Inhibitory Control Deficits in Individuals with Amnestic Mild Cognitive Impairment: a Meta-Analysis

The impact of reward and punishment sensitivity on memory and executive performance in individuals with amnestic mild cognitive impairment

Amnestic mild cognitive impairment (aMCI) is defined by memory impairment but executive function (EF) deficits could be also a common feature. This study examined the underlying neurocognitive processes associated with executive function (EF) deficits in patients with aMCI using the Wisconsin Card Sorting Test (WCST) and computational modeling. Forty-two patients with aMCI and thirty-eight matched Controls performed the WSCT and underwent neurocognitive assessment. The Attentional Learning Model was applied the WCST. Patients with aMCI demonstrated deficits in feedback-learning. More specifically, patients showed increased Reward-Sensitivity and reduced Punishment-Sensitivity. These alterations were associated with poor WSCT performance and deficits in EF and Memory. Goal-directed deficits in aMCI, as observed in the WCST, are associated with difficulties in updating attention after feedback as its changes too rapidly following positive feedback and too slowly following negative feedback. Consequently, memory and EF deficits interact and reinforce each other generating performance deficits in patients with aMCI.

Subjective Cognitive Impairment Can Be Detected from the Decline of Complex Cognition: Findings from the Examination of Remedes 4 Alzheimer's (R4Alz) Structural Validity

R4Alz is utilized for the early detection of minor neurocognitive disorders. It was designed to assess three main dimensions of cognitive-control abilities: working-memory capacity, attentional control, and executive functioning.

OBJECTIVES

To reveal the cognitive-control dimensions that can differentiate between adults and older adults with healthy cognition, people with subjective cognitive impairment, and people diagnosed with mild cognitive impairment by examining the factorial structure of the R4Alz tool.

METHODS

The study comprised 404 participants: (a) healthy adults (n = 192), (b) healthy older adults (n = 29), (c) people with SCI (n = 74), and (d) people diagnosed with MCI (n = 109). The R4Alz battery was administered to all participants, including tests that assess short-term memory storage, information processing, information updating in working memory, and selective, sustained and divided attention), task/rule-switching, inhibitory control, and cognitive flexibility.

RESULTS

A two-factorial structural model was confirmed for R4Alz, with the first factor representing "fluid intelligence (FI)" and the second factor reflecting "executive functions (EF)". Both FI and EFs discriminate among all groups.

CONCLUSIONS

The R4Alz battery presents sound construct validity, evaluating abilities in FI and EF. Both abilities can differentiate very early cognitive impairment (SCI) from healthy cognitive aging and MCI.

Brain activity during Stroop task performance at age 74 after exposure to the Dutch famine during early gestation

OBJECTIVE

Poorer performance on the Stroop task has been reported after prenatal famine exposure at age 58, potentially indicating cognitive decline. We investigated whether brain activation during Stroop task performance at age 74 differed between individuals exposed to famine prenatally, individuals born before and individuals conceived after the famine.

METHOD

In the Dutch famine birth cohort, we performed a Stroop task fMRI study of individuals exposed (n = 22) or unexposed (born before (n = 18) or conceived after (n = 25)) to famine in early gestation. We studied group differences in task-related mean activation of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC) and posterior parietal cortex (PPC). Additionally, we explored potential disconnectivity of the DLPFC using psychophysiological interaction analysis.

RESULTS

We observed similar activation patterns in the DLPFC, ACC and PPC in individuals born before and individuals exposed to famine, while individuals conceived after famine had generally higher activation patterns. However, activation patterns were not significantly different between groups. Task-related decreases in connectivity were observed between left DLPFC-left PPC and right DLPFC-right PPC, but were not significantly different between groups.

CONCLUSIONS

Although not statistically significant, the observed patterns of activation may reflect a combined effect of general brain aging and prenatal famine exposure.

The assessment of executive function abilities in healthy and neurodegenerative aging-A selective literature review

Numerous studies have examined executive function (EF) abilities in cognitively healthy older adults and those living with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Currently, there are no standard accepted protocols for testing specific EFs; thus, researchers have used their preferred tool, which leads to variability in assessments of decline in a particular ability across studies. Therefore, there is a need for guidance as to the most sensitive tests for assessing EF decline. A search of the most current literature published between 2000 and 2022 on EF studies assessing cognitively healthy older adults and individuals living with MCI and AD was conducted using PubMed/Medline, PsycINFO, Embase, Web of Science, and Google Scholar. Emphasis was placed on the EF's dual-tasking, inhibition, shifting or switching, and working memory updating. Many tasks and their outcomes were reviewed. Of particular importance was the difference in outcomes for tasks applied to the same group of participants. These various EF assessment tools demonstrate differences in effectively identifying decline in EF ability due to the aging process and neurodegenerative conditions, such as MCI and AD. This review identifies various factors to consider in using particular EF tasks in particular populations, including task demand and stimuli factors, and also when comparing differing results across studies.

Relationship between reaction time variability on go/no go tasks and neuropsychological functioning in younger and older adults

INTRODUCTION

Early detection of cognitive impairment in older adults is important for the prevention of dementia. Intra-individual variability in reaction time (IIV-RT) during go/no-go tasks can be used for the early detection of cognitive impairment in older adults living in the community. This study aimed to determine the relationship between IIV-RT and cognitive function during go/no-go tasks and the cutoff values for determining the risk of cognitive impairment in community-dwelling older adults.

METHODS

This study included 31 older adults without cognitive impairment, 15 community-dwelling older adults with cognitive impairment, and 34 healthy young adults. All participants performed a go/no-go task to assess the IIV-RT. Additionally, older adults underwent neuropsychological testing. Based on the results of the Japanese version of the Montreal Test of Cognitive Abilities (MoCA-J), older adults were divided into those with normal cognition and those with cognitive impairment.

RESULTS

There were significant differences in the IIV-RT among groups, including a higher IIV in the cognitively impaired group than in young adults and cognitively normal older adults. Moreover, the IIV-RT was correlated with the MoCA-J (r =  -0.531, p < 0.001), Trail Making Test Part A (r = 0.571, p < 0.001), and Verbal Fluency Test scores (r =  -0.442, p = 0.002). Receiver operating curve analysis showed that the area under the curve for IIV-RT was 0.935, and the cutoff value at which the IIV-RT identified cognitive impairment was 25.37%.

CONCLUSIONS

These findings indicate that the IIV-RT during go/no-go tasks is a useful early indicator of cognitive impairment in community-dwelling older adults.

Effects of Remote Expressive Arts Program in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

BACKGROUND

Mild cognitive impairment (MCI) is a stage of cognitive ability loss with intact activities of daily living and an increased risk for the development of dementia.

OBJECTIVE

This study evaluated the intervention effect of remote expressive arts program (rEAP) on cognitive function in older adults with MCI and investigated the underlying neurobiological mechanisms.

METHODS

We assigned 73 older MCI patients to receive rEAP or health education (HE), who underwent neuropsychological evaluation and resting-state functional magnetic resonance imaging before and after treatment. Neuropsychological scores were analyzed using SPSS software, and regional homogeneity (ReHo) values and seed-based functional connectivity (FC) were analyzed using Matlab software.

RESULTS

The rEAP group showed more significant improvements in cognitive function than the HE group. rEAP affected spontaneous brain activity and brain networks. The ReHo values in the right anterior cingulate/paracingulate cortex and the left dorsolateral superior frontal gyrus significantly increased and decreased, respectively, in the rEAP and HE groups. Further, ReHo value changes were significantly associated with the corresponding neuropsychological test score changes in the rEAP group. Moreover, the rEAP group showed decreased FC between the posterior cingulate cortex and the right middle temporal gyrus and increased FC between the ventromedial prefrontal cortex and left angular gyrus.

CONCLUSION

The 12-week rEAP improved cognitive function in MCI patients. Additionally, the alterations of spontaneous brain network connections and activity helped improve and maintain cognitive function in MCI patients.

The Ability to Use Contextual Information in Object and Scene Recognition in Patients with Mild Cognitive Impairment

BACKGROUND

The ability to understand and make use of object-scene relationships are critical for object and scene recognition.

OBJECTIVE

The current study assessed whether patients with mild cognitive impairment (MCI), possibly in the preclinical phase of Alzheimer's disease, exhibited impairment in processing contextual information in scene and object recognition.

METHODS

In Experiment 1, subjects viewed images of foreground objects in either semantic consistent or inconsistent scenes under no time pressure, and they verbally reported the names of foreground objects and backgrounds. Experiment 2 replicated Experiment 1, except that subjects were required to name scene first. Experiment 3 examined object and scene recognition accuracy baselines, recognition difficulty, familiarity with objects/scenes, and object-scene consistency judgements.

RESULTS

There were contextual consistency effects on scene recognition for MCI and healthy subjects, regardless of response sequence. Scenes were recognized more accurately under the consistent condition than the inconsistent condition. Additionally, MCI patients were more susceptible to incongruent contextual information, possibly due to inhibitory deficits or over-dependence on semantic knowledge. However, no significant differences between MCI and healthy subjects were observed in consistency judgement, recognition accuracy, recognition difficulty and familiarity rating, suggesting no significant impairment in object and scene knowledge among MCI subjects.

CONCLUSIONS

The study indicates that MCI patients retain relatively intact contextual processing ability but may exhibit inhibitory deficits or over-reliance on semantic knowledge.

Effects of exercise interventions on executive function in old adults with mild cognitive impairment: A systematic review and meta-analysis of randomized controlled trials

AIMS

To assess the effect of exercise interventions on subdomains of executive function (EF) in older adults with mild cognitive impairment (MCI).

METHODS

Nine electronic databases were comprehensively searched from their inception to February 2021. Randomized controlled trials examining the effect of exercise training on EF in MCI were included.

RESULTS

Twenty-four eligible articles involving 2278 participants were identified. The results showed that exercise interventions had positive benefits on working memory, switching and inhibition in MCI. Subgroup analysis based on exercise prescriptions revealed that both aerobatic exercise and mind-body exercise had similar positive effect size on working memory. However, only mind-body exercise had significant effect on switching. Exercise training with moderate frequency (3-4 times/week) had larger effect size than low frequency (1-2 times/week) and only moderate frequency had positive benefits on switching. Both short (4-12 weeks), medium (13-24 weeks) and long (more than 24 weeks) exercise duration significantly ameliorate working memory and switching, however with short duration having slight larger effect sizes than medium and long.

CONCLUSION

Exercise significantly improves three subdomains of EF in MCI, especially mind-body exercise. Exercise training sticking to at least 4 weeks with 3-4 times a week tends to have larger effect size.

Time of Day Effects on Inhibitory Functioning: Cognitive and Neural Evidence of Sundowning in Amnestic Mild Cognitive Impairment

Background: Amnestic mild cognitive impairment (aMCI), a prodromal phase of Alzheimer’s disease (AD), is characterized by episodic memory dysfunction, but inhibitory deficits have also been commonly reported. Time of day (TOD) effects have been confirmed in 1) healthy aging on cognitive processes such as inhibitory control, and 2) on behavior in AD (termed the sundowning effect), but no such research has addressed aMCI. Objective: The present study examined the impact of TOD on the behavioral and electrophysiological correlates of inhibition in 54 individuals with aMCI and 52 healthy controls (HCs), all of morning chronotype. Methods: Participants were randomly assigned to complete two inhibition tasks (Go-NoGo and Flanker) during their optimal (morning) or non-optimal (evening) TOD, while electroencephalography was recorded. Results: Both tasks elicited changes in N2 and P3 event-related potential (ERP) components, which commonly index inhibitory functioning. Analyses showed that the Go-NoGo difference in P3 amplitude was reduced in individuals with aMCI relative to HCs. Compared to HCs, the Flanker difference in P3 amplitude was also reduced and coincided with more errors in the aMCI group. Notably, these behavioral and ERP differences were exaggerated in the non-optimal TOD relative to the optimal TOD. Conclusion: Findings confirm the presence of inhibition deficits in aMCI and provide novel evidence of sundowning effects on inhibitory control in aMCI. Results reinforce the need to consider the influences of TOD in clinical assessments involving individuals with aMCI.

Body mass index related to executive function and hippocampal subregion volume in subjective cognitive decline

Objective

This study aims to explore whether body mass index (BMI) level affects the executive function and hippocampal subregion volume of subjective cognitive decline (SCD).

Materials and methods

A total of 111 participants were included in the analysis, including SCD (38 of normal BMI, 27 of overweight and obesity) and normal cognitive control (NC) (29 of normal BMI, 17 of overweight and obesity). All subjects underwent the Chinese version of the Stroop Color-Word Test (SCWT) to measure the executive function and a high-resolution 3D T1 structural image acquisition. Two-way ANOVA was used to examine the differences in executive function and gray matter volume in hippocampal subregions under different BMI levels between the SCD and NC.

Result

The subdimensions of executive function in which different BMI levels interact with SCD and NC include inhibition control function [SCWT C-B reaction time(s): F (1,104) = 5.732, p = 0.018], and the hippocampal subregion volume of CA1 [F (1,99) = 8.607, p = 0.004], hippocampal tail [F (1,99) = 4.077, p = 0.046], and molecular layer [F (1,99) = 6.309, p = 0.014]. After correction by Bonferroni method, the population × BMI interaction only had a significant effect on the CA1 (p = 0.004). Further analysis found that the SCWT C-B reaction time of SCD was significantly longer than NC no matter whether it is at the normal BMI level [F (1,104) = 4.325, p = 0.040] or the high BMI level [F (1,104) = 21.530, p < 0.001], and the inhibitory control function of SCD was worse than that of NC. In the normal BMI group, gray matter volume in the hippocampal subregion (CA1) of SCD was significantly smaller than that of NC [F (1,99) = 4.938, p = 0.029]. For patients with SCD, the high BMI group had worse inhibitory control function [F (1,104) = 13.499, p < 0.001] and greater CA1 volume compared with the normal BMI group [F (1,99) = 7.619, p = 0.007].

Conclusion

The BMI level is related to the inhibition control function and the gray matter volume of CA1 subregion in SCD. Overweight seems to increase the gray matter volume of CA1 in the elderly with SCD, but it is not enough to compensate for the damage to executive function caused by the disease. These data provide new insights into the relationship between BMI level and executive function of SCD from the perspective of imaging.

The "Ifs" and "Hows" of the Role of Music on the Implementation of Emotional Regulation Strategies

Music is believed to aid the implementation of emotion regulation strategies like distraction or reappraisal, but empirical studies have shown null results. However, the moderating role of one’s relation with music (musical sophistication) and/or executive functioning skills has not been considered yet. In addition, little is known about how music acts. In the present study, we induced anger in a group of participants characterized by musical sophistication and executive functioning. We asked them to regulate their emotional state and measured regulation efficacy. Participants were split into four groups, defined by regulation strategy (distraction vs. reappraisal) and music (with vs. without). Results indicated music effects in higher, but not in lower musical sophistication participants. In the former, music benefitted from reappraisal but was an impaired distraction. Two different executive functions—working memory and affective flexibility—had opposite effects: higher, but not lower working memory participants benefited from music; lower, but not higher, effective flexibility participants took advantage of music. Reports of subjective experience suggested that music favors more empathic reappraisals, and that these may be more long-lasting. Our findings support the idea that music effects depend on listeners’ characteristics, and they raise new hypotheses concerning the specificity of emotional regulation aided by music.

Protocol for Rhapsody: a longitudinal observational study examining the feasibility of speech phenotyping for remote assessment of neurodegenerative and psychiatric disorders

INTRODUCTION

Neurodegenerative and psychiatric disorders (NPDs) confer a huge health burden, which is set to increase as populations age. New, remotely delivered diagnostic assessments that can detect early stage NPDs by profiling speech could enable earlier intervention and fewer missed diagnoses. The feasibility of collecting speech data remotely in those with NPDs should be established.

METHODS AND ANALYSIS

The present study will assess the feasibility of obtaining speech data, collected remotely using a smartphone app, from individuals across three NPD cohorts: neurodegenerative cognitive diseases (n=50), other neurodegenerative diseases (n=50) and affective disorders (n=50), in addition to matched controls (n=75). Participants will complete audio-recorded speech tasks and both general and cohort-specific symptom scales. The battery of speech tasks will serve several purposes, such as measuring various elements of executive control (eg, attention and short-term memory), as well as measures of voice quality. Participants will then remotely self-administer speech tasks and follow-up symptom scales over a 4-week period. The primary objective is to assess the feasibility of remote collection of continuous narrative speech across a wide range of NPDs using self-administered speech tasks. Additionally, the study evaluates if acoustic and linguistic patterns can predict diagnostic group, as measured by the sensitivity, specificity, Cohen's kappa and area under the receiver operating characteristic curve of the binary classifiers distinguishing each diagnostic group from each other. Acoustic features analysed include mel-frequency cepstrum coefficients, formant frequencies, intensity and loudness, whereas text-based features such as number of words, noun and pronoun rate and idea density will also be used.

ETHICS AND DISSEMINATION

The study received ethical approval from the Health Research Authority and Health and Care Research Wales (REC reference: 21/PR/0070). Results will be disseminated through open access publication in academic journals, relevant conferences and other publicly accessible channels. Results will be made available to participants on request.

TRIAL REGISTRATION NUMBER

NCT04939818.

Training and Transfer Effects of Combining Inhibitory Control Training With Transcutaneous Vagus Nerve Stimulation in Healthy Adults

Inhibitory control training (ICT) is a promising method to improve individual performance of inhibitory control (IC). Recent studies have suggested transcutaneous vagus nerve stimulation (tVNS) as a novel approach to affect cognitive function owing to its ability to modulate the locus coeruleus-noradrenaline system. To examine the synergistic effects of combining ICT with tVNS, 58 young males in college were randomly assigned to four groups: ICT + tVNS, ICT + sham tVNS, sham ICT + tVNS, and sham ICT + sham tVNS. Participants were instructed to complete three sessions that comprised pre-training tests, a training session, and post-training tests sequentially. Results showed that the ICT + tVNS group significantly improved training and near-transfer effects on the stop-signal and Go/No-go tasks, and these effects were larger than those of the other groups. However, none of the groups exhibited the far-transfer effect on the color-word Stroop task. These results suggest that tVNS augments the intervention effects of training and similar inhibition tasks to achieve the synergistic effect; however, it does not modulate the effects of non-training tasks and obtain the far-transfer effect. ICT combined with tVNS may be a valuable intervention for improving IC in healthy individuals in certain industries and offers novel research ideas for using tVNS for cognitive improvement.

Multitask Versus Multicomponent Training on Cognitive and Motor Functions in Persons With Mild Cognitive Impairment: A Randomized Trial

This study aims to compare the effects of multitask (MTT; multiple tasks performed simultaneously) and multicomponent training (MCT; various types of exercise performed sequentially) on processing speed, cognitive functions, gait speed, and balance functions in persons with mild cognitive impairment. Forty-two persons with mild cognitive impairment were randomly allocated to MTT (n = 21) or MCT (n = 21). Outcome measures included processing speed, cognitive functions (attention and executive functions), single-task gait speed, dual-task gait speed (DTGS-Arithmetic and DTGS-Verbal), and balance functions. Processing speed (except inhibition), cognitive functions, gait speed, and balance functions improved in the MTT and MCT groups following training, with no significant differences between the groups in processing speed or cognitive functions. The MCT group improved more on single-task gait speed (F = 15.097; p = .000; r = .270) and DTGS (DTGS-Arithmetic; F = 10.594; p = .002; r = .214), while the MTT group improved more on balance functions (F = 4.366; p = .043; r = .101). MTT and MCT strategies can be used to improve cognitive and physical outcomes in persons with mild cognitive impairment.

Automated semantic relevance as an indicator of cognitive decline: Out-of-sample validation on a large-scale longitudinal dataset

We developed and evaluated an automatically extracted measure of cognition (semantic relevance) using automated and manual transcripts of audio recordings from healthy and cognitively impaired participants describing the Cookie Theft picture from the Boston Diagnostic Aphasia Examination. We describe the rationale and metric validation. We developed the measure on one dataset and evaluated it on a large database (>2000 samples) by comparing accuracy against a manually calculated metric and evaluating its clinical relevance. The fully automated measure was accurate (r = .84), had moderate to good reliability (intra-class correlation = .73), correlated with Mini-Mental State Examination and improved the fit in the context of other automatic language features (r = .65), and longitudinally declined with age and level of cognitive impairment. This study demonstrates the use of a rigorous analytical and clinical framework for validating automatic measures of speech, and applied it to a measure that is accurate and clinically relevant.

EEG theta and alpha oscillations in early versus late mild cognitive impairment during a semantic Go/NoGo task

Amnestic mild cognitive impairment (aMCI) is marked by episodic memory deficits, which can be used to classify individuals into early MCI (EMCI) and late MCI (LMCI). Although mounting evidence suggests that individuals with aMCI have additional cognitive alterations including deficits in cognitive control, few have examined if EMCI and LMCI differ on processes other than episodic memory. Using a semantic Go/NoGo task, we examined differences in cognitive control between EMCI and LMCI on behavioral (accuracy and reaction time) and neural (scalp-recorded event-related oscillations in theta and alpha band) measures. Although no behavioral differences were observed between the EMCI and LMCI groups, differences in neural oscillations were observed. The LMCI group had higher theta synchronization on Go trials at central electrodes compared to the EMCI group. In addition, the EMCI group showed differences in theta power at central electrodes and alpha power at central and centro-parietal electrodes between Go and NoGo trials, while the LMCI group did not exhibit such differences. These findings suggest that while behavioral differences may not be observable, neural changes underlying cognitive control processes may differentiate EMCI and LMCI stages and may be useful to understand the trajectory of aMCI in future studies.

Planning in amnestic mild cognitive impairment: an fMRI study

INTRODUCTION

The memory impairment that is characteristic of amnestic mild cognitive impairment (aMCI) is often accompanied by difficulties in executive functioning, including planning. Though planning deficits in aMCI are well documented, their neural correlates are largely unknown, and have not yet been investigated with functional magnetic resonance imaging (fMRI).

OBJECTIVES

The aim of this study was to: (1) identify differences in brain activity and connectivity during planning in people with aMCI and cognitively healthy older adults, and (2) find whether planning-related activity and connectivity are associated with cognitive performance and symptoms of apathy.

METHODS

Twenty-five people with aMCI and 15 cognitively healthy older adults performed a visuospatial planning task (Tower of London; ToL) during fMRI. Task-related brain activation, spatial maps of task-related independent components, and seed-to-voxel functional connectivity were compared between the two groups and regressed against measures of executive functions (Trail Making Test difference score, TMT B-A; Digit Symbol Substitution Test, DSST), delayed recall (Rey Auditory Verbal Learning Test), and apathy (Apathy Evaluation Scale).

RESULTS

People with aMCI scored lower on task-switching (TMT B-A), working memory (DSST), and planning (ToL). During planning, people with aMCI had less activation in the bilateral anterior calcarine sulcus/cuneus, the bilateral temporal cortices, the left precentral gyrus, the thalamus, and the right cerebellum. Across all participants, higher planning-related activity in the supplementary motor area, the retrosplenial cortex and surrounding areas, and the right temporal cortex was related to better delayed recall. There were no between-group differences in functional connectivity, nor were there any associations between connectivity and cognition. We also did not find any associations between brain activity or connectivity and apathy.

CONCLUSION

Impaired planning in people with aMCI appears to be accompanied by lower activation in a diffuse cortico-thalamic network. Across all participants, higher planning-related activity in parieto-occipital, temporal, and frontal areas was related to better memory performance. The results point to the relevance of planning deficits for understanding aMCI and extend its clinical and neurobiological signature.

Assessing a Sensory-Motor-Cognition Triad in Amnestic Mild Cognitive Impairment With Dichotic Listening While Walking: A Dual-Task Paradigm

A contemporary topic in aging research relates to the significance of cognitive changes proper to mild cognitive impairment (MCI) to higher risk of falls and gait deteriorations. The present study addresses this question in the amnestic type of MCI (aMCI) by examining a triad of interrelated comorbidities occurring in the MCI condition: attentional impairments, hearing loss and gait disturbances. To this end, we applied a dichotic listening (DL) test during over-ground walking. DL assesses spontaneous and lateralized auditory attention in three conditions (i.e., free report or Non-forced (NF), Forced-Right (FR) ear and Forced-Left (FL) ear). Earlier reports suggest that this dual-task paradigm evoke asymmetric gait effects on healthy controls, which are moderated by degree of hearing loss. Therefore, the aim of the present study was to evaluate the effects of DL on bilateral (data from both limbs) and lateralized (each limb separately) gait outcomes in a group of forty-three aMCI participants (mean = 71.19) and fifty-two healthy older controls (mean = 70.90) by using hearing loss as a covariate in all analyses. Results showed the aMCI group presented overall compromised gait parameters, especially higher gait variability in all DL conditions during lateralized attentional control. These findings were observed bilaterally, and no lateralized effects on gait were observed. Only after controlling for hearing acuity, gait asymmetries on step length variability emerged almost exclusively in healthy controls. It was concluded that hearing loss in the aMCI group together with higher attentional impairments preclude aMCI individuals to properly execute DL and therefore, they do not display gait asymmetries. The present data demonstrate that varied demands on attentional control dependent on hearing acuity affects gait negatively in healthy older adults and aMCI individuals in very different ways. The appearance of asymmetric effects seems to be a perturbation related to normal aging, while the lack of asymmetries but exaggerated gait variability characterizes aMCI. The present findings show the intricate interplay of sensory, cognitive, and motor deteriorations in different group of older adults, which stresses the need of addressing co-occurring comorbidities behind gait perturbations in individuals prone to develop a dementia state.

Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment

INTRODUCTION

Mean cognitive performance is worse in amnestic mild cognitive impairment (aMCI) compared to control groups. However, studies on variability of cognitive performance in aMCI have yielded inconclusive results, with many differences in variability measures and samples from one study to another.

METHODS

We examined variability in aMCI using an existing older adult sample (n = 91; 51 with aMCI, 40 with normal cognition for age), measured with an online self-administered computerized cognitive assessment (Cogniciti's Brain Health Assessment). Our methodology extended past findings by using pure measures of variability (controlling for confounding effects of group performance or practice), and a clinically representative aMCI sample (reflecting the continuum of cognitive performance between normal cognition and aMCI).

RESULTS

Between-group t-tests showed significantly greater between-person variability (interindividual variability or diversity) in overall cognitive performance in aMCI than controls, although the effect size was with a small to moderate effect size, d = 0.44. No significant group differences were found in within-person variability (intraindividual variability) across cognitive tasks (dispersion) or across trials of a response time task (inconsistency), which may be because we used a sample measuring the continuum of cognitive performance. Exploratory correlation analyses showed that a worse overall score was associated with greater inter- and intraindividual variability, and that variability measures were correlated with each other, indicating people with worse cognitive performance were more variable.

DISCUSSION

The current study demonstrates that self-administered online tests can be used to remotely assess different types of variability in people at risk of Alzheimer`s. Our findings show small but significantly more interindividual differences in people with aMCI. This diversity is considered as "noise" in standard assessments of mean performance, but offers an interesting and cognitively informative "signal" in itself.

Is the Discrimination of Subjective Cognitive Decline from Cognitively Healthy Adulthood and Mild Cognitive Impairment Possible? A Pilot Study Utilizing the R4Alz Battery

BACKGROUND

The early diagnosis of neurocognitive disorders before the symptoms' onset is the ultimate goal of the scientific community. REMEDES for Alzheimer (R4Alz) is a battery, designed for assessing cognitive control abilities in people with minor and major neurocognitive disorders.

OBJECTIVE

To investigate whether the R4Alz battery's tasks differentiate subjective cognitive decline (SCD) from cognitively healthy adults (CHA) and mild cognitive impairment (MCI).

METHODS

The R4Alz battery was administered to 175 Greek adults, categorized in five groups a) healthy young adults (HYA; n = 42), b) healthy middle-aged adults (HMaA; n = 33), c) healthy older adults (HOA; n = 14), d) community-dwelling older adults with SCD (n = 34), and e) people with MCI (n = 52).

RESULTS

Between the seven R4Alz subtasks, four showcased the best results for differentiating HOA from SCD: the working memory updating (WMCUT-S3), the inhibition and switching subtask (ICT/RST-S1&S2), the failure sets (FS) of the ICT/RST-S1&S2, and the cognitive flexibility subtask (ICT/RST-S3). The total score of the four R4Alz subtasks (R4AlzTot4) leads to an excellent discrimination among SCD and healthy adulthood, and to fare discrimination among SCD and MCI.

CONCLUSION

The R4Alz battery is a novel approach regarding the neuropsychological assessment of people with SCD, since it can very well assist toward discriminating SCD from HOA. The R4Alz is able to measure decline of specific cognitive control abilities - namely of working memory updating, and complex executive functions - which seem to be the neuropsychological substrate of cognitive complaints in community dwelling adults of advancing age.

Executive-function tasks in patients with mild cognitive impairment and Alzheimer's Disease: Effects of decline and gender

It is exceedingly rare to find studies that analyze the effect of gender differences in executive-function tasks in normal cognitive aging, Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). The objective of the present study was to analyze the mean differences in performance in four executive-function tasks, the Clock Drawing Test verbal-command, Clock Drawing Test-copy, Phonetic Fluency Test and Trail Making Test-A, according to the gender and impairment group variables. A total of 90 participants (30 patients with Alzheimer's Disease, 30 patients with Mild Cognitive Impairment, and 30 healthy elderly participants; 50% men and 50% women in each group) took part in the study. As expected, the results showed a main effect of the group in most tasks, with a progressively worse performance according to cognitive impairment. Regarding the effect of gender, there were no significant differences in the Mild Cognitive Impairment and healthy elderly groups, but a significantly higher performance of women compared to men was found in the Alzheimer's group. The clinical and theoretical implications of these results are discussed. In particular, the abnormal performance of women with Alzheimer's in the sample may be related to a possible cognitive reserve due to social and educational background in their sociocultural and generational context.

An fMRI Investigation into the Effects of Ketogenic Medium-Chain Triglycerides on Cognitive Function in Elderly Adults: A Pilot Study

Evidence suggests that oral intake of medium-chain triglycerides (MCTs), which promote the production of ketone bodies, may improve cognitive functions in elderly people; however, the underlying brain mechanisms remain elusive. We tested the hypothesis that cognitive improvement accompanies physiological changes in the brain and reflects the use of ketone bodies as an extra energy source. To this end, by using functional magnetic resonance imaging, cerebral blood oxygenation level-dependent (BOLD) signals were measured while 20 healthy elderly subjects (14 females and 6 males; mean age: 65.7 ± 3.9 years) were engaged in executive function tasks (N-back and Go-Nogo) after ingesting a single MCT meal (Ketonformula^®) or placebo meal in a randomized, double-blind placebo-controlled design (UMIN000031539). Morphological characteristics of the brain were also examined in relation to the effects of an MCT meal. The MCT meal improved N-back task performance, and this was prominent in subjects who had reduced grey matter volume in the dorsolateral prefrontal cortex (DLPFC), a region known to promote executive functions. When the participants were dichotomized into high/low level groups of global cognitive function at baseline, the high group showed improved N-back task performance, while the low group showed improved Go-Nogo task performance. This was accompanied by decreased BOLD signals in the DLPFC, indicative of the consumption of ketone bodies as an extra energy source.

Confirmation of age-related alterations in inhibitory control using a modified minimally delayed oculomotor response (MDOR) task

Considerable effort has been made to measure and understand the effects of ageing on inhibitory control using a range of behavioural tasks. In the minimally delayed oculomotor response (MDOR) task, participants are presented with a simple visual target step with variable target display duration (TDD), and instructed to saccade to the target not when it appears (a prosaccade response), but when it disappears (i.e., on target offset). Using this task, we recently found higher error rates and longer latencies for correct responses in older compared to younger participants. Here we have used a modified MDOR task, in which participants were presented with static placeholders identifying potential target positions (increasing spatial information), and three TDDs rather than two (reducing temporal predictability). We found that the yield of analysable trials was generally higher with this modified task and in 28 older (mean ± SD age: 65 ± 7 y) and 25 younger (26 ± 7 y) participants the total overall error rate was again higher in the older group (30 ± 18% vs. 16 ± 11%). An analysis of the temporal distribution of responses demonstrated a pronounced peak in error production around 150 ms (young) or 200 ms (old) after target onset. When we recalculated the error rate focusing on these errors, it was again significantly higher in the older group. The latency of correct responses (to offsets) was significantly increased in the older group, although much of this increase was accounted for by expected age-related visuomotor slowing. However, both latency and distribution data suggested that while older participants could generate increased levels of inhibition, they could not maintain these levels as efficiently as the younger participants. In 24 participants (15 old, 9 young) who completed both versions of the MDOR task, neither latency nor error rates differed significantly between versions. These results confirm an inhibitory control deficit in healthy older participants, and suggest that the dynamics of inhibitory control are also affected by ageing. The modified MDOR task yields more data while not altering basic performance parameters.

Event-Related Potential Measures of the Passive Processing of Rapidly and Slowly Presented Auditory Stimuli in MCI

Much research effort is currently devoted to the development of a simple, low-cost method to determine early signs of Alzheimer’s disease (AD) pathology. The present study employs a simple paradigm in which event-related potentials (ERPs) were recorded to a single auditory stimulus that was presented rapidly or very slowly while the participant was engaged in a visual task. A multi-channel EEG was recorded in 20 healthy older adults and 20 people with mild cognitive impairment (MCI). In two different conditions, a single 80 dB sound pressure level (SPL) auditory stimulus was presented every 1.5 s (fast condition) or every 12.0 s (slow condition). Participants were instructed to watch a silent video and ignore the auditory stimuli. Auditory processing thus occurred passively. When the auditory stimuli were presented rapidly (every 1.5 s), N1 and P2 amplitudes did not differ between the two groups. When the stimuli were presented very slowly, the amplitude of N1 and P2 increased in both groups and their latencies were prolonged. The amplitude of N1 did not significantly differ between the two groups. However, the subsequent positivity was reduced in people with MCI compared to healthy older adults. This late positivity in the slow condition may reflect a delayed P2 or a summation of a composite P2 + P3a. In people with MCI, the priority of processing may not be switched from the visual task to the potentially much more relevant auditory input. ERPs offer promise as a means to identify the pathology underlying cognitive impairment associated with MCI.

Reaction time intra-individual variability reveals inhibitory deficits in single- and multiple-domain amnestic mild cognitive impairment

OBJECTIVES

Amnestic mild cognitive impairment (aMCI), a prodromal stage of Alzheimer's disease and other dementias, is characterized by episodic memory impairment. Recent evidence has shown inhibitory control deficits in aMCI, but the extent of these deficits across inhibitory domains (i.e., response inhibition and interference control) and aMCI subtypes (i.e., single- versus multiple-domain) remains unclear. Few studies have included response time intra-individual variability (RT IIV) in these efforts. The aim of this study was to compare response inhibition and interference control between aMCI subtypes using measures of accuracy, mean RT, and RT IIV.

METHOD

We report data from 34 individuals with single-domain aMCI (sdaMCI, 66-86 years), 20 individuals with multiple-domain aMCI (mdaMCI, 68-88 years), and 52 healthy controls (64-88 years) who completed tasks of response inhibition (Go-NoGo) and interference control (Flanker). Group differences in accuracy, mean RT, and RT IIV were examined for both tasks.

RESULTS

Individuals with mdaMCI had higher RT IIV than the other groups on both tasks. In RT IIV, we observed an interference control deficit in mdaMCI and sdaMCI relative to healthy controls, a finding not observed through accuracy or mean RT.

DISCUSSION

RT IIV may detect subtle differences in inhibition deficits between aMCI subtypes that may not be evident with conventional behavioral measures. Findings support the supplementary use of RT IIV when assessing early executive function deficits.

Evaluation of sensitivity and specificity of the INECO Frontal Screening and the Frontal Assessment Battery in mild cognitive impairment

The Frontal Assessment Battery (FAB) and the INECO Frontal Screening (IFS) are two instruments frequently used to explore cognitive deficits in different diseases. However, studies reporting their use in patients with mild cognitive impairment (MCI) are limited.

Behavioral and Neurophysiological Aspects of Inhibition-The Effects of Acute Cardiovascular Exercise

This review summarizes behavioral and neurophysiological aspects of inhibitory control affected by a single bout of cardiovascular exercise. The review also examines the effect of a single bout of cardiovascular exercise on these processes in young adults with a focus on the functioning of prefrontal pathways (including the left dorsolateral prefrontal cortex (DLPFC) and elements of the prefrontal-basal ganglia pathways). Finally, the review offers an overview on the potential effects of cardiovascular exercise on GABA-ergic and glutamatergic neurotransmission in the adult brain and propose mechanisms or processes that may mediate these effects. The main findings show that a single bout of cardiovascular exercise can enhance inhibitory control. In addition, acute exercise appears to facilitate activation of prefrontal brain regions that regulate excitatory and inhibitory pathways (specifically but not exclusively the prefrontal-basal-ganglia pathways) which appear to be impaired in older age. Based on the reviewed studies, we suggest that future work examine the beneficial effects of exercise on the inhibitory networks in the aging brain.

Age-Related Structural and Functional Changes of the Hippocampus and the Relationship with Inhibitory Control

Aging is associated with structural and functional changes in the hippocampus, and hippocampal dysfunction represents a risk marker of Alzheimer’s disease. Previously, we demonstrated age-related changes in reactive and proactive control in the stop signal task, each quantified by the stop signal reaction time (SSRT) and sequential effect computed as the correlation between the estimated stop signal probability and go trial reaction time. Age was positively correlated with the SSRT, but not with the sequential effect. Here, we explored hippocampal gray matter volume (GMV) and activation to response inhibition and to p(Stop) in healthy adults 18 to 72 years of age. The results showed age-related reduction of right anterior hippocampal activation during stop success vs. go trials, and the hippocampal activities correlated negatively with the SSRT. In contrast, the right posterior hippocampus showed higher age-related responses to p(Stop), but the activities did not correlate with the sequential effect. Further, we observed diminished GMVs of the anterior and posterior hippocampus. However, the GMVs were not related to behavioral performance or regional activities. Together, these findings suggest that hippocampal GMVs and regional activities represent distinct neural markers of cognitive aging, and distinguish the roles of the anterior and posterior hippocampus in age-related changes in cognitive control.