cognition consists of specific domains that are differentially linked to health outcomes. We provide guidance on how to derive cognitive domains in the National Social Life, Health, and Aging Project (NSHAP) study. We suggest the use of a bifactor analysis to derive cognitive domains. To support our view that a bifactor analysis is necessary, we created cognitive domains from a bifactor analysis and created cognitive domains through summing the cognitive items; we then regressed the cognitive domains created through both methods with functional health (activites of daily living [ADLs] and instrumental activities of daily living [IADLs]) and compared the regression results.

METHODS

NSHAP is a nationally representative longitudinal study of U.S. older adults that started in 2005. Data from Round 3 (2015-2016) were used. The MoCA-SA contains 18 cognitive items to represent 6 cognitive domains: modified trail-making test-B, clock drawing test (3 items), rhinoceros naming, digit span (2 items), serial 7 subtractions, sentence repetition, phonemic fluency, abstraction, delayed recall (5 items), and orientation (2 items). We created cognitive domains through a bifactor analysis and through summing up the cognitive items. We used linear regression to examine how global cognition and each cognitive domain derived from both methods were associated with ADLs and IADLs. Analyses were restricted to respondents aged 50+ without dementia.

RESULTS

The global cognition score derived from both methods was statistically significantly associated with ADLs and with IADLs. All but the memory domain constructed from summing the cognitive items were associated with IADLs; only the visuospatial domain was associated with ADLs. None of the domains derived from a bifactor analysis were associated with ADLs or IADLs.

DISCUSSION

Researchers should derive cognitive domains using a bifactor analysis to reduce spurious associations.

Subjective cognitive functioning in patients with cancer: A network approach

PURPOSE

The current study aimed to (1) examine the sociodemographic, clinical and psychological factors related to subjective cognitive functioning (SCF); (2) analyze the complex mutual interconnections between SCFs; and (3) address patients' perspectives on SCF and supportive care.

METHOD

A heterogeneous sample of oncological patients (N = 566) was recruited.Items inquiring about the senses, attention, memory, spatial functions, decision-making and speech were administered. A network of subjectively perceived changes in cognitive functions was estimated while three open-ended questions addressed patients' perspectives on SCF.

RESULTS

Within the network, deficits in spatial perception, attention focus and problem-solving ability had the highest strength index while the deficits related to the senses were the least influential.

CONCLUSION

The findings indicate that psychological-based interventions focused on higher cognitive functions could improve patients' quality of life. The presence of supportive care and available information could strengthen SCF intervention and prevention for patients with cancer.

Comparative effectiveness of physical activity interventions on cognitive functions in children and adolescents with Neurodevelopmental Disorders: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Physical activity (PA) interventions have been shown to yield positive effects on cognitive functions. However, it is unclear which type of PA intervention is the most effective in children and adolescents with Neurodevelopmental Disorders (NDDs). This study aimed to compare the effectiveness of different types of PA interventions on cognitive functions in children and adolescents with NDDs, with additional analyses examining intervention effects across specific NDD types including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

METHODS

In this systematic review and network meta-analysis, seven databases (Web of Science, PubMed, Medline, APA PsycINFO, Embase, CINAHL, and SPORTDiscus) for randomized controlled trials from database inception to September 2023 were searched. Randomized controlled trials comparing the effectiveness of PA intervention with any non-pharmacological treatment or control group on cognitive functions in children and adolescents diagnosed with NDDs aged 5-17 years were included. Frequentist network meta-analyses were performed based on standardized mean differences (SMD) using random effects models to examine post-intervention differences in cognitive functions, including attention, memory, and executive functions. Intervention dropout was assessed as a measure of treatment acceptability.

RESULTS

Thirty-one randomized controlled trials (n = 1,403, mean age 10.0 ± 1.9 years) with 66 arms were included in the network. Mind-body exercise (MBE; SMD = 1.91 for attention; 0.92 for executive functions), exergaming (SMD = 1.58 for attention; 0.97 for memory; 0.94 for executive functions), and multi-component physical activity (MPA; SMD = 0.79 for executive functions) were associated with moderate to substantial cognitive improvements compared with usual care, whereas the effectiveness of aerobic exercise (AE) was non-significant. Exergaming (SMD = 0.78, 95%CI 0.12 to 1.45) and MPA (SMD = 0.64, 95%CI 0.11 to 1.18) were more effective than AE for executive functions. When analyzing specific NDD types, exergaming lost its superiority over usual care for attention and memory in ADHD, nor for executive functions in ASD. Instead, MPA demonstrated significant benefits across these domains and populations. The certainty of evidence for these comparisons was very low to low. No significant differences in acceptability were observed among MBE, exergaming, and MPA.

CONCLUSIONS

The findings in this study suggest that MBE, exergaming, and MPA were effective interventions for improving domain-specific cognitive functions in children and adolescents with NDDs. AE demonstrated non-significant effectiveness for all outcomes. MBE emerges as particularly advantageous for attention. MPA yielded consistent improvements in memory and executive functions across NDD types. Further high-quality randomized controlled trials of direct comparisons are needed to confirm and expand on the findings from this NMA.

TRIAL REGISTRATION

PROSPERO CRD42023409606.

Relationship between leisure activity and depression in Chinese older adults: chain mediating effect of diet and cognition

BACKGROUND

Leisure activity was associated with depression in older adults. However, the specific processes by which diet and cognition mediate the role of leisure activities and depression remain uncertain. The study aims to investigate the relationship between leisure activity and depression in older people and the underlying mechanisms involved, while constructing a comprehensive model that links these variables.

METHODS

Data came from the 2018 Chinese Longitudinal Healthy Longevity Survey. Mini-Mental State Examination and CES-D-10 were used to assess cognition and depression, respectively. PROCESS macro was employed to assess the mediation effects of diet and cognition on the relationship between leisure activity and depression.

RESULTS

Leisure activity was negatively associated with depression, with 35.90% of the total effect mediated through dietary diversity and cognitive function, of which 1.28% was from the chain-mediated effect of dietary diversity and cognition. In addition, 20.94% of the total effect mediated through a plant-based diet and cognitive function, of which 0.43% was from the chain-mediated effect of plant-based diet and cognition.

CONCLUSIONS

Leisure activities are linked to depression, with diet and cognition acting as chain-mediating factors. Public health experts recommend that older adults engage in leisure activities, ensure a broad spectrum of dietary intake, and prioritize the augmentation of plant-based diets as preventative strategies against depression.

Role of nurse practitioners in comprehensive Alzheimer's disease care: Barriers and opportunities for timely diagnosis

Alzheimer's disease (AD) is a progressive neurodegenerative disease. Treatments include disease-modifying therapies (DMTs), which studies showed are most effective when initiated during the early disease stages. Timely AD diagnosis is therefore important, as DMTs can potentially extend an acceptable quality of life for people with this condition. This scoping review presents the current role of nurse practitioners (NPs) in AD care and describe the current and potential future role NPs can play in timely AD diagnosis and management. A systematic search of the PubMed and CINAHL databases identified 15 relevant articles. The literature review revealed that NPs play an active role in the initial assessment of cognitive disorders; however, there is a lack of evidence for NPs acting autonomously to diagnose and treat AD. Several opportunities to increase the autonomous role of NPs are described, which could reduce barriers to timely AD diagnosis and management.

Cognitive Decline in Alzheimer's Disease

Deficits in memory, language, and other cognitive domains that impact an individual's ability to perform necessary tasks of daily living are symptoms of dementia, which is a major cause of death and disability in older adults. As the global population continues to age, deepening our understanding of dementia is crucial. Alzheimer's disease is the leading cause of dementia and accounts for between 60% and 80% of total dementia cases. Declines in episodic memory are considered a hallmark of Alzheimer's disease and occur early in disease progression. The cognitive effects of Alzheimer's disease differ from the cognitive changes expected in nonpathological or normal aging. While some cognitive changes are expected as a part of the aging processes, the declines in cognition associated with Alzheimer's disease are to a degree that the individual diagnosed with the disease is unable to function independently in activities of daily living. In this review, we will discuss how cognition is impacted by both normal and pathological aging, with a focus on Alzheimer's disease. We describe the progressive nature of Alzheimer's disease, as well as the effects of each stage of the disease on cognition.

Oral Diseases Are Associated with Cognitive Decline and Dementia

Common oral diseases, including periodontitis and dental caries, and their endpoint as tooth loss are controllable yet highly prevalent among adults worldwide. Cognitive decline also poses significant global public health challenges during the aging process, especially the pathological form of cognitive decline such as dementia. Dementia is irreversible and is one of the leading causes of death, disability, and dependency in the aging population. Emerging research suggests a bidirectional association between oral diseases and cognitive decline or dementia. This potential link has implications for designing better oral care plans for patients with dementia and recognizing oral diseases as modifiable risk factors for dementia prevention.This chapter provides an overview of the association between oral diseases and cognitive decline, followed by a discussion of current evidence on such associations in two directions: (1) the impact of cognitive decline or dementia on oral health and (2) the role of oral diseases as modifiable risk factors for dementia. We critically evaluate several hypotheses regarding the underlying mechanisms of this association, including (1) life-course hypothesis, (2) shared inflammation and bacterial infection mechanisms, (3) malnourishment mechanism, (4) pain pathway, and (5) sensory feedback pathway.However, the association between oral diseases and cognitive decline or dementia remains controversial due to limited high-quality evidence, particularly from biomedical research. Much of the existing evidence is from observational studies prone to confounding bias, with inconclusive questions about causation and the direction of causality.This chapter concludes by emphasizing the need for future studies with robust methodological designs, including randomized controlled trials, biomedical studies, and innovative research techniques such as Mendelian randomization. Such studies are crucial for disease prevention and enhancing patient care and quality of life. By providing a comprehensive overview, this chapter contributes to an advanced understanding of this field, addresses current study gaps, and suggests future research directions.

Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients: Findings from the prospective multicenter NeNeSCo study

OBJECTIVE

This study aimed to investigate the prevalence and nature of cognitive impairment among severely ill COVID-19 patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it.

METHOD

We evaluated cognition in COVID-19 patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into z-scores. Scores within each cognitive domain were averaged and categorized as average and above (z-score ≥ -0.84), low average (z-score -1.28 to -0.84), below average (z-score -1.65 to -1.28), and exceptionally low (z-score < -1.65). Patients were classified with cognitive impairment if at least one domain's z-score fell below -1.65. We assessed the MoCA's accuracy using both the original cutoff (<26) and an "optimal" cutoff determined by Youden's index.

RESULTS

Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below -1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of <24, maintained sensitivity while improving specificity to 81%.

CONCLUSIONS

Cognitive impairment prevalence in initially hospitalized COVID-19 patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to <24 improves specificity.

Usability and psychometric properties of a battery of tools to assess intelligence, executive functioning, and sustained attention in Tanzanian children

BACKGROUND

Measuring neurocognitive functioning in children requires validated, age-appropriate instruments that are adapted to the local cultural and linguistic context. We sought to evaluate the usability and psychometric properties of five tools that assess general intelligence, executive functioning, and sustained attention among Tanzanian children.

METHODS

We adapted five age-appropriate neurocognitive assessment batteries from previously published assessment materials to the Tanzanian context. We enrolled children 6 months to 12 years of age residing in the rural ward of Yombo, Pwani Region. Feasibility and acceptability of all instruments was assessed qualitatively and quantitatively, including measurement of refusal rates, ceiling or floor effects, and time requirements. We assessed internal consistency using Cronbach's alpha and convergent validity using standard correlation analysis. Score gradients across age were explored using polynomial regression analysis.

FINDINGS

All five instruments required minimal adaptations to the Tanzanian context. Two-hundred sixty one children aged 6 months to 12 years completed the assessment. Refusal rates were consistently low (5.9% at the highest) and no ceiling or floor effects of measurements were observed. Feedback from assessors and caregivers indicated adequate test durations and generally high acceptability of instruments. All instruments showed good internal consistency with Cronbach alphas at least 0.84 for all tests. We found satisfactory convergent validity; all test scores strongly correlated with age.

CONCLUSION

The five instruments identified to assess general intelligence, executive functioning, and sustained attention constructs in Tanzanian children seem to work well in this setting.