Specificity of inhibitory deficits in normal aging and Alzheimer's disease

Autobiographical Storytelling in Patients with Mild Alzheimer's Disease: Focused, Reflected, and Entertaining; A Comparative Study

OBJECTIVES

We assessed whether individuals with mild Alzheimer's disease (AD), despite some deficits in autobiographical memory, could effectively convey their personal experiences through storytelling.

METHODS

We invited 37 individuals with mild AD and 37 control participants to share their personal experiences. We rated these narratives based on five characteristics of storytelling: focus, reflection, entertainment, structure, and specificity.

RESULTS

Analyses demonstrated that individuals with AD conveyed more general than specific memories, and no significant differences were observed between structured and unstructured memories. Importantly, individuals with AD recounted more memories with focus than without, with reflection than without, and that were entertaining than were not. Compared with those of the control participants, the narratives of the individuals with AD were less focused, structured, and specific. However, no significant differences were observed between the two samples regarding reflection or entertainment.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Individuals with mild AD can have difficulties in retrieving specific memories, but their storytelling of personal experience can be focused, exhibit reflection, and be entertaining. Individuals with mild AD can engage in reflective and entertaining autobiographical storytelling, potentially contributing to their sense of identity and connection with others.

Semantic Priming from Uncued Distractors in Alzheimer's Disease

RESEARCH QUESTION

Are semantic impairments in Alzheimer's disease (AD) partially due to deficits in spatial attention?

METHODS AND RESULTS

In a target detection task, both older adults (OAs) and AD individuals were facilitated by valid spatial cues, but only OAs were impaired by invalid cues compared to neutral. In a reading task, spatial cues validly or invalidly cued the location of pictures, which were related or unrelated to subsequent, centrally presented, words. OAs showed semantic priming only after valid cues, whereas AD individuals showed priming after valid and invalid cues.

DISCUSSION

Failure to inhibit uncued locations results in processing of potentially distracting semantic information in AD.

Association between executive functions and COMT Val108/158Met polymorphism among healthy younger and older adults: A preliminary study

BACKGROUND AND OBJECTIVES

Genetic variability in the dopaminergic system could contribute to age-related impairments in executive control. In this study, we examined whether genetic polymorphism for catechol-O-methyltransferase (COMT Val158Met) is related to performance on updating, shifting and inhibition tasks.

METHODS

We administered a battery of executive tasks assessing updating, shifting and inhibition functions to 45 older and 55 younger healthy participants, and created composite z-scores associated to each function. Six groups were created based on genetic alleles (Val/Val, Val/Met, Met/Met) derived from the COMT gene and age (younger, older). Age and genotype effects were assessed with t-test and ANOVA (p<0.05).

RESULTS

A lower performance was observed in the older group for the three executive processes, and more particularly for inhibition. Moreover, older participants homozygous for the Val allele have a lower performance on the inhibition composite in comparison to younger Val/Val.

CONCLUSIONS

These results confirm presence of executive performance decrease in healthy aging. With regard to genetic effect, older participants seem particularly disadvantaged when they have a lower baseline dopamine level (i.e., Val/Val homozygous) that is magnified by aging, and when the executive measure emphasize the need of stable representations (as in inhibition task requiring to maintain active the instruction to not perform an automated process).

Development and psychometric properties of a friendly dietary function assessment scale for home-dwelling people with dementia

BACKGROUND

Mealtime difficulties related to cognitive functioning negatively impact a patient's life during the various stages of dementia, and they typically cause a burden and stress on family caregivers. Most people with dementia live at home alone or are cared for by informal caregivers, typically their spouses or other family members. However, no suitable screening tools for home-dwelling patients with dementia have been developed, nor have measurements focused on executive and self-eating functions. This study aimed to develop and evaluate the psychometric properties of the Dietary Function Assessment Scale (DFAS) for community-dwelling persons with dementia.

METHODS

A mixed-method design was used to develop the instrument. Methods included a comprehensive literature review to identify the item pool and an expert panel to assess the initial item pool. We performed convenience sampling of 190 home-dwelling people with dementia for psychometrical evaluation. The psychometric properties tests included item and factor analyses, criterion-related validity testing, internal consistency reliability testing, and defining the optimal cut-off values. The study was conducted from 2018 to 2019.

RESULTS

Items were generated based on an extensive literature review and pre-existing scales related to mealtime and executive functions in persons with dementia. The S-CVI/Ave of the DFAS was 0.89. A Principal Component factor analysis demonstrated seven items, with a two-factor structure accounting for 56.94% of the total variance. The two extracted factors were Self-eating ability and Dietary executive function. The confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = -0.528, p < 0.01). The reliability of Cronbach's alpha internal consistency was 0.74, and McDonald's Omega coefficient was 0.80; the optimal cut-off value of 13 points with an AUC of 0.74 was established to determine poor dietary functioning in persons with dementia.

CONCLUSION

The DFAS was simple, user-friendly, and a valid and reliable instrument to assess dietary functioning in community-dwelling persons with dementia. This short scale can be helpful for caretakers, who can use it to identify the dietary needs of home-dwelling persons with dementia and improve their care and eating experience.

Hand Dexterity Is Associated with the Ability to Resolve Perceptual and Cognitive Interference in Older Adults: Pilot Study

The relationship between hand dexterity and inhibitory control across the lifespan is underexplored. In this pilot study, we examined inhibitory control using a modified Simon task. During the task, participants were presented with right- and left-pointing arrows located either on the right or the left parts of the screen. In the congruent trials, the arrow location and direction matched. In the incongruent trials, they mismatched, thus creating cognitive interference. In 50% of trials, the arrow presentation was accompanied by a task-irrelevant but environmentally meaningful sound that created perceptual interference. Hand dexterity was measured with the 9-hole peg test. Significantly faster reaction time (RT) on the modified Simon task (p < 0.001) was observed in younger adults, trials with concurrent sound stimuli, and congruent trials. Older adults who reported recent falls had greater difficulty resolving cognitive interference than older adults without recent falls. Hand dexterity significantly moderated the effect of sound on RT, but only in the group of older individuals. Interestingly, older individuals with reduced hand dexterity benefited from concurrent sounds more than those with better hand dexterity. Our findings suggest that task-irrelevant but environmentally meaningful sounds may increase alertness and enhance stimulus perception and recognition, thus improving motor performance in older individuals.

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.

Neurostimulation for cognitive enhancement in Alzheimer's disease (the NICE-AD study): a randomized clinical trial

New therapies for symptoms in Alzheimer's disease (AD) are urgently needed. Prior studies suggest that transcranial direct current stimulation (tDCS), a noninvasive neuromodulatory method, may be a safe and potentially effective treatment, but conclusions have been limited by small-sample sizes and brief stimulation protocols. This double-blind randomized trial involving 100 older adults with mild-to-moderate AD examines effects of 6 months of at-home active tDCS or sham delivered over the dorsolateral prefrontal cortex. The primary outcome is global cognitive performance. Secondary outcomes include executive-control/spatial selective attention, functional neuroplasticity, depressive symptoms, quality of life and the durability of effects 3 months after the stimulation period. The results will provide evidence on the efficacy of multimonth at-home tDCS in the AD treatment. =Clinical trial identifier NCT04404153 (Clinicaltrials.gov).

Deficits in saccadic eye movements differ between subtypes of patients with mild cognitive impairment

Introduction: Mild cognitive impairment (MCI) is known to be heterogeneous in its cognitive features and course of progression. Whilst memory impairment is characteristic of amnestic MCI (aMCI), cognitive deficits other than memory can occur in both aMCI and non-amnestic MCI (naMCI) and accurate assessment of the subtypes of MCI is difficult for clinicians without the application of extensive neuropsychological testing. In this study, we examine metrics derived from recording of reflexive and voluntary saccadic eye movements as a potential alternative method for discriminating between subtypes and assessing cognitive functions in MCI.Method: A total of 29 MCI patients and 29 age- and education-matched healthy controls (HCs) participated in the cross-sectional study. We recorded horizontal and vertical pro-saccades and anti-saccade responses. All the participants also completed a comprehensive neuropsychological tests battery.Results: Significant differences in saccadic eye movement were found between the subtypes of MCI and HCs. Patients with aMCI had a higher percentage of short latency "express" saccades than HCs. We found strong associations between saccadic reaction times and cognitive domains, including executive functions and attention. The mini-mental state examination (MMSE) was also found to correlate with uncorrected errors in the anti-saccade task.Conclusions: The increased proportion of saccades in the express latency range in aMCI may be indicative of problems with cognitive inhibitory control in these patients. A focus on this and other saccade metrics in the preclinical and prodromal stages of dementia may help to predict the clinical progression of the disease and direct interventions for the management of MCI. The clinical significance of saccadic eye movement impairments in MCI is not yet fully understood and should be investigated in further studies using larger samples.

[Distracter inhibition in mild cognitive impairment]

OBJECTIVE

To study the effectiveness of interfering visual stimuli inhibition using the flanker task in a group of healthy young and healthy old participants, and in a group of participants with mild cognitive impairment (MCI).

MATERIAL AND METHODS

Reaction times and accuracy, as well as the diffusion model of reaction times with parameters reflecting perceptual and motor processes, stimulus processing speed, and conservativeness of response selection were analyzed.

RESULTS

We found reduced speed and accuracy in older age, especially in MCI patients. The reduction was especially pronounced in patients with the incongruent distracters. For diffusion model parameters, perceptual and motor processes took longer with older age, reduced processing speed was found only in pathological aging, and specific effectiveness reduction for incongruent probes in patients was driven by increased conservativeness of responses.

CONCLUSIONS

The results indicate the joint influence of normal and pathological aging processes on patients with MCI. The deceleration of the perceptual-motor components of the reaction time reflects the processes of normal cognitive aging, while the deceleration of the processing speed (in the presence of any distractors, including congruent ones) characterizes pathological cognitive aging. Differential diagnosis of normal and pathological cognitive changes is possible using data based on the analysis of reaction time components. It is important to take into account the conservativeness of responses as a factor slowing down the reaction time in pathological and normal cognitive aging.

Behavioral and electrophysiological correlates of Simon and flanker conflict interference in younger and older adults

Conflict processing and interference control have been popular topics of research in the study of pathological brain aging. However, there remains much to be learned about how these cognitive processes are altered in the course of healthy brain aging. Moreover, few studies have combined multiple measures of interference control using factorial designs. The aim of this study was to determine the nature of age-related changes in behavioral and electroencephalographic correlates of interference control using a factorial combination of the Simon and flanker interference conditions. Data were collected from a group of younger and high-functioning older adults. Behavioral results indicated the presence of conflict interference effects in both groups, that both Simon and flanker conflict effects are increased in high-functioning older adults, that the two types of conflict interference interact superadditively, and that older adults are more susceptible to the superadditive costs of multiple conflict types. ERP analyses revealed that early perceptual and response-selection processes are differentially modulated by flanker and Simon conflict respectively, however, there was no evidence that these early processes were impaired in older adults. Later components of the ERP in the P3 time range mirrored behavioral results, reflecting the increased susceptibility to flanker and Simon conflict in older adults.

Reaction time and response inhibition in autosomal dominant Alzheimer's disease

OBJECTIVE

Subtle deficits in several cognitive domains characterize the neuropsychological profile of preclinical Alzheimer's disease (AD). Assessment of preclinical individuals with genes causing autosomal dominant AD (ADAD) provides a model for prodromal disease. We sought to sensitively evaluate attention and working memory using a computerized battery in non-demented persons carrying ADAD mutations.

METHOD

A total of 71 non-demented Latinos at-risk for ADAD mutations were recruited [40 mutation carriers (MCs), 31 non-mutation carriers (NCs)] and completed a Spanish language chronometric battery of speeded decision and working memory tasks.

RESULTS

On two complex reaction time (RT) tasks involving decision-making and response inhibition, MCs exhibited slower RTs than NCs as they approached their anticipated age of dementia diagnosis. Education moderated these effects, but only in younger MCs. APOE ε4 status was not associated with age-related slowing among NCs or MCs on any of the tests.

CONCLUSIONS

Our findings indicate MCs respond more slowly as they approach the age of dementia onset on tasks with greater demands on executive function. Our results also suggest these effects were not explained by APOE ε4 status independently of ADAD mutation status. Computerized reaction time tests can provide sensitive measures of the earliest cognitive changes in AD.

Cognitive and behavioural inhibition deficits in neurodegenerative dementias

Disinhibition, mainly caused by damage in frontotemporal brain regions, is one of the major causes of caregiver distress in neurodegenerative dementias. Behavioural inhibition deficits are usually described as a loss of social conduct and impulsivity, whereas cognitive inhibition deficits refer to impairments in the suppression of prepotent verbal responses and resistance to distractor interference. In this review, we aim to discuss inhibition deficits in neurodegenerative dementias through behavioural, cognitive, neuroanatomical and neurophysiological exploration. We also discuss impulsivity and compulsivity behaviours as related to disinhibition. We will therefore describe different tests available to assess both behavioural and cognitive disinhibition and summarise different manifestations of disinhibition across several neurodegenerative diseases (behavioural variant of frontotemporal dementia, Alzheimer's disease, Parkinson's disease, progressive supranuclear palsy, Huntington's disease). Finally, we will present the latest findings about structural, metabolic, functional, neurophysiological and also neuropathological correlates of inhibition impairments. We will briefly conclude by mentioning some of the latest pharmacological and non pharmacological treatment options available for disinhibition. Within this framework, we aim to highlight i) the current interests and limits of tests and questionnaires available to assess behavioural and cognitive inhibition in clinical practice and in clinical research; ii) the interpretation of impulsivity and compulsivity within the spectrum of inhibition deficits; and iii) the brain regions and networks involved in such behaviours.

Effect of Age in Auditory Go/No-Go Tasks: A Magnetoencephalographic Study

Response inhibition is frequently examined using visual go/no-go tasks. Recently, the auditory go/no-go paradigm has been also applied to several clinical and aging populations. However, age-related changes in the neural underpinnings of auditory go/no-go tasks are yet to be elucidated. We used magnetoencephalography combined with distributed source imaging methods to examine age-associated changes in neural responses to auditory no-go stimuli. Additionally, we compared the performance of high- and low-performing older adults to explore differences in cortical activation. Behavioral performance in terms of response inhibition was similar in younger and older adult groups. Relative to the younger adults, the older adults exhibited reduced cortical activation in the superior and middle temporal gyrus. However, we did not find any significant differences in cortical activation between the high- and low-performing older adults. Our results therefore support the hypothesis that inhibition is reduced during aging. The variation in cognitive performance among older adults confirms the need for further study on the underlying mechanisms of inhibition.

Alzheimer's disease disrupts domain-specific and domain-general processes in numerosity estimation

INTRODUCTION

This study investigated how Alzheimer's Disease (AD) affects numerosity estimation abilities (e.g., finding the approximate number of items in a collection).

METHOD

Across two experiments, performance from HOA (i.e., Healthy Older Adults; N = 48) and AD patients (N = 50) was compared on dot comparison tasks. Participants were presented with two dot arrays and had to select the more numerous dot array in comparison tasks. They also took a Simon task and a number-line tasks (i.e., number-line tasks in which they had to indicate the position of a number on a line 0 to 100 or on a line 0 to 1,000 in the number-line task).

RESULTS

In Experiment 1, (a) AD patients obtained significantly poorer performance while comparing collections of dots, especially harder (small-ratio) collections, (b) these deficits correlated with poorer performance on the number-line task for larger numerosities (i.e., 0 to 1,000), and (c) AD patients showed poorer performance on incongruent (where numerosity and area occupied by dots mismatched) than on congruent items (where both features matched), while HOA showed no congruency effects. Experiment 2 showed (a) congruency effects in both groups when convex hull was tested as an incongruent feature, and (b) comparable sequential modulations of congruency effects in both groups.

CONCLUSIONS

Our findings showed that numerosity abilities decline in AD patients, and that this decline results from impaired domain-specific processes (i.e., numerosity processing) and domain-general processes (i.e., inhibition). These findings have important implications to further our understanding of how specific and general cognitive processes contribute to numerosity estimation/comparison performance, and how such contributions change during Alzheimer's disease.

Functioning of Cognitive Memory Inhibition Processes in People with Down Syndrome: An Empirical Study

Cognitive inhibition is part of executive functions. When it exercises control over memory processes, it has the function of regulating the accessibility of memories and allows interference to be resolved. The impairment of its functioning has been related to the presence of forgetfulness of relevant information. In this research, we study the functioning of cognitive memory inhibition processes in people with intellectual disabilities in tasks of delayed visual recognition and analyze the influence of age. For this purpose, 36 people with Down syndrome (mean age = 33.44, standard deviation = 7.54, 50% females) and 36 people with neurotypical development (mean age = 33.55, standard deviation = 7.52, 50% females) participated. The results reflected a lower effectiveness in the group of people with Down syndrome, F(1, 68) = 159.09, p < .001, $ {\upeta}_{\mathrm{p}}^2 $ = .70. The people in the group with Down syndrome had difficulties in interference resolution, both in the subgroup of young people (p = .014, $ \hat{\updelta\ } $= 0.88) and in the subgroup of older people (p = .022, $ \hat{\updelta\ } $= 0.67). The impairment of cognitive inhibition in people with Down syndrome warrants the need to develop specific intervention programs for this process.

Memory of decisions: Relationship between decline of autobiographical memory and temporal discounting in Alzheimer's disease

Temporal discounting refers to the tendency to attribute higher value to a reward received early than to one received later. We evaluated this tendency in patients with Alzheimer's Disease. We also evaluated whether temporal discounting is associated with decline in autobiographical memory (i.e., the ability to remember past personal experiences), with executive dysfunction, and/or with general cognitive decline. We invited patients with AD and control participants to answer binary questions involving the choice between receiving a smaller amount of money earlier or a larger one later (e.g., "Which do you prefer, 10 euros in cash right now or 50 euros in a month?"). Results demonstrated higher temporal discounting in patients with AD than in control participants. Temporal discounting was significantly correlated with decline in AM and general cognitive decline but not with executive dysfunction in patients with AD. The tendency to decide based on immediate rewards (i.e., temporal discounting) in AD is related with difficulty in remembering information about experiences of previous decisions, and/or their consequences (i.e., decline in autobiographical memory).

Effects of Tai Chi Chuan on Inhibitory Control in Elderly Women: An fNIRS Study

Background

Inhibitory control is a sub-ability of executive function and plays an important role in the entire cognitive process. However, declines in inhibitory control during aging significantly impair the quality of life of elderly people. Investigating methods to delay the decline of inhibitory control has become a focal point in current research. Tai Chi Chuan (TCC) is one effective method used to delay cognitive declines in older adults. However, the specific effects of TCC on inhibitory control and the mechanisms through which TCC may improve cognition in older adults have not been comprehensively investigated.

Objective

The study explores possible neurological mechanisms related to the effects of TCC interventions on inhibitory control in older people using a functional near-infrared spectroscopy (fNIRS) technique and reaction times (RTs).

Methods

A total of 26 healthy, elderly people who had not received TCC training completed all study procedures. The subjects were randomized to either the TCC group or the control group. Subjects in the TCC group were taught TCC by a certified instructor and trained for 8 weeks. The control group continued to perform general daily activities. The Flanker task was administered to every participant to evaluate inhibitory control pre- and post-intervention. While participants were performing the Flanker task, fNIRS data were collected.

Results

Post-intervention, significant differences for incongruent flankers were found only for the TCC intervention group. Faster RTs were observed for the incongruent flankers in the TCC group than in the control group (p < 0.05). Analysis of the fNIRS data revealed an increase in oxy-Hb in the prefrontal cortex during the incongruent flankers after the TCC exercise intervention.

Conclusion

The TCC intervention significantly improved inhibitory control in older adults, suggesting that TCC is an effective, suitable exercise for improving executive function and neurological health in elderly people.

Clinical Trial Registration

Chinese Clinical Trial Register, ChiCTR1900028457.

Proactive interference in aging: A model-based study

Proactive interference occurs when previously learned information interrupts the storage or retrieval of new information. Congruent with previous reports, traditional analyses dealing with response times and error rates separately have indicated an increase in sensitivity to proactive interference in older adults. We reanalyzed the same data using diffusion decision model (DDM). Such models enable a more fine-grained interpretation concerning the latent processing mechanisms underlying performance. Now a different picture emerged. The DDM results showed that older adults needed more evidence than young adults before responding. The results also clearly indicated that peripheral processes (encoding time and motor execution), as well as recognition memory, decline with age. However, the drift rates, reflecting proactive interference, were similar, suggesting—contrary to earlier reports—that the inhibitory processes observed with this paradigm remain intact in older adults.

Response initiation and inhibition and the relationship with fluid intelligence across the adult lifespan

Background

Cognitive processes associated with frontal lobe functioning are often termed “executive functions.” Two such processes are initiation and inhibition or the starting and stopping of responses. It has recently been claimed dysfunction of executive abilities can be explained by a single measure of fluid intelligence. Here, we test this claim, specifically for the executive abilities of response initiation and inhibition, across the healthy lifespan.

Method

In a cohort of 336 healthy adults (18–89 years), initiation and inhibition were assessed with the Hayling test, Stroop test, and phonemic and semantic verbal fluency. All participants also completed a measure of fluid intelligence. The relationship between fluid intelligence and executive measures was explored across the lifespan using a continuous approach. Mediation models were computed to assess whether age-related decline across the four initiation/inhibition tasks could be fully explained by a single measure of fluid intelligence.

Results

Age was negatively correlated with response initiation/inhibition and fluid intelligence. The mediation analyses identified only partial mediation of fluid intelligence for age and Hayling performance. By contrast, fluid intelligence did not mediate performance on the Stroop test or phonemic and semantic verbal fluency.

Conclusions

Response initiation/inhibition are not able to be explained by fluid intelligence. The results support a multifactorial theory of executive functions and provide evidence for the inclusion of multiple specific executive measures in a thorough neuropsychological assessment of age-related cognitive decline.

Initiation, Inhibition and Strategy Generation Across the Healthy Adult Lifespan

OBJECTIVE

Executive functions are crucial for adaptive behavior in novel contexts. In healthy aging, these abilities are more sensitive to dysfunction than other cognitive abilities. The effect of aging on initiation, inhibition, and strategy use was investigated via performance on the Hayling Sentence Completion Test.

METHOD

The standard Hayling Test and baseline cognitive tests were administered to healthy adults (N = 344), aged 18-89 years (cross-sectional study). Bivariate Pearson's correlations, partial correlations, and regression analyses were used to assess the impact of aging on the components of the Hayling Test.

RESULTS

There were significant positive correlations between age and response time for both Initiation and Suppression, and the number of Suppression Errors. Further, older age was negatively associated with strategy use. These findings remained significant after controlling for demographic factors such as education and crystallized intelligence and other cognitive functions sensitive to aging such as fluid intelligence, attention, working memory and semantic and phonemic word fluency.

CONCLUSIONS

This study provides clarification of the effect of age on the processes of initiation, inhibition, and strategy generation across the adult lifespan. The focus and analysis of strategy on the Hayling Test provides clinicians with an additional and valuable measure of executive functioning. That is, it provides insight into how older adults may be able to compensate for decline in these processes, and thus maximize quality of life and independence.

Dissociation among preserved resistance to proactive interference and impaired behavioral inhibition in a patient with bilateral lesions in the inferior frontal gyrus: A single-case study

Inhibition is not a unitary construct, as different inhibition-related functions have been disentangled. The present single-case study compares performance of a patient with bilateral lesions in the inferior frontal gyrus (IFG) and anterior insula to healthy age-matched controls in different inhibition-related tasks. Particular focus was on the resolution of proactive interference that is supposed to rely on bilateral IFG and anterior insula. Two working memory tasks previously proven sensitive to deficits in proactive interference (recent-probes, n-back) and two tasks measuring behavioral inhibition (verb generation task, Stroop task) were administered. Against expectations, the patient did not show any deficits in measures of proactive interference. However, compared to controls, she demonstrated considerably reduced performance in both measures of behavioral inhibition, thus resulting in a classical dissociation between proactive interference and behavioral inhibition. Although performance improved during the chronic phase post stroke, the overall pattern of a classical dissociation between proactive interference and behavioral inhibition remained stable across time. Taken together, the present data support the role of the IFG in inhibition-related functions, but a direct relationship between lesions in the IFG and difficulties in resolution of proactive interference could not be corroborated.

Executive Functions in Alzheimer Disease: A Systematic Review

Alzheimer's disease is a severe irreversible syndrome, characterized by a slow and progressive cognitive decline that interferes with the standard instrumental and essential functions of daily life. Promptly identifying the impairment of particular cognitive functions could be a fundamental condition to limit, through preventive or therapeutic interventions, the functional damages found in this degenerative dementia. This study aims to analyse, through a systematic review of the studies, the sensitivity of four experimental paradigms (Wisconsin Card Sorting Test, Stroop Task, Go/No-Go Task, and Flanker Task) considered as golden standard instruments for executive functions assessment in elderly subjects affected by Alzheimer dementia. This review was carried out according to the PRISMA method. Forty-five studies comparing the executive performance of patients with Alzheimer's dementia (diagnosed according to different classification criteria for dementia) and healthy elderly patients both over the age of sixty, were selected. For the research, PubMed, PsycINFO, PsycArticles databases were used. The study highlighted the importance of using standard protocols to evaluate executive dysfunction in Alzheimer's disease. The Stroop task allows discriminating better between healthy and pathological aging.

Age Effects on Spatiotemporal Dynamics of Response Inhibition: An MEG Study

Inhibition, the ability to suppress irrelevant information, thoughts or movements, is crucial for humans to perform context-appropriate behaviors. It was suggested that declined cognitive performance in older adults might be attributed to inhibitory deficiencies. Although previous studies have shown an age-associated reduction in inhibitory ability, the understanding regarding its cortical spatiotemporal maps remained limited. Thus, we used a whole-head magnetoencephalography (MEG) to elucidate the age effects on response inhibition, and to explore the brain activation differences in high- and low-performing seniors. We recruited 22 younger and 22 older adults to participate in the visual Go/No-go task. Both behavioral performance and neuromagnetic responses to No-go stimuli were analyzed. The behavioral results showed that the older adults made more false alarm (FA) errors than the younger adults did. The MEG results showed that the seniors exhibited declined cortical activities in middle temporal gyrus (MTG) and delayed activation in MTG, prefrontal cortex (PFC) and pre-supplementary motor area (pre-SMA). Furthermore, among the older adults, more recruitment of the left PFC was found in the high-performers than in the lower-performers. In conclusion, age-related deficiencies in response inhibition were observed in both behavioral performance and neurophysiological measurement. Our results also suggested that frontal recruitment plays a compensatory role in successful inhibition.

Can the post-error effect mask age-related differences in congruency conditions when education and overall accuracy are controlled for?

OBJECTIVE

Age-related differences in stimulus-response congruency tasks have been attributed to older adults' greater difficulties in handling the irrelevant spatial-dimensional overlap between stimulus and response. However, performance on congruency tasks may also be influenced by the previous trial accuracy (i.e. post-error effect), which may affect young and older adults differently. The main objective of this study was to analyse age-related differences in the post-error effect as a function of congruency. In addition, we examined the meditational role of the Gratton effect on the age-related differences in the post-error slowing (PES) and post-error increased accuracy (PIA) as a function of congruency.

METHOD

The sample comprised 165 healthy adult participants with diverse educational attainment, divided into five age groups. Participants performed a spatial stimulus-response congruency task. Age-related differences in the post-error effect were analysed for each congruency condition taking into account educational attainment and overall accuracy. Statistical procedures were used to neutralize age-related processing speed effects on the PES.

RESULTS

PES was observed across all age groups, except the Very old group (aged 85-98 years), and it was not related to congruency condition. PIA was observed across age groups in all congruency conditions and was slightly higher in incongruent trials. Evidence of simultaneous PES and PIA was found for young participants and older participants under 85 years. The Very old group did not need to significantly slow down their responses after errors to improve accuracy. No age- related difference was found in the influence of the Gratton effect on PES or PIA as a function of congruency.

CONCLUSIONS

PES and PIA were observed in young adults and older adults under 85 years old. Evidence of simultaneous PES and PIA in the young and older age group (except for the Very old) indicates that the post-error effect can be interpreted in terms of recruitment of additional resources to prevent subsequent errors. Slightly higher accuracy was observed in the incongruent condition in post-error trials relative to pre-error correct trials across age groups.

Hallucinations in Alzheimer's disease: failure to suppress irrelevant memories

INTRODUCTION

Research with patients with schizophrenia suggests that inhibitory dysfunction leads to the emergence of redundant or irrelevant information from long-term memory into awareness, and that this process may be involved in generating hallucinations. We investigated whether inhibitory dysfunction in Alzheimer's disease (AD) leads to hallucinations.

METHOD

AD participants and healthy matched controls were assessed with a hallucinations scale and a directed forgetting task. On the directed forgetting task, they were asked to retain a list of 10 words (i.e., List 1). Thereafter, half of the participants were asked to forget this list whereas the other half were asked to retain the list in memory. After the List 1 presentation, all participants were asked to retain another list of 10 words and, successively, were asked to remember all of the words from both lists, regardless of the previous forget or remember instruction.

RESULTS

Relative to healthy matched controls, AD participants showed difficulties in suppressing the words from List 1. AD participants also showed more hallucinatory experiences than healthy matched controls. Interestingly, a significant correlation was observed between the score on the hallucinations measure and difficulties in suppressing List 1 in AD participants.

DISCUSSION

Hallucinations in AD may, at least in part, be related to difficulties in suppressing memory representations, such that unwanted or repetitive thoughts intrude into consciousness.

Effects of age on inhibitory control are affected by task-specific features

Older adults have been argued to have impoverished inhibitory control compared to younger adults. However, these effects of age may depend on processing speed and their manifestation may furthermore depend on the type of inhibitory control task that is used. We present two experiments that examine age effects on inhibition across three tasks: a Simon arrow, static flanker and motion flanker task. The results showed overall slower reaction times (RTs) for older adults on all three tasks. However, effects of age on inhibition costs were only found for the Simon task, but not for the two flanker tasks. The motion flanker task furthermore showed an effect of baseline processing speed on the relation between age and inhibition costs. Older adults with slower baseline responses showed smaller inhibition costs, suggesting they were affected less by the flanker items than faster older adults. These findings suggest that effects of age on inhibition are task dependent and can be modulated by task-specific features such as the type of interference, type of stimuli and processing speed.

Negative Prospective Memory in Alzheimer's Disease: "Do Not Perform That Action"

Relatively to "standard" prospective memory, i.e., remembering to perform a future action, little is known about negative prospective memory, i.e., remembering not to perform a future action. This study investigated the latter ability in Alzheimer's disease (AD). AD participants and healthy older adults were asked to click on the keyboard or not to click on it when a cue word was encountered. Results showed more omissions (i.e., forgetting to click the keyboard when the instruction was to do so) in AD participants than in healthy older adults, suggesting a prospective memory deficit. Interestingly, more commissions (i.e., clicking the keyboard when the instruction was not to do so) were also observed in AD participants than in healthy older adults. Similar levels of commissions and omissions were observed in AD participants and in healthy older adults. Also, commissions and omissions were correlated with performance on an inhibition assessment task. Our findings reveal that AD is characterized by not only difficulty in the retrieval of recent information, but also difficulty to inhibit no-longer appropriate stimulus-response associations previously learned, suggesting a specific deficit of negative prospective memory in AD.

The need for harmonisation and innovation of neuropsychological assessment in neurodegenerative dementias in Europe: consensus document of the Joint Program for Neurodegenerative Diseases Working Group

Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status.

Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a “big data” common data set.

We present here the results of a project funded by the Joint Program for Neurodegenerative Diseases (JPND) and by the Italian Ministry of Health. The project aimed at providing a consensus framework for the harmonisation of assessment tools to be applied to research in neurodegenerative disorders affecting cognition across Europe. A panel of European experts reviewed the current methods of neuropsychological assessment, identified pending issues, and made recommendations for the harmonisation of neuropsychological assessment of neurodegenerative dementias in Europe.

A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment, with the aim of harmonising tools and procedures to achieve more reliable data on the cognitive-behavioural examination. The results of this study should be considered as a first step to enhancing a common view and practise on NDD assessment across European countries.

A multifactorial and integrative approach to impulsivity in neuropsychology: insights from the UPPS model of impulsivity

Risky and excessive behaviors, such as aggressive and compulsive behaviors, are frequently described in patients with brain damage and have dramatic psychosocial consequences. Although there is strong evidence that impulsivity constitutes a key factor at play in these behaviors, the literature about impulsivity in neuropsychology is to date scarce. In addition, examining and understanding these problematic behaviors requires the assumption that impulsivity is a multidimensional construct. Consequently, this article aims at shedding light on frequent risky and excessive behaviors in patients with brain damage by focusing on a unified, comprehensive, and well-validated model, namely, the UPPS model of impulsivity. This model considers impulsivity as a multidimensional construct that includes four facets: urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Furthermore, we discuss the psychological mechanisms underlying the dimensions of impulsivity, as well as the laboratory tasks designed to assess each mechanism and their neural bases. We then present a scale specifically designed to assess these four dimensions of impulsivity in patients with brain damage and examine the data regarding this multidimensional approach to impulsivity in neuropsychology. This review supports the need to adopt a multifactorial and integrative approach toward impulsive behaviors, and the model presented provides a valuable rationale to disentangle the nature of brain systems and mechanisms underlying impulsive behaviors in patients with brain damage. It may also foster further relevant research in the field of impulsivity and improve assessment and rehabilitation of impulsive behaviors in clinical settings.

Interference Impacts Working Memory in Mild Cognitive Impairment

Mild cognitive impairment (MCI) is considered a transitional stage between healthy aging and dementia, specifically Alzheimer's disease (AD). The most common cognitive impairment of MCI includes episodic memory loss and difficulties in working memory (WM). Interference can deplete WM, and an optimal WM performance requires an effective control of attentional resources between the memoranda and the incoming stimuli. Difficulties in handling interference lead to forgetting. However, the interplay between interference and WM in MCI is not well-understood and needs further investigation. The current study investigated the effect of interference during a WM task in 20 MCIs and 20 healthy elder volunteers. Participants performed a delayed match-to-sample paradigm which consisted in two interference conditions, distraction and interruption, and one control condition without any interference. Results evidenced a disproportionate impact of interference on the WM performance of MCIs, mainly in the presence of interruption. These findings demonstrate that interference, and more precisely interruption, is an important proxy for memory-related deficits in MCI. Thus, the current findings reveal novel evidence regarding the causes of WM forgetting in MCI patients, associated with difficulties in the mechanisms of attentional control.

The suppression effect in visuospatial and verbal working memory span tasks in patients with Alzheimer's disease: a 2-year follow-up study

This study adapted a new task to assess visuospatial and verbal working memory impairments in patients with Alzheimer Disease (AD), including an executive strategy of information suppression. The aim was to examine the visuospatial and verbal difficulties, and additionally to explore the average sex differences, during a 2-year follow-up study. The results indicated that patients with AD showed a significantly lower performance, compared with healthy elderly controls, especially with the suppression of information required in this new task. However, suppression did not lead to a significantly greater decline in the performance of patients when compared with the control group.

Apolipoprotein E (APOE) ε4 and episodic memory decline in Alzheimer's disease: A review

A growing body of research has examined the relationship between episodic memory decline, the cognitive hallmark of Alzheimer's disease (AD), and the presence of Apolipoprotein E ε4 (APOE ε4) allele, a major genetic risk factor for the disease. Our review attempts to summarize and critically evaluate this literature. We performed a systematic search for studies assessing episodic memory in AD patients who were genotyped for APOE ε4 and identified fourteen papers. Although most of these papers reported significant relationships between APOE ε4 and episodic memory decline in AD, some papers did not confirm this relationship. Our review links this controversy to the conflicting literature about the effects of APOE ε4 on general cognitive functioning in AD. We identify several shortcoming and limitations of the research on the relationship between APOE ε4 and episodic memory in AD, such as small sample sizes, non-representative populations, lack of comparison of early-onset vs. late-onset disease, and lack of comparison among different genotypes that include APOE ε4 (i.e., zero, one, or two ε4 alleles). Another major shortcoming of the reviewed literature was the lack of comprehensive evaluation of episodic memory decline, since episodic memory was solely evaluated with regard to encoding and retrieval, omitting evaluation of core episodic features that decline in AD, such as context recall (e.g., how, where, and when an episodic event has occurred) and subjective experience of remembering (e.g., reliving, emotion and feeling during episodic recollection). Future research taking these limitations into consideration could illuminate the nature of the relationship between APOE ε4 and episodic memory decline in AD.

Age differences in behavioral and neural correlates of proactive interference: Disentangling the role of overall working memory performance

Reliable performance in working memory (WM) critically depends on the ability to resist proactive interference (PI) from previously relevant WM contents. Both WM performance and PI susceptibility are subject to cognitive decline at older adult age. However, the behavioral and neural processes underlying these co-evolving developmental changes and their potential interdependencies are not yet understood. Here, we investigated PI using a recent-probes WM paradigm and functional MRI in a cross-sectional sample of younger (n=18, 10 female, 23.4 ± 2.7 years) and older adults (n=18, 10 female, 70.2 ± 2.7 years). As expected, older adults showed lower WM performance and higher PI susceptibility than younger adults. Resolution of PI activated a mainly bilateral frontal network across all participants. Significant interactions with age indicated reduced neural activation in older adults for PI resolution. A second analysis in a selection of younger and older adults (n=12 each) with matched WM performance also revealed significant differences in PI between both age groups and - on a descriptive level - again a hypo-activation of the older adults' PI network. But the differential effect of age on the neural PI effects did not reach significance in this smaller sample most likely to the reduced statistical power. However, given the highly similar patterns in both the overall and the WM-matched samples, we propose that the hypo-activation of the PI network in the older adults may not be attributable to age-related differences in overall WM performance, hence suggesting that higher PI susceptibility in older adult age does not directly depend on their lower WM performance.

Inhibitory deterioration may contribute to hallucinations in Alzheimer's disease

INTRODUCTION

Although delusions and hallucinations are relatively common symptoms in individuals with Alzheimer's disease (AD), very little is known regarding underlying mechanisms. We examined whether these manifestations could be underpinned by psychological distress and executive impairments.

METHODS

Thirty-one participants with probable mild AD and 33 healthy older adults were administered a neuropsychological and clinical battery assessing delusions, hallucinations, anxiety, depression, episodic memory and executive functions (shifting, updating and inhibition).

RESULTS

Prevalence of delusions and hallucinations were significantly higher in AD participants compared to control participants. Further, hallucinations in AD participants were significantly correlated with poor inhibition, with the latter uniquely predicting the former, as compared to other variables. In addition, hallucinations in AD participants were associated with depression, a relationship that was further mediated by inhibition.

CONCLUSION

Hallucinations in individuals with AD seem to be related to difficulties suppressing irrelevant thoughts, resulting in these irrelevant thoughts becoming confused with ongoing reality.

Memory suppression in Alzheimer's disease

An important challenge for memory is the competition between appropriate and inappropriate information during retrieval. This competition is normally reduced thanks to controlled inhibitory processes that suppress irrelevant memories. In Alzheimer's disease (AD), compromise of suppression ability may result in strong competition between relevant and irrelevant memories during retrieval. The present review highlights this issue by examining studies using the directed forgetting method in AD. This method in which participants are typically instructed to forget no longer relevant information is argued to reflect suppression in memory. Studies using the directed forgetting method suggest that AD participants experience difficulties when they are asked to suppress no longer relevant information in working, autobiographical, source and destination memory. Difficulties in suppressing irrelevant information, as may be observed in AD, may hamper memory retrieval by activating irrelevant memories at the expense of relevant ones.

Autobiographical memory decline in Alzheimer's disease, a theoretical and clinical overview

Autobiographical memory, or memory for personal experiences, allows individuals to define themselves and construct a meaningful life story. Decline of this ability, as observed in Alzheimer's disease (AD), results in an impaired sense of self and identity. In our model (AMAD: Autobiographical Memory in Alzheimer's Disease), we present a critical review of theories and findings regarding cognitive and neuroanatomical underpinnings of autobiographical memory and its decline in AD and highlight studies on its clinical rehabilitation. We propose that autobiographical recall in AD is mainly characterized by loss of associated episodic information, which leads to de-contextualization of autobiographical memories and a shift from reliving past events to a general sense of familiarity. This decline refers to retrograde, but also anterograde amnesia that affects newly acquired memories besides remote ones. One consequence of autobiographical memory decline in AD is decreased access to memories that shape self-consciousness, self-knowledge, and self-images, leading to a diminished sense of self and identity. The link between autobiographical decline and compromised sense of self in AD can also manifest itself as low correspondence and coherence between past memories and current goals and beliefs. By linking cognitive, neuroanatomical, and clinical aspects of autobiographical decline in AD, our review provides a theoretical foundation, which may lead to better rehabilitation strategies.

Directed forgetting of source memory in normal aging and Alzheimer's disease

BACKGROUND AND AIMS

Using the source directed forgetting method, the present paper investigated whether older adults and Alzheimer's disease (AD) patients were able to inhibit source information.

METHODS

Younger adults, older adults and AD participants were presented with two sets of six items each: Set1 and Set2. Each item was presented by one of two sources: an experimenter black- or white-gloved hand. After the presentation of the Set1 items, participants were instructed either to forget or to continue remembering the source of the items. Afterward, all participants were presented with the Set2 items, and were asked to remember their source. Finally, subjects were exposed to the Set1 and Set2 items, and were asked to recall, for each item, its original source presentation (i.e., the experimenter black- or white-gloved hand).

RESULTS

In comparison with younger adults, older adults and AD participants showed no differences in remembering the source of the Set1 and Set2 items. In other words, they failed to inhibit the source information.

DISCUSSION AND CONCLUSION

Our outcomes are discussed in terms of retrieval inhibition deficits and changes in adaptive nature of memory in normal aging and AD.

"Forget to whom you have told this proverb": directed forgetting of destination memory in Alzheimer's disease

Destination memory is the ability to remember the receiver of transmitted information. By means of a destination memory directed forgetting task, we investigated whether participants with Alzheimer's Disease (AD) were able to suppress irrelevant information in destination memory. Twenty-six AD participants and 30 healthy elderly subjects were asked to tell 10 different proverbs to 10 different celebrities (List 1). Afterwards, half of the participants were instructed to forget the destinations (i.e., the celebrities) whereas the other half were asked to keep them in mind. After telling 10 other proverbs to 10 other celebrities (List 2), participants were asked to read numbers aloud. Subsequently, all the participants were asked to remember the destinations of List 1 and List 2, regardless of the forget or remember instructions. The results show similar destination memory in AD participants who were asked to forget the destinations of List 1 and those who were asked to retain them. These findings are attributed to inhibitory deficits, by which AD participants have difficulties to suppress irrelevant information in destination memory.

The Role of Memory Traces Quality in Directed Forgetting: A Comparison of Young and Older Participants

A reduced directed-forgetting (DF) effect in normal aging has frequently been observed with the item method. These results were interpreted as age-related difficulties in inhibiting the processing of irrelevant information. However, since the performance of older adults is usually lower on items to remember, the age effect on DF abilities could also be interpreted as reflecting memory problems. Consequently, the present study aimed at investigating the influence of memory traces quality on the magnitude of the DF effects in normal aging. We predicted that increasing the quality of memory traces (by increasing presentation times at encoding) would be associated with attenuated DF effects in older participants due to the increased difficulty of inhibiting highly activated memory traces. A classical item-method DF paradigm was administered to 48 young and 48 older participants under short and long encoding conditions. Memory performance for information to memorize and to suppress was assessed with recall and recognition procedures, as well as with a Remember/Know/Guess (RKG) paradigm. The results indicated that, when memory traces are equated between groups, DF effects observed with the recall, recognition and RKG procedures are of similar amplitude in both groups (all ps>0.05). This suggests that the decreased DF effect previously observed in older adults might not actually depend on their inhibitory abilities but may rather reflect quantitative and qualitative differences in episodic memory functioning.

Inhibitory dysfunction in frontotemporal dementia: a review

Failure of inhibitory control is an early and consistent feature in patients suffering from frontotemporal dementia (FTD). This appears because of their pervasive ventromedial prefrontal atrophy-particularly in the orbitofrontal cortex-which has been linked to inhibitory dysfunction in studies on human and monkey lesions. However, the range of measures currently available to assess inhibitory processes in FTD is limited, and, as such, inhibitory dysfunction in FTD remains relatively underexplored. Subjective caregiver questionnaires are useful for defining disinhibition as it manifests behaviorally; however, endorsement of symptoms can vary largely across patients as it is contingent on the perceptiveness of the caregiver. The few objective neuropsychological tasks that tap directly into inhibitory functioning have potential, although they mostly rely on intact language and semantics, which can confound performance in FTD patients. An emergent possibility is to explore inhibitory functioning in FTD through nonverbal experimental tasks. Adaptation of such experimental tasks into clinical tools is a promising avenue for exploring one of the earliest behavioral features in FTD patients and concomitantly tap into their prevalent orbitofrontal cortex dysfunction. We suggest that improved characterization of early inhibitory dysfunction may facilitate more accurate diagnosis of FTD.

The role of working memory and attentional disengagement on inhibitory control: effects of aging and Alzheimer's disease

Patients with Alzheimer's disease have an impairment of inhibitory control for reasons that are currently unclear. Using an eye-tracking task (the gap-overlap paradigm), we examined whether the uncorrected errors relate to the task of attentional disengagement in preparation for action. Alternatively, the difficulty in correcting for errors may be caused by the working memory representation of the task. A major aim of this study was to distinguish between the effects of healthy aging and neurodegenerative disease on the voluntary control of saccadic eye movements. Using the antisaccade task (AST) and pro-saccade task (PST) with the 'gap' and 'overlap' procedures, we obtained detailed eye-tracking measures in patients, with 18 patients with probable Alzheimer's disease, 25 patients with Parkinson's disease and 17 healthy young and 18 old participants. Uncorrected errors in the AST were selectively increased in Alzheimer's disease, but not in Parkinson's disease compared to the control groups. These uncorrected errors were strongly correlated with spatial working memory. There was an increase in the saccade reaction times to targets that were presented simultaneously with the fixation stimulus, compared to the removal of fixation. This 'gap' effect (i.e. overlap-gap) saccade reaction time was elevated in the older groups compared to young group, which yielded a strong effect of aging and no specific effect of neurodegenerative disease. Healthy aging, rather than neurodegenerative disease, accounted for the increase in the saccade reaction times to the target that are presented simultaneously with a fixation stimulus. These results suggest that the impairment of inhibitory control in the AST may provide a convenient and putative mark of working memory dysfunction in Alzheimer's disease.

Neural correlates of saccadic inhibition in healthy elderly and patients with amnestic mild cognitive impairment

Performance on tasks that require saccadic inhibition declines with age and altered inhibitory functioning has also been reported in patients with Alzheimer's disease. Although mild cognitive impairment (MCI) is assumed to be a high-risk factor for conversion to AD, little is known about changes in saccadic inhibition and its neural correlates in this condition. Our study determined whether the neural activation associated with saccadic inhibition is altered in persons with amnestic mild cognitive impairment (aMCI). Functional magnetic resonance imaging (fMRI) revealed decreased activation in parietal lobe in healthy elderly persons compared to young persons and decreased activation in frontal eye fields in aMCI patients compared to healthy elderly persons during the execution of anti-saccades. These results illustrate that the decline in inhibitory functions is associated with impaired frontal activation in aMCI. This alteration in function might reflect early manifestations of AD and provide new insights in the neural activation changes that occur in pathological ageing.