Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience

Theory-driven assessment of cognitive flexibility in bulimia nervosa: a preliminary study

BACKGROUND

Cognitive flexibility (CF) is defined as the ability to switch efficiently between different concepts or tasks. Empirical evidence of CF in individuals with bulimia nervosa (BN), offers conflicting conclusions, attributed to how CF is conceptualized and operationalized. The aims of the current study were to compare CF performance of women with BN to healthy controls, utilising a CF model that includes three subtypes termed: task switching, switching sets and stimulus-response mapping. In addition, to examine the association between CF subtypes and BN clinical characteristics.

METHODS

Sixty-two women (twenty-eight with BN and thirty-four healthy controls) with a mean age of 24.4, completed a CF cognitive battery. Performance was measured by response time and accuracy.

RESULTS

The BN group's response time was worse only on task switching, but was significantly more accurate on stimulus-response mapping. There was no significant correlation between CF scores and BN clinical characteristics.

CONCLUSIONS

Women with BN present with an impairment only on higher CF demands, whereas their performance at lower-level CF tends to be more accurate. Additionally, CF is independent of clinical characteristics, thus supporting evidence that it may reflect a trait nature in BN.

Probing the Neurodynamic Mechanisms of Cognitive Flexibility in Depressed Individuals with Autism Spectrum Disorder

Introduction: Autism spectrum disorder (ASD) is characterized by deficits in social behavior and executive function (EF), particularly in cognitive flexibility. Whether transcranial magnetic stimulation (TMS) can improve cognitive outcomes in patients with ASD remains an open question. We examined the acute effects of prefrontal TMS on cortical excitability and fluid cognition in individuals with ASD who underwent TMS for refractory major depression. Methods: We analyzed data from an open-label pilot study involving nine participants with ASD and treatment-resistant depression who received 30 sessions of accelerated theta burst stimulation of the dorsolateral prefrontal cortex, either unilaterally or bilaterally. Electroencephalography data were collected at baseline and 1, 4, and 12-weeks posttreatment and analyzed using a mixed-effects linear model to assess changes in regional cortical excitability using three models of spectral parametrization. Fluid cognition was measured using the National Institutes of Health Toolbox Cognitive Battery. Results: Prefrontal TMS led to a decrease in prefrontal cortical excitability and an increase in right temporoparietal excitability, as measured using spectral exponent analysis. This was associated with a significant improvement in the NIH Toolbox Fluid Cognition Composite score and the Dimensional Change Card Sort subtest from baseline to 12 weeks posttreatment (t = 3.79, p = 0.005, n = 9). Improvement in depressive symptomatology was significant (HDRS-17, F (3, 21) = 28.49, p < 0.001) and there was a significant correlation between cognitive improvement at week 4 and improvement in depression at week 12 (r = 0.71, p = 0.05). Conclusion: These findings link reduced prefrontal excitability in patients with ASD and improvements in cognitive flexibility. The degree to which these mechanisms can be generalized to ASD populations without Major Depressive Disorder remains a compelling question for future research.

Effects of chronic social defeat stress on social behavior and cognitive flexibility for early and late adolescent

This study investigated the risk to social behavior and cognitive flexibility induced by chronic social defeat stress (CSDS) during early and late adolescence (EA and LA). Utilizing the "resident-intruder" stress paradigm, adolescent male Sprague-Dawley rats were exposed to CSDS during either EA (postnatal days 29-38) or LA (postnatal days 39-48) to explore how social defeat at different stages of adolescence affects behavioral and cognitive symptoms commonly associated with psychiatric disorders. After stress exposure, the rats were assessed for anxiety-like behavior in the elevated plus maze, social interaction, and cognitive flexibility through set-shifting and reversal-learning tasks under immediate and delayed reward conditions. The results showed that CSDS during EA, but not LA, led to impaired cognitive flexibility in adulthood, as evidenced by increased perseverative and regressive errors in the set-shifting and reversal-learning tasks, particularly under the delayed reward condition. This suggests that the timing of stress exposure during development has a significant impact on the long-term consequences for behavioral and cognitive function. The findings highlight the vulnerability of the prefrontal cortex, which undergoes critical maturation during early adolescence, to the effects of social stress. Overall, this study demonstrates that the timing of social stressors during adolescence can differentially shape the developmental trajectory of cognitive flexibility, with important implications for understanding the link between childhood/adolescent adversity and the emergence of psychiatric disorders.

Structural brain basis of latent factors of executive functions in childhood

Executive functions can be classified into processes of inhibition, working memory and shifting, which together support flexible and goal-directed behaviour and are crucial for both current and later-life outcomes. A large body of literature has identified distinct brain regions critical to performing each of these functions. These findings are however predicated on a piecemeal and single-task approach. It is therefore unclear to what extent these associations reflect task-specific features or actual constructs of executive functions. Here, in a sample of 141 children aged 6-13 years, we administered a battery of 9 executive function tasks, derived latent factors of inhibition, working memory, and shifting and examined their associations with markers of brain structure (whole-brain cortical thickness). We identified associations between working memory and cortical thickness of right superior frontal and left medial temporal lobe as well as associations between shifting and cortical thickness in bilateral frontal and occipital lobes and left medial and anterior temporal lobes. While working memory and shifting shared a cortical substrate in right superior frontal cortex as well as left middle and inferior temporal regions no significant brain clusters were associated with inhibition. We discuss these findings in relation to theories of executive functions and their development.

Cognition enhances cognition: A comprehensive analysis on cognitive stimulation protocols and their effects on cognitive functions in animal models

Brain plasticity is involved in the regulation of neural differentiation as well as in functional processes related to memory consolidation, learning, and cognition during healthy life and brain pathology. Modifications in lifestyle, like poor diet, insufficient physical exercise and cognitive stimulation are associated with an increased risk of neurodegeneration; however, there is a paucity of research regarding the impact of individual factors on dementia risk or progression. Cognitive stimulation is a group of techniques and strategies, including cognitive enrichment (CE) and cognitive training (CT), aimed to maintain or improve the functionality of cognitive abilities, such as memory, learning, cognitive flexibility, and attention. The present scoping review focuses on cognitive stimulation by investigating its neuroprotective and therapeutic role on these cognitive functions in rodents. A methodical bibliographic search of experimental studies on rats and mice was conducted on PubMed and Scopus databases up to June 3, 2024. A pool of 29 original research articles was considered as relevant to the topic of the present work. Evidence shows that CE but above all CT influence cognitive performance and brain structure in rodents with specific differences with respect to the quality and quantity of stimulation. There would appear to be greater effects in restoring damage than in preserving or improving a functioning condition. These results provide a theoretical basis to be considered in the therapeutic setting, although further systematic studies would be necessary to identify and characterize the cognitive stimulation protocols which hold the greatest and task-transferable impact on cognitive functioning and maintenance.

Understanding the pathways to text generation: A longitudinal study on executive functions, oral language, and transcription skills from kindergarten to first grade

This longitudinal study explored the contribution of transcription skills, oral language abilities, and executive functions in kindergarten to written production in grade 1 among Spanish-speaking children (N = 191) through structural equation modeling (SEM). Three dimentions of written production were assessed, including productivity, quality, and syntactic complexity. Accordingly, three SEM models were tested to explore these relationships, and the estimated models for each endogenous variable demonstrated good fit. The results indicate that transcription skills and executive functions were key predictors of productivity, while both transcription and narrative oral competence contributed to writing quality. Syntactic complexity, on the other hand, was primarily influenced by narrative oral competence and executive functions. The results are interpreted within the framework of the not-so-simple view of writing model, particularly considering the characteristics of a shallow orthography. Limitations and educational implications are also discussed.

Dysregulated acetylcholine-mediated dopamine neurotransmission in the eIF4E Tg mouse model of autism spectrum disorders

Autism spectrum disorder (ASD) consists of diverse neurodevelopmental conditions where core behavioral symptoms are critical for diagnosis. Altered dopamine (DA) neurotransmission in the striatum has been suggested to contribute to the behavioral features of ASD. Here, we examine DA neurotransmission in a mouse model of ASD characterized by elevated expression of eukaryotic initiation factor 4E (eIF4E), a key regulator of cap-dependent translation, using a comprehensive approach that encompasses genetics, behavior, synaptic physiology, and imaging. The results indicate that increased eIF4E expression leads to behavioral inflexibility and impaired striatal DA release. The loss of normal DA neurotransmission is due to a defect in nicotinic receptor signaling that regulates calcium dynamics in dopaminergic axons. These findings provide a mechanistic understanding of ASD symptoms and offer a foundation for targeted therapeutic interventions by revealing the intricate interplay between eIF4E, DA neurotransmission, and behavioral flexibility.

Boosting Psychotherapy With Noninvasive Brain Stimulation: The Whys and Wherefores of Modulating Neural Plasticity to Promote Therapeutic Change

The phenomenon of neural plasticity pertains to the intrinsic capacity of neurons to undergo structural and functional reconfiguration through learning and experiential interaction with the environment. These changes could manifest themselves not only as a consequence of various life experiences but also following therapeutic interventions, including the application of noninvasive brain stimulation (NIBS) and psychotherapy. As standalone therapies, both NIBS and psychotherapy have demonstrated their efficacy in the amelioration of psychiatric disorders' symptoms, with a certain variability in terms of effect sizes and duration. Consequently, scholars suggested the convenience of integrating the two interventions into a multimodal treatment to boost and prolong the therapeutic outcomes. Such an approach is still in its infancy, and the physiological underpinnings substantiating the effectiveness and utility of combined interventions are still to be clarified. Therefore, this opinion paper aims to provide a theoretical framework consisting of compelling arguments as to why adding NIBS to psychotherapy can promote therapeutic change. Namely, we will discuss the physiological effects of the two interventions, thus providing a rationale to explain the potential advantages of a combined approach.

Cognitive Flexibility: What Mental Health Professionals Need to Know

In the aftermath of the coronavirus disease 2019 pandemic, increasing attention has been drawn to the physical and emotional demands of mental health professionals (MHPs) navigating workplace stressors with limited coping mechanisms. As a result, MHPs themselves are at increased risk for developing burnout and mental health disorders, including anxiety and depression. In addition, these emotional strains have impacted professional performance and career satisfaction, which poses significant challenges to the profession and patient outcomes. Cognitive flexibility (CF) is a cognitive-behavioral tool that is well-known for scaffolding resilience, encouraging self-awareness, and ameliorating workplace stressors and burnout. CF is also a teachable skill that uses many methods to encourage pre-frontal cortex neuroplasticity and practice. The current brief overview provides simple yet effective tools to enhance CF and safeguard the mental health and well-being of MHPs in the clinical setting. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Beyond the blur: Scopolamine's utility and limits in modeling cognitive disorders across sexes - Narrative review

Scopolamine, widely regarded as the gold standard in preclinical studies of memory impairments, acts as a non-selective antagonist of central and peripheral muscarinic receptors. While its application in modeling dementia primarily involves antagonism at the M1 receptor, its non-selective peripheral actions may introduce adverse effects that influence behavioral test outcomes. This review analyzes preclinical findings to consolidate knowledge on scopolamine's use and elucidate potential mechanisms responsible for its amnestic effects. We focused on recognition, spatial, and emotional memory processes, alongside executive functions such as attention, cognitive flexibility, and working memory. The cognitive effects of scopolamine are highly dose-dependent, influenced by factors such as species, age, and sex of subjects. Notably, scopolamine rapidly induces observable memory impairments across species, from fish to rodents and primates, often with deficits that can persist for days. However, the compound's broad action on muscarinic receptors and its peripheral side effects, including pupil dilation and reduced salivation, complicates result interpretation, particularly in tasks requiring visual discrimination or food intake. The review also highlights scopolamine's translational value in modeling dementia and Alzheimer's disease, emphasizing the importance of considering individual factors and task-specific designs. Despite its widespread use, scopolamine's limited specificity for cholinergic dysfunction and inability to fully mimic the complex pathophysiology of cognitive disorders like Alzheimer's and Parkinson's disease point to the need for complementary models. This review aims to guide researchers in using scopolamine for modeling cognitive impairments, ensuring attention to factors impacting experimental outcomes.

One Score to Rule Them All? Comparing the Predictive and Concurrent Validity of 30 Hearts and Flowers Scoring Approaches

The Hearts and Flowers (H&F) task is a computerized executive functioning (EF) assessment that has been used to measure EF from early childhood to adulthood. It provides data on accuracy and reaction time (RT) across three different task blocks (hearts, flowers, and mixed). However, there is a lack of consensus in the field on how to score the task that makes it difficult to interpret findings across studies. The current study, which includes a demographically diverse population of kindergarteners from Boston Public Schools (N = 946), compares the predictive and concurrent validity of 30 ways of scoring H&F, each with a different combination of accuracy, RT, and task block(s). Our exploratory results provide evidence supporting the use of a two-vector average score based on Zelazo et al.'s approach of adding accuracy and RT scores together only after individuals pass a certain accuracy threshold. Findings have implications for scoring future tablet-based developmental assessments.

Beyond the serotonin deficit hypothesis: communicating a neuroplasticity framework of major depressive disorder

The serotonin deficit hypothesis explanation for major depressive disorder (MDD) has persisted among clinicians and the general public alike despite insufficient supporting evidence. To combat rising mental health crises and eroding public trust in science and medicine, researchers and clinicians must be able to communicate to patients and the public an updated framework of MDD: one that is (1) accessible to a general audience, (2) accurately integrates current evidence about the efficacy of conventional serotonergic antidepressants with broader and deeper understandings of pathophysiology and treatment, and (3) capable of accommodating new evidence. In this article, we summarize a framework for the pathophysiology and treatment of MDD that is informed by clinical and preclinical research in psychiatry and neuroscience. First, we discuss how MDD can be understood as inflexibility in cognitive and emotional brain circuits that involves a persistent negativity bias. Second, we discuss how effective treatments for MDD enhance mechanisms of neuroplasticity-including via serotonergic interventions-to restore synaptic, network, and behavioral function in ways that facilitate adaptive cognitive and emotional processing. These treatments include typical monoaminergic antidepressants, novel antidepressants like ketamine and psychedelics, and psychotherapy and neuromodulation techniques. At the end of the article, we discuss this framework from the perspective of effective science communication and provide useful language and metaphors for researchers, clinicians, and other professionals discussing MDD with a general or patient audience.

Applying the Research Domain Criteria to Rodent Studies of Sex Differences in Chronic Stress Susceptibility

Women have a 2-fold increased rate of stress-associated psychiatric disorders such as depression and anxiety, but the mechanisms that underlie this increased susceptibility remain incompletely understood. Historically, female subjects were excluded from preclinical studies and clinical trials. Additionally, chronic stress paradigms used to study psychiatric pathology in animal models were developed for use in males. However, recent changes in National Institutes of Health policy encourage inclusion of female subjects, and considerable work has been performed in recent years to understand biological sex differences that may underlie differences in susceptibility to chronic stress-associated psychiatric conditions. Here, we review the utility as well as current challenges of using the framework of the National Institute of Mental Health's Research Domain Criteria as a transdiagnostic approach to study sex differences in rodent models of chronic stress including recent progress in the study of sex differences in the neurobehavioral domains of negative valence, positive valence, cognition, social processes, and arousal.

Alcohol, flexible behavior, and the prefrontal cortex: Functional changes underlying impaired cognitive flexibility

Cognitive flexibility enables individuals to alter their behavior in response to changing environmental demands, facilitating optimal behavior in a dynamic world. The inability to do this, called behavioral inflexibility, is a pervasive behavioral phenotype in alcohol use disorder (AUD), driven by disruptions in cognitive flexibility. Research has repeatedly shown that behavioral inflexibility not only results from alcohol exposure across species but can itself be predictive of future drinking. Like many high-level executive functions, flexible behavior requires healthy functioning of the prefrontal cortex (PFC). The scope of this review addresses two primary themes: first, we outline tasks that have been used to investigate flexibility in the context of AUD or AUD models. We characterize these based on the task features and underlying cognitive processes that differentiate them from one another. We highlight the neural basis of flexibility measures, focusing on the PFC, and how acute or chronic alcohol in humans and non-human animal models impacts flexibility. Second, we consolidate findings on the molecular, physiological and functional changes in the PFC elicited by alcohol, that may contribute to cognitive flexibility deficits seen in AUD. Collectively, this approach identifies several key avenues for future research that will facilitate effective treatments to promote flexible behavior in the context of AUD, to reduce the risk of alcohol related harm, and to improve outcomes following AUD. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".

Intolerance of uncertainty and psychological flexibility as predictors of mental health from adolescence to old age

PURPOSE

The COVID-19 pandemic brought with it significant social, economic and health uncertainties. These were proposed to impact young people more compared to adults, leading adolescents to report more mental health problems during the pandemic. The current study examined whether differences in cognitive risk (tolerance of uncertainty) and protective (psychological flexibility) factors accounted for age-related differences in depression and anxiety.

METHODS

These associations were investigated in the COVID-19 Risks Across the Lifespan (CORAL) cohort (N = 2280, 11-89 years).

RESULTS

The results showed that adolescents experienced greater intolerance of uncertainty and lower psychological flexibility compared to adults and older adults. Tolerance of uncertainty did not account for age-related differences in depression or anxiety. However, psychological flexibility conferred more protective advantage for anxiety in adults compared to adolescents.

CONCLUSION

The observed age-related differences in risk and protective factors advance our understanding of developmental vulnerabilities to depression and anxiety. Implications for mental health interventions in the context of future pandemics are discussed.

Age-related decline in cognitive flexibility and inadequate preparation: evidence from task-state network analysis

Behavioral evidence showed decreased cognitive flexibility in older adults. However, task-based network mechanisms of cognitive flexibility in aging (CFA) remain unclear. Here, we provided the first task-state network evidence that CFA was associated with inadequate preparation for switching trials by revealing age-related changes in functional integration. We examined functional integration in a letter-number switch task that distinguished between the cue and target stages. Both young and older adults showed decreased functional integration from the cue stage to the target stage, indicating that control-related processes were executed as the task progressed. However, compared to young adults, older adults showed less cue-to-target reduction in functional integration, which was primarily driven by higher network integration in the target stage. Moreover, less cue-to-target reductions were correlated with age-related decreases in task performance in the switch task. To sum up, compared to young adults, older adults pre-executed less control-related processes in the cue stage and more control-related processes in the target stage. Therefore, the decline in cognitive flexibility in older adults was associated with inadequate preparation for the impending demands of cognitive switching. This study offered novel insights into network mechanisms underlying CFA. Furthermore, we highlighted that training the function of brain networks, in conjunction with providing more preparation time for older adults, may be beneficial to their cognitive flexibility.

Inhibition of midbrain cholinergic neurons impairs decision-making strategies during reversal learning

Introduction

The pedunculopontine nucleus (PPN) plays a role in coordinating complex behaviors and adapting to changing environmental conditions. The specific role of cholinergic neurons in PPN function is not well understood, but their ascending connectivity with basal ganglia and thalamus suggests involvement in adaptive functions.

Methods

We used a chemogenetic approach in ChAT::Cre rats to explore the specific contribution of PPN cholinergic neurons to behavioral flexibility, focusing on the adaptation to shifting reward contingencies in a Reversal Learning Task. Rats were first trained in a non-probabilistic reversal learning task, followed by a probabilistic phase to challenge their adaptive strategies under varying reward conditions.

Results

Motor functions were evaluated to confirm that behavioral observations were not confounded by motor deficits. We found that inhibition of PPN cholinergic neurons did not affect performance in the non-probabilistic condition but significantly altered the rats' ability to adapt to the probabilistic condition. Under chemogenetic inhibition, the rats showed a marked deficiency in utilizing previous trial outcomes for decision-making and an increased sensitivity to negative outcomes. Logistic regression and Q-learning models revealed that suppression of PPN cholinergic activity impaired the adaptation of decision-making strategies.

Discussion

Our results highlight the role of PPN cholinergic neurons in dynamically updating action-outcome expectations and adapting to new contingencies. The observed impairments in decision-making under PPN cholinergic inhibition align with cognitive deficits associated with cholinergic dysfunction in neurodegenerative disorders. These findings suggest that cholinergic neurons in the PPN are essential for maximizing rewards through the flexible updating of behavioral strategies.

Supplementation with inulin reverses cognitive flexibility alterations and modulates the gut microbiota in high-fat-fed mice

Introduction

Alterations in cognitive performance are associated with inadequate nutritional states and diet composition. Prebiotics, such as inulin, are substances that can modulate the gut microbiome and, consequently, brain function by producing metabolites such as short-chain fatty acids (SCFAs). This study aimed to evaluate the effect of supplementation with inulin on cognitive flexibility, body composition, and gut microbiota in a murine model exposed to a high-fat (HF) diet.

Methods

CD1 mice were divided into five groups: control fed a standard diet (C), high-fat diet (HF), inulin (I), high-fat diet with inulin (HFI), and manipulation control (M). Dietary supplementation was administered for 6 weeks. Cognitive flexibility was assessed using the Attentional Set-Shifting Test (AST). In addition, body composition was measured via electrical bioimpedance and adipose tissue compartments of each mouse were removed and weighed. Finally, gut microbiota metataxonomic was analyzed through metataxonomic bacterial 16S rRNA sequencing.

Results

We observed that HF group required more AST trials than the C, HFI, and I groups in the compound discrimination (CD) and extra-dimensional (ED) stages. Notably, the HFI group required fewer trials than the HF group in the ED stage (p = 0.0187). No significant differences in overall body composition were observed between the groups. However, the percentage of gonadal and peritoneal adipose tissue was significantly higher in the HF and I groups compared to the C group. Statistically significant differences in alpha diversity for gut microbiota were observed using the Shannon, Simpson, and Chao1 indices. The I group showed a decrease in bacterial diversity compared to the HF group. While no differences were observed between groups in the phyla Bacillota and Bacteroidotes, Clostridium bacteria represented a lower proportion of sequences in the I group compared to the C group. Additionally, Lactobacillus represented a lower proportion of sequences in the HF group compared to the C and I groups.

Discussion

These findings suggest that supplementation with inulin could be a useful approach to mitigate the negative effects of an HF diet on cognitive flexibility and modulate gut microbiota composition.

The Role of Mindfulness Therapy in the Treatment of Chronic Pain

PURPOSE OF REVIEW

Mindfulness therapy is a widely used treatment for many diseases and has been shown to improve pain-related functions. There is growing support for the use of psychotherapy in the treatment of chronic pain. While studies have shown a positive effect of mindfulness therapy, it is important to consider psychosocial factors as there are still a small number of studies that question its effectiveness.

RECENT FINDINGS

Based on current studies, mindfulness therapy involves cognitive factors related to chronic pain, both in terms of cognitive production and its impact on cognitive control. Psychological and neurobasic studies were reviewed to provide a deeper understanding of these components, which include thought inhibition, attention deficit, pain catastrophizing, and self-efficacy. Mindfulness therapy has the potential to normalize psychology and nerves, and increase internal and external connectivity to work networks related to stress perception, cognition, and emotion. However, further research is needed to fully understand its effects. By exploring the relationship between mindfulness therapy and chronic pain. This review provides a new avenue for future research in psychotherapy for patients with chronic pain.

Validity, Reliability, and Cultural Adaptability of the Arabic Cognitive Flexibility Scale (Ar-CFS) Among Saudi Arabians: A Two-Cohort Investigation

Background/objectives: Cognitive flexibility is the mental skill that allows a person to shift between different ideas or concepts and think about several concepts simultaneously. A commonly used tool to assess cognitive flexibility is the Cognitive Flexibility Scale (CFS). This study focused on translating and validating the CFS into Arabic, given the lack of existing Arabic tools for assessing cognitive flexibility. Methods: Conducted at King Saud University, Riyadh, between April and June 2024, the study employed random sampling and involved 529 participants, including 419 students and 110 patients. Results: The average participant age was 25.8 years, with females making up 56.9% of the sample. Participants completed the Arabic CFS, along with the Emotion Regulation Questionnaire (ERQ) and the Perceived Stress Scale (PSS), at two time points 3-6 weeks apart. Reliability was evaluated through internal consistency (Cronbach's alpha = 0.8) and test-retest reliability (intraclass correlation coefficient = 0.82). Item analysis indicated that removing any single item did not significantly impact overall reliability, and inter-item correlations were strongest between items 4 and 6 (0.55) and items 6 and 7 (0.51). Validity was assessed through face, content, and construct validity, with factor analysis revealing a dominant single component accounting for 34.4% of the variance, confirming the scale's unidimensionality. Content validity indices for all items exceeded 0.9 in terms of relevance, importance, simplicity, and clarity. The Arabic CFS demonstrated good construct validity, showing significant correlations with the ERQ's reappraisal and suppression dimensions and the PSS. Conclusion: In conclusion, the Arabic version of the CFS is a valid and reliable tool for assessing cognitive flexibility in Arabic-speaking populations. This tool will be valuable in both clinical and research settings within Saudi Arabia, offering a robust instrument for evaluating cognitive flexibility.

Piloting the Coffs Harbour Executive Functioning Screen (CHEFS): An off-road tool to predict fitness to drive

Mental processes responsible for goal-oriented behavior - executive functioning (EF) - include working memory, flexible thinking, and cognitive control. A reliable and valid assessment of EF can inform appropriate interventions and decisions to drive. We investigated the feasibility and validity of a short, iPad-administered EF screening tool in a non-clinical sample: the Coffs Harbour Executive Functioning Screen (CHEFS). Participants (N = 55) completed the CHEFS alongside a neuropsychological assessment of EF used to assess fitness to drive. Discriminant function analysis (DFA) showed that the CHEFS correctly classified 87% of participants to normative clinical ranges on the Verbal Fluency Test. The results suggest that CHEFS is a novel, easily administered tool for assessing EF in a non-clinical sample. DFA is an appropriate within-tool analysis to support the widespread administration of a screening tool to determine fitness to drive and classify patient referral needs. Further assessment is required to determine CHEFS reliability and validity with a broader range of participants varying in neuropsychological functioning, age, ethnicity, test experience, and compared to on-road driving performance.

Connectome-based Predictive Models of General and Specific Cognitive Control

Cognitive control, the ability to adapt thoughts and actions to shifting contexts and goals, is composed primarily of three distinct yet interrelated components: Inhibition, Shifting, and Updating. While prior research has examined the nature of different cognitive components as well as their inter-relationships, fewer studies examined whole-brain connectivity to predict individual differences for the three cognitive components and associated tasks. Here, using the Connectome-based Predictive Modelling (CPM) approach and open-access data from the Human Connectome Project, we built brain network models to successfully predict individual performance differences on the Flanker task, the Dimensional Change Card Sort task, and the 2-Back task, each putatively corresponding to Inhibition, Shifting, and Updating. We focused on grayordinate fMRI data collected during the 2-Back tasks after confirming superior predictive performance over resting-state and volumetric data. High cross-task prediction accuracy as well as joint recruitment of canonical networks, such as the frontoparietal and default-mode networks, suggest the existence of a common cognitive control factor. To directly investigate the relationships among the three cognitive control components, we developed new measures to disentangle their shared and unique aspects. Our analysis confirmed that a shared control component can be well predicted from functional connectivity patterns densely located around the frontoparietal, default-mode and dorsal attention networks. In contrast, the Shifting-specific and Inhibition-specific components exhibited lower cross-prediction performance, indicating their distinct and specialized roles. Notably, the Updating-specific component showed significant cross-prediction with the general control factor, suggesting its central role in cognitive control. Given the limitation that individual behavioral measures do not purely reflect the intended cognitive constructs, our study demonstrates the need to distinguish between common and specific components of cognitive control.

Assessing acute effects of two motor-cognitive training modalities on cognitive functions, postural control, and gait stability in older adults: a randomized crossover study

Background

The process of aging often accompanies a decline in cognitive function, postural control, and gait stability, consequently increasing the susceptibility to falls among older individuals. In response to these challenges, motor-cognitive training has emerged as a potential intervention to mitigate age-related declines.

Objective

This study aims to assess the acute effects of two distinct motor-cognitive training modalities, treadmill dual-task training (TMDT) and interactive motor-cognitive training (IMCT), on cognitive function, postural control, walking ability, and dual-task performance in the elderly population.

Method

In this randomized crossover study, 35 healthy elderly individuals (aged 60-75) participated in three acute training sessions involving TMDT, IMCT, and a control reading condition. Assessments of executive function, postural control, gait performance, and cognitive accuracy were conducted both before and after each session.

Results

Both TMDT and IMCT improved executive functions. Notably, IMCT resulted in a significant enhancement in correct response rates and a reduction in reaction times in the Stroop task (p < 0.05) compared to TMDT and the control condition. IMCT also led to an increase in dual-task gait speed (p < 0.001) and showed a trend towards improved cognitive accuracy (p = 0.07). Conversely, TMDT increased postural sway with eyes open (p = 0.013), indicating a potential detriment to postural control.

Conclusion

The findings suggest that IMCT holds greater immediate efficacy in enhancing cognitive function and gait stability among older adults compared to TMDT, with a lesser adverse impact on postural control. This underscores the potential of IMCT as a preferred approach for mitigating fall risk and enhancing both cognitive and physical functions in the elderly population.

People with HIV exhibit spectrally distinct patterns of rhythmic cortical activity serving cognitive flexibility

Despite effective antiretroviral therapy, cognitive impairment remains prevalent among people with HIV (PWH) and decrements in executive function are particularly prominent. One component of executive function is cognitive flexibility, which integrates a variety of executive functions to dynamically adapt one's behavior in response to changing contextual demands. Though substantial work has illuminated HIV-related aberrations in brain function, it remains unclear how the neural oscillatory dynamics serving cognitive flexibility are affected by HIV-related alterations in neural functioning. Herein, 149 participants (PWH: 74; seronegative controls: 75) between the ages of 29-76 years completed a perceptual feature matching task that probes cognitive flexibility during high-density magnetoencephalography (MEG). Neural responses were decomposed into the time-frequency domain and significant oscillatory responses in the theta (4-8 Hz), alpha (10-16 Hz), and gamma (74-98 Hz) spectral windows were imaged using a beamforming approach. Whole-brain voxel-wise comparisons were then conducted on these dynamic functional maps to identify HIV-related differences in the neural oscillatory dynamics supporting cognitive flexibility. Our findings indicated group differences in alpha oscillatory activity in the cingulo-opercular cortices, and differences in gamma activity were found in the cerebellum. Across all participants, alpha and gamma activity in these regions were associated with performance on the cognitive flexibility task. Further, PWH who had been treated with antiretroviral therapy for a longer duration and those with higher current CD4 counts had alpha responses that more closely resembled those of seronegative controls, suggesting that optimal clinical management of HIV infection is associated with preserved neural dynamics supporting cognitive flexibility.

Microstructural and functional substrates underlying dispositional greed and its link with trait but not state impulsivity

The interplay between personality traits and impulsivity has long been a central theme in psychology and psychiatry. However, the potential association between Greed Personality Traits (GPT) and impulsivity, encompassing both trait and state impulsivity and future time perspective, remains largely unexplored. To address these issues, we employed questionnaires and an inter-temporal choice task to estimate corresponding trait/state impulsivity and collected multi-modal neuroimaging data (resting-state functional imaging: n = 430; diffusion-weighted imaging: n = 426; task-related functional imaging: n = 53) to investigate the underlying microstructural and functional substrates. Behavioral analyses revealed that GPT mediated the association between time perspective (e.g., present fatalism) and trait impulsivity (e.g., motor impulsivity). Functional imaging analyses further identified that brain activation strengths and patterns related to delay length, particularly in the dorsomedial prefrontal cortex, superior parietal lobule, and cerebellum, were associated with GPT. Moreover, individuals with similar levels of greed exhibited analogous spontaneous brain activity patterns, predominantly in the Default Mode Network (DMN), Fronto-Parietal Network (FPN), and Visual Network (VIS). Diffusion imaging analysis observed specific microstructural characteristics in the spinocerebellar/pontocerebellar fasciculus, internal/external capsule, and corona radiata that support the formation of GPT. Furthermore, the corresponding neural activation pattern, spontaneous neural activity pattern, and analogous functional couplings among the aforementioned brain regions mediated the relationships between time perspective and GPT and between GPT and motor impulsivity. These findings provide novel insights into the possible pathway such as time perspective → dispositional greed → impulsivity and uncover their underlying microstructural and functional substrates.

The effect of psychodrama-based intervention on therapeutic communication skills and cognitive flexibility among nursing students: A 12-month follow-up study

AIM

This research aimed to evaluate the effect of the psychodrama-based intervention used in the communication course of 2nd year nursing students on their therapeutic communication skills and cognitive flexibility.

BACKGROUND

Psychodrama has been defined as a way of practicing living without being punished for making mistakes. The psychodrama-based interventions can be used as a novel teaching method to improve therapeutic communication skills and cognitive flexibility in education by allowing students to learn from their trials and errors before going into clinical practice and communicating one-on-one with the patient.

DESIGN

A single group, pretest-posttest with a follow-up quasi-experimental design was adopted.

METHOD

The participants were a convenience sample of 24 s-year undergraduate nursing students. Students attended a one-day in-a-week psychodrama-based communication course for 14 weeks. The data of the study were collected with the Demographic Information Form, the Therapeutic Communication Skills Scale and the Cognitive Flexibility Inventory. Outcomes were measured on the first day (baseline), at the end of the course and 6 and 12 months after completing the course. Outcomes were analyzed using descriptive and repeated measures analysis of variance, Friedman and Dunn tests.

RESULTS

It was determined that the nontherapeutic communication scores were significantly lower at the post-test, 6 months and 12 months than at baseline in participants. Therapeutic-one scores were significantly increased at the post-test compared with baseline in participants. Therapeutic-two scores were significantly increased at 6 months compared with baseline. There was no statistical difference in any measure in the cognitive flexibility inventory.

CONCLUSION

The psychodrama-based intervention in communication course significantly improved nursing students' therapeutic communication skills. It is also recommended to conduct studies with larger samples of nursing students from different institutions and also randomized controlled studies with control groups and qualitative studies. It is recommended to conduct studies evaluating an intervention that includes subheadings more related to cognitive flexibility which is an important nursing competency, as well as new studies that evaluate cognitive flexibility with different measurement tools.

A meta-analysis of cognitive flexibility in aging: Perspective from functional network and lateralization

Cognitive flexibility, the ability to switch between mental processes to generate appropriate behavioral responses, is reduced with typical aging. Previous studies have found that age-related declines in cognitive flexibility are often accompanied by variations in the activation of multiple regions. However, no meta-analyses have examined the relationship between cognitive flexibility in aging and age-related variations in activation within large-scale networks. Here, we conducted a meta-analysis employing multilevel kernel density analysis to identify regions with different activity patterns between age groups, and determined how these regions fall into functional networks. We also employed lateralization analysis to explore the spatial distribution of regions exhibiting group differences in activation. The permutation tests based on Monte Carlo simulation were used to determine the significance of the activation and lateralization results. The results showed that cognitive flexibility in aging was associated with both decreased and increased activation in several functional networks. Compared to young adults, older adults exhibited increased activation in the default mode, dorsal attention, ventral attention, and somatomotor networks, while displayed decreased activation in the visual network. Moreover, we found a global-level left lateralization for regions with decreased activation, but no lateralization for regions with higher activation in older adults. At the network level, the regions with decreased activation were left-lateralized, while the regions with increased activation showed varying lateralization patterns within different networks. To sum up, we found that networks that support various mental functions contribute to age-related variations in cognitive flexibility. Additionally, the aging brain exhibited network-dependent activation and lateralization patterns in response to tasks involving cognitive flexibility. We highlighted that the comprehensive meta-analysis in this study offered new insights into understanding cognitive flexibility in aging from a network perspective.

Transcranial direct current stimulation combined with cognitive training improves two executive functions: Cognitive flexibility and information updating after traumatic brain injury

Traumatic brain injury (TBI) often causes persistent deficits in cognitive flexibility and information updating. Cognitive flexibility refers to the brain's ability to adjust its thinking and behavior in response to changing circumstances, whereas information updating is the process of incorporating new facts into current knowledge. Both cognitive flexibility and information updating are critical components of executive function, and their impairment can have a major influence on a person's capacity to operate independently and adjust to life's problems following a TBI. Understanding and addressing these specific cognitive processes is therefore critical in designing successful therapies for TBI patients. Previous studies have examined the effects of non-invasive brain stimulation and cognitive training separately. This study investigated the effects of combining transcranial direct current stimulation (tDCS) with computer-based cognitive training, comparing this combined intervention against a control group with no treatment, to assess improvements in two executive functions in TBI patients: cognitive flexibility and information updating. Thirty TBI patients, 2-12 weeks post-injury with impaired executive dysfunction, were randomized to an experimental or control group. The experimental group received ten 30-minute sessions over 2 weeks of anodal (A-tDCS), 2.0 mA to the prefrontal cortex while performing cognitive training tasks from the RehaCom software. The control group received no intervention during this period. Cognitive flexibility and information updating were assessed before and after the intervention period using the n-back working memory task, Wisconsin Sorting Card Test, and quantitative electroencephalography (qEEG) during eyes-closed state. Statistically significant differences in theta, alpha, beta, and gamma band power were observed between groups (p < .05, 4 < f < 6). Secondary outcomes indicated significant improvements in cognitive flexibility within Wisconsin Card Sorting Test and information updating performance within n-back task (p < .05, 7 < f < 20). The combination of tDCS and cognitive training may improve cognitive flexibility and information updating in TBI patients by enhancing plasticity and connectivity in prefrontal regions involved in these complex cognitive processes.

Psilocybin restrains activity-based anorexia in female rats by enhancing cognitive flexibility: contributions from 5-HT1A and 5-HT2A receptor mechanisms

Psilocybin has shown promise for alleviating symptoms of depression and is currently in clinical trials for the treatment of anorexia nervosa (AN), a condition that is characterised by persistent cognitive inflexibility. Considering that enhanced cognitive flexibility after psilocybin treatment is reported to occur in individuals with depression, it is plausible that psilocybin could improve symptoms of AN by breaking down cognitive inflexibility. A mechanistic understanding of the actions of psilocybin is required to tailor the clinical application of psilocybin to individuals most likely to respond with positive outcomes. This can only be achieved using incisive neurobiological approaches in animal models. Here, we use the activity-based anorexia (ABA) rat model and comprehensively assess aspects of reinforcement learning to show that psilocybin (post-acutely) improves body weight maintenance in female rats and facilitates cognitive flexibility, specifically via improved adaptation to the initial reversal of reward contingencies. Further, we reveal the involvement of signalling through the serotonin (5-HT) 1 A and 5-HT2A receptor subtypes in specific aspects of learning, demonstrating that 5-HT1A antagonism negates the cognitive enhancing effects of psilocybin. Moreover, we show that psilocybin elicits a transient increase and decrease in cortical transcription of these receptors (Htr2a and Htr1a, respectively), and a further reduction in the abundance of Htr2a transcripts in rats exposed to the ABA model. Together, these findings support the hypothesis that psilocybin could ameliorate cognitive inflexibility in the context of AN and highlight a need to better understand the therapeutic mechanisms independent of 5-HT2A receptor binding.

Decoding ruminative reflection in healthy individuals: The role of triple network connectivity

Ruminative reflection has been linked to enhanced executive control in processing internally represented emotional information, suggesting it may serve as an adaptive strategy for emotion regulation. Investigating the neural substrates of reflection can deepen our understanding of its adaptive properties. This study used network-based statistic (NBS)-Predict methodology to identify resting state functional connectivity (FC)-based predictors of ruminative reflection in a healthy sample. Our results showed that reflection in healthy subjects was predicted by FC within and between the default mode network (DMN), fronto-parietal network (FPN), and salience network (SN). Notably, FC within the FPN and SN, as well as between the FPN and DMN, contributed more significantly to the predictive model. These results underscore the greater influence of FPN and SN connectivity in predicting reflection, providing empirical evidence that increased executive control over internal emotional representations is integral to adaptive reflective processes. Moreover, the triple-network model, particularly the FPN-DMN coupling, emerges as a crucial predictor of ruminative reflection, highlighting the importance of coordinating self-relevant and goal-directed processing in reflective mechanisms. These identified connectivity fingerprints may offer insights into the role of reflective processes in facilitating recovery from depression.

Development and Validation of Quadri Condition Dichotic Double Word Test in Kannada

INTRODUCTION

Dichotic listening (DL) is a test where auditory stimuli are presented simultaneously to each ear. DL has clinical applications in assessing APD, schizophrenia, and brain injury. It is sensitive to hemisphere differences and has been used to study language lateralization. The study aimed to develop, validate, and establish norms for a Quadri condition Dichotic Double Word Test (free recall, forced right, forced left, and switch attention) in the Kannada language (DDWT-K).

METHODS

This study was carried out in two phases. Phase 1 aimed to develop and validate the DDWT-K and phase 2 involved data collection. The developed novel dichotic test was administered on 100 normal-hearing adults in four conditions - free recall, forced right, forced left, and switch attention.

RESULTS

The results showed significant ear differences in free recall condition indicating right ear advantage. The switch attention condition showed slightly poorer performance when compared to both the forced attention condition indicating greater task difficulty. The test-retest reliability was above 0.7 for all the conditions indicating good reliability.

CONCLUSIONS

The findings demonstrated the best preservation of the original dichotic effects and hence ready for clinical use.

Unraveling the spectrum: overlap, distinctions, and nuances of ADHD and ASD in children

This review explores the clinical presentation of similarities and differences in Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). This paper investigates the deficits in executive function, social function, and emotional intelligence that are seen in both conditions and how the presence of both conditions can exacerbate these deficiencies. Understanding the clinical presentations in these domains is critical to refine diagnostic methods and treatments and improve outcomes for those affected by these neurodevelopmental disorders. The similarities in clinical presentation between ADHD and ASD present a significant diagnostic challenge, with individuals often exhibiting similar behaviors and difficulty navigating the complexities that encompass reacting to their environment. Further research is paramount in gaining more knowledge of the disorders and challenges faced by these individuals, especially those with the presence of both conditions.

Functioning Management and Recovery, a psychoeducational intervention for psychiatric residential facilities: a multicenter follow-up study

AIM

Functional Management and Recovery is a standardized Psychoeducational Intervention, derived from "Integro", an effective salutogenic-psychoeducational intervention for people in recovery journey, designed to improve recovery and functioning of individuals with psychotic disorders in Psychiatric Residential Facilities (PRFs). The aim of this study is to evaluate the primary and secondary outcomes of this intervention elaborated specifically for PRFs where evidence based structured interventions seem rare and desirable.

METHODS

66 individuals with psychotic disorders were recruited in 9 PRFs dislocated in the North, Center and South Italy and 63 underwent a multicenter follow-up study with a two time-point evaluation (t0, pre-treatment and t1, 6 months; ). At each time point, social functioning was assessed as primary outcome by the Personal and Social Performance scale (PSP); furthermore, psychopathological status was assessed by Brief Psychiatric Rating Scale (BPRS), Recovery by Recovery Assessment Scale (RAS), Cognitive Functioning by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Stress management by Stress-Scale, Cognitive Flexibility by Modified Five-Point Test (M-FPT), Emotional Intelligence by Emotional Intelligence Index (EI-I), the PRF Atmosphere and the Opinion of users about the PFR by an ad hoc questionnaire. The Abilities Knowledge, the Utility and Pleasantness of sessions were measured by an ad hoc list of items.

RESULTS

63 individuals out of 66, 52 (82,5%) affected by schizophrenia and 11 (17,5%) by bipolar I disorder with psychotic symptoms according to DSM-5-TR completed the study. At the end of the study, 43 (68,3%) were male, 57 (90.5%) were single, 5 (7.9%) engaged, 1 (1.6%) married; 45 (71.4%) unemployed. The total scores of PSP, RAS, BPRS, BANS, Stress management, Abilities Knowledge, Utility and Pleasantness of sessions showed a statistically significant improvement at t1 vs. t0. Two sub-scales out of 5 of M-FPT showed a statistically significant improvement. The Emotional Intelligence, the Unit Atmosphere and the Opinion of Users about PFR improved without statistical significance. Six months after the end of the follow-up study 22 individuals of the sample were dismissed with a very high turnover.

CONCLUSIONS

After a six-month follow-up (a short period of time), these results showed improvement in functioning, the primary outcome, as well as in the following secondary outcome variables: RAS, BPRS, BANS, Stress management, Abilities Knowledge, two sub-scales out of 5 of M-FPT, Utility and Pleasantness of sessions. Overall, a remarkable impact of psychoeducational structured intervention on the key Recovery variables is observed. Further studies are needed to address extent and duration of these improvements.

Testing associations between assessments of cognitive flexibility and eating disorder symptoms in adolescent bulimia nervosa

OBJECTIVE

Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents.

METHODS

Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT).

RESULTS

Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT.

DISCUSSION

The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes.

PUBLIC SIGNIFICANCE

Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN.

Hyperglycemia and cognitive impairments anticipate the onset of an overt type 2 diabetes-like phenotype in TALLYHO/JngJ mice

Type 2 Diabetes mellitus (T2DM) is a metabolic disorder characterized by chronic hyperglycemia, resulting from deficits in insulin secretion, insulin action, or both. Whilst the role of insulin in the peripheral nervous system has been ascertained in countless studies, its role in the central nervous system (CNS) is emerging only recently. Brain insulin has been lately associated with brain disorders like Alzheimer's disease, obsessive compulsive disorder, and attention deficit hyperactivity disorder. Thus, understanding the role of insulin as a common risk factor for mental and somatic comorbidities may disclose novel preventative and therapeutic approaches. We evaluated general metabolism (glucose tolerance, insulin sensitivity, energy expenditure, lipid metabolism, and polydipsia) and cognitive capabilities (attention, cognitive flexibility, and memory), in adolescent, young adult, and adult male and female TALLYHO/JngJ mice (TH, previously reported to constitute a valid experimental model of T2DM due to impaired insulin signaling). Adult TH mice have also been studied for alterations in gut microbiota diversity and composition. While TH mice exhibited profound deficits in cognitive flexibility and altered glucose metabolism, we observed that these alterations emerged either much earlier (males) or independent of (females) a comprehensive constellation of symptoms, isomorphic to an overt T2DM-like phenotype (insulin resistance, polydipsia, higher energy expenditure, and altered lipid metabolism). We also observed significant sex-dependent alterations in gut microbiota alpha diversity and taxonomy in adult TH mice. Deficits in insulin signaling may represent a common risk factor for both T2DM and CNS-related deficits, which may stem from (partly) independent mechanisms.

Prevalence and characteristics of vascular cognitive impairment in a European cohort of adult patients with Moyamoya angiopathy

INTRODUCTION

Moyamoya angiopathy (MMA) is associated with a high risk of stroke, but it is also increasingly recognized as leading to cognitive impairment. The aim of this study was to determine the prevalence, nature, and severity of vascular cognitive impairment no dementia (VCIND) in adults with MMA and to identify clinical and imaging factors associated with VCIND.

METHODS

We conducted a retrospective study of consecutive adult patients with MMA followed in two tertiary hospitals (Toulouse and Paris Lariboisiere). All patients underwent neuropsychological assessment and brain magnetic resonance imaging (MRI). VCIND was defined as at least two variables of the same cognitive process with z-scores of < 2 standard deviations, regardless of the cognitive domain, that do not interfere in everyday life. Baseline demographic, clinical, and imaging data were compared between patients with and without VCIND.

RESULTS

A total of 102 patients (mean age 43 years; 65% women) were included. Thirty-four patients (33.3%) had VCIND. VCIND was mild in 20/34 (59%), moderate in 8/34 (23%), and severe in 6/34 (18%) patients. Executive function was the most widely affected (25.5%), followed by attention and processing speed (24.8%). In univariable analyses, VCIND was associated with ischemic stroke at diagnosis and the presence of ischemic lesions on MRI.

CONCLUSIONS

VCIND is highly prevalent in adults with MMA. Executive functions and processing speed are predominantly affected. These findings may guide clinicians in their evaluation of patients with MMA. Further research should assess the effect of revascularization therapies on cognitive functions.

Anodal transcranial direct-current stimulation and non-verbal intelligence in autism spectrum disorder: A randomized controlled trial

AIM

To understand the impact of anodal transcranial direct-current stimulation (tDCS) on non-verbal intelligence in high-functioning young adults with autism spectrum disorder (ASD).

METHOD

Thirty individuals with ASD were randomly divided into three groups receiving 2 mA, 20 minutes daily anodal tDCS for 10 sessions. Group A received 10 sham tDCS sessions, group B five real followed by five sham sessions, and group C received 10 real tDCS sessions. The total score of non-verbal intelligence was measured using the Test of Nonverbal Intelligence, Fourth Edition. The left dorsolateral prefrontal cortex (LDLPFC) was targeted using the International 10-20 electroencephalography system, and concurrent cognitive training was avoided.

RESULTS

Group C demonstrated a mean difference of 4.10 (95% confidence interval 1.41-6.79; p = 0.005) in Test of Nonverbal Intelligence scores compared with group A, with an effect size of 0.47. No significant differences were observed between groups A and B (p = 0.296), or between groups B and C (p = 0.140).

INTERPRETATION

Ten sessions of anodal tDCS to the LDLPFC led to improved non-verbal intelligence among individuals with ASD. These results emphasize the potential of tDCS as a discrete method for boosting cognitive abilities in the high-functioning population with ASD. Future studies with larger groups of participants and extended observation periods are necessary to validate these findings.

The impact of cognitive flexibility on prospective EFL teachers' critical thinking disposition: the mediating role of self-efficacy

Critical thinking as one of the key skills for success in the 21st-century has been considered by many scholars in teacher education. This study tries to examine the interaction of critical thinking disposition with two other key characteristics of successful teachers: cognitive flexibility and self-efficacy. To this end, a sample of pre-service English as a Foreign Language (EFL) teachers was selected for this study. Based on the findings, a positive and strong relationship between cognitive flexibility and critical thinking disposition, and a positive and robust correlation between self-efficacy and critical thinking disposition were observed. Hence, it can be suggested that teacher-educationists can use this link for designing teacher-training courses with tailored tasks for both in and pre-service teachers. The main contribution of the findings might be beneficial for homogenizing teacher-training courses around the globe with the 21st-century trends. In addition, this line of research can be followed by empirical studies for checking the effectiveness of tailored tasks for provoking teachers' critical thinking dispositions, cognitive flexibility, and self-efficacy in teaching activities.

Structural and functional connectivity in relation to executive functions in antipsychotic-naïve patients with first episode schizophrenia and levels of glutamatergic metabolites

Patients with schizophrenia exhibit structural and functional dysconnectivity but the relationship to the well-documented cognitive impairments is less clear. This study investigates associations between structural and functional connectivity and executive functions in antipsychotic-naïve patients experiencing schizophrenia. Sixty-four patients with schizophrenia and 95 matched controls underwent cognitive testing, diffusion weighted imaging and resting state functional magnetic resonance imaging. In the primary analyses, groupwise interactions between structural connectivity as measured by fixel-based analyses and executive functions were investigated using multivariate linear regression analyses. For significant structural connections, secondary analyses examined whether functional connectivity and associations with executive functions also differed for the two groups. In group comparisons, patients exhibited cognitive impairments across all executive functions compared to controls (p < 0.001), but no group difference were observed in the fixel-based measures. Primary analyses revealed a groupwise interaction between planning abilities and fixel-based measures in the left anterior thalamic radiation (p = 0.004), as well as interactions between cognitive flexibility and fixel-based measures in the isthmus of corpus callosum and cingulum (p = 0.049). Secondary analyses revealed increased functional connectivity between grey matter regions connected by the left anterior thalamic radiation (left thalamus with pars opercularis p = 0.018, and pars orbitalis p = 0.003) in patients compared to controls. Moreover, a groupwise interaction was observed between cognitive flexibility and functional connectivity between contralateral regions connected by the isthmus (precuneus p = 0.028, postcentral p = 0.012), all p-values corrected for multiple comparisons. We conclude that structural and functional connectivity appear to associate with executive functions differently in antipsychotic-naïve patients with schizophrenia compared to controls.

Probing cognitive flexibility in Shank2-deficient mice: Effects of D-cycloserine and NMDAR signaling hub dynamics

Neurodevelopmental disorders such as autism spectrum disorder (ASD) have a heterogeneous etiology but are largely associated with genetic factors. Robust evidence from recent human genetic studies has linked mutations in the Shank2 gene to idiopathic ASD. Modeling these Shank2 mutations in animal models recapitulates behavioral changes, e.g. impaired social interaction and repetitive behavior of ASD patients. Shank2-deficient mice exhibit NMDA receptor (NMDAR) hypofunction and associated behavioral deficits. Of note, NMDARs are strongly implicated in cognitive flexibility. Their hypofunction, e.g. observed in schizophrenia, or their pharmacological inhibition leads to impaired cognitive flexibility. However, the association between Shank2 mutations and cognitive flexibility is poorly understood. Using Shank2-deficient mice, we explored the role of Shank2 in cognitive flexibility measured by the attentional set shifting task (ASST) and whether ASST performance in Shank2-deficient mice can be modulated by treatment with the partial NMDAR agonist D-cycloserine (DCS). Furthermore, we investigated the effects of Shank2 deficiency, ASST training, and DCS treatment on the expression level of NMDAR signaling hub components in the orbitofrontal cortex (OFC), including NMDAR subunits (GluN2A, GluN2B, GluN2C), phosphoglycerate dehydrogenase and serine racemase. Surprisingly, Shank2 deficiency did not affect ASST performance or alter the expression of the investigated NMDAR signaling hub components. Importantly, however, DCS significantly improved ASST performance, demonstrating that positive NMDAR modulation facilitates cognitive flexibility. Furthermore, DCS increased the expression of GluN2A in the OFC, but not that of other NMDAR signaling hub components. Our findings highlight the potential of DCS as a pharmacological intervention to improve cognitive flexibility impairments downstream of NMDAR modulation and substantiate the key role of NMDAR in cognitive flexibility.

Diverging functional connectivity timescales: Capturing distinct aspects of cognitive performance in early psychosis

BACKGROUND

Psychosis spectrum disorders (PSDs) are marked by cognitive impairments, the neurobiological correlates of which remain poorly understood. Here, we investigate the entropy of time-varying functional connectivity (TVFC) patterns from resting-state functional magnetic resonance imaging (rs-fMRI) as potential biomarker for cognitive performance in PSDs. By combining our results with multimodal reference data, we hope to generate new insights into the mechanisms underlying cognitive dysfunction in PSDs. We hypothesized that low-entropy TVFC patterns (LEN) would be more behaviorally informative than high-entropy TVFC patterns (HEN), especially for tasks that require extensive integration across diverse cognitive subdomains.

METHODS

rs-fMRI and behavioral data from 97 patients in the early phases of psychosis and 53 controls were analyzed. Positron emission tomography (PET) and magnetoencephalography (MEG) data were taken from a public repository (Hansen et al., 2022). Multivariate analyses were conducted to examine relationships between TVFC patterns at multiple spatial scales and cognitive performance in patients.

RESULTS

Compared to HEN, LEN explained significantly more cognitive variance on average in PSD patients, driven by superior encoding of information on psychometrically more integrated tasks. HEN better captured information in specific subdomains of executive functioning. Nodal HEN-LEN transitions were spatially aligned with neurobiological gradients reflecting monoaminergic transporter densities and MEG beta-power. Exploratory analyses revealed a close statistical relationship between LEN and positive symptom severity in patients.

CONCLUSION

Our entropy-based analysis of TVFC patterns dissociates distinct aspects of cognition in PSDs. By linking topographies of neurotransmission and oscillatory dynamics with cognitive performance, it enhances our understanding of the mechanisms underlying cognitive deficits in PSDs.

Examining the relationship between functional connectivity and broader autistic traits in non-autistic children

In the current study, we used functional near-infrared spectroscopy (fNIRS) to examine functional connectivity (FC) in relation to measures of cognitive flexibility and autistic features in non-autistic children. Previous research suggests that disruptions in FC between brain regions may underlie the cognitive and behavioral traits of autism. Moreover, research has identified a broader autistic phenotype (BAP), which refers to a set of behavioral traits that fall along a continuum of behaviors typical for autism but which do not cross a clinically relevant threshold. Thus, by examining FC in relation to the BAP in non-autistic children, we can better understand the spectrum of behaviors related to this condition and their neural basis. Results indicated age-related differences in performance across three measures of cognitive flexibility, as expected given the rapid development of this skill within this time period. Additionally, results showed that across the flexibility tasks, measures of autistic traits were associated with weaker FC along the executive control network, though task performance was not associated with FC. These results suggest that behavioral scores may be less sensitive than neural measures to autistic traits. Further, these results corroborate the use of broader autistic traits and the BAP to better understand disruptions to neural function associated with autism.

Decoding Cognitive Control and Cognitive Flexibility as Concomitants for Experiential Avoidance in Social Anxiety

Background and objectives: Avoidance is regarded as a central hallmark of social anxiety. Experiential avoidance is perilous for social anxiety, specifically among university students (young adults). Additionally, cognitive control and cognitive flexibility are crucial components of executive functions for a fulfilling and healthy lifestyle. The current research is a modest attempt to understand how cognitive flexibility and cognitive control affect the emergence of experiential avoidance in social anxiety in young adults. Methods: Using an ex-post facto design, the Social Phobia Inventory was employed to screen university students with social anxiety based on which one hundred and ninety-five were identified. Thereafter, participants completed the standardized measures on experiential avoidance, cognitive control and cognitive flexibility. Results: A stepwise multiple regression analysis was computed wherein the cognitive control predicts an amount of 5% of variance towards experiential avoidance, whereas a 10% of additional variance has been contributed by cognitive flexibility. Interpretation and Conclusions: The statistical outcome indicated that cognitive control is positively associated with experiential avoidance which is a negative correlate to cognitive flexibility among university students. Both also emerged as significant predictors of experiential avoidance and add a cumulative variance of 15% towards the same. This conclusion supports the need for improved and efficient management techniques in counseling and clinical settings.

Neurocognitive outcome in children and adolescents following infectious encephalitis

Infectious encephalitis in children is fairly uncommon, but unfavorable outcomes are seen in many survivors. The aim of this study was to prospectively describe the long-term neurocognitive consequences following infectious encephalitis in childhood. Children admitted to a primary and tertiary hospital in Sweden between 2011 and 2016 were asked to participate. Fifty-nine children were assessed at a median time of 18 months (IQR 18-20) after hospitalization. Follow-up included measures of intellectual functioning, attention, working memory, and executive functions. Caregiver ratings of executive functioning and behavioral - emotional symptoms were assessed with standardized questionnaires. Neurocognitive outcome and measures of executive functions and behavioral-emotional symptoms varied greatly among participants. Basic auditory attention, working memory, and mental processing speed were affected and significantly lower compared to a standardized mean. Other domains identified as areas of vulnerability included executive functions, sustained attention, and the exert of self-control. Behavioral-emotional symptoms were less common; however, somatic complaints and behaviors related to conduct problems were seen in about one-third of individuals. This study highlights the importance of a comprehensive neurocognitive examination to identify children with unfavorable outcomes.

Adolescent-to-adult gains in cognitive flexibility are adaptively supported by reward sensitivity, exploration, and neural variability

Cognitive flexibility exhibits dynamic changes throughout development, with different forms of flexibility showing dissociable developmental trajectories. In this review, we propose that an adolescent-specific mode of flexibility in the face of changing environmental contingencies supports the emergence of adolescent-to-adult gains in cognitive shifting efficiency. We first describe how cognitive shifting abilities monotonically improve from childhood to adulthood, accompanied by increases in brain state flexibility, neural variability, and excitatory/inhibitory balance. We next summarize evidence supporting the existence of a dopamine-driven, adolescent peak in flexible behavior that results in reward seeking, undirected exploration, and environmental sampling. We propose a neurodevelopmental framework that relates these adolescent behaviors to the refinement of neural phenotypes relevant to mature cognitive flexibility, and thus highlight the importance of the adolescent period in fostering healthy neurocognitive trajectories.

The Cerebellum and Cognitive Function: Anatomical Evidence from a Transdiagnostic Sample

Multiple lines of evidence across human functional, lesion, and animal data point to a cerebellar role, in particular of crus I, crus II, and lobule VIIB, in cognitive function. However, a mapping of distinct facets of cognitive function to cerebellar structure is missing. We analyzed structural neuroimaging data from the Healthy Brain Network (HBN). Cerebellar parcellation was performed with a validated automated segmentation pipeline (CERES) and stringent visual quality check (n = 662 subjects retained from initial n = 1452). Canonical correlation analyses (CCA) examined regional gray matter volumetric (GMV) differences in association to cognitive function (quantified with NIH Toolbox Cognition domain, NIH-TB), accounting for psychopathology severity, age, sex, scan location, and intracranial volume. Multivariate CCA uncovered a significant correlation between two components entailing a latent cognitive canonical (NIH-TB subscales) and a brain canonical variate (cerebellar GMV and intracranial volume, ICV), surviving bootstrapping and permutation procedures. The components correspond to partly shared cerebellar-cognitive function relationship with a first map encompassing cognitive flexibility (r = 0.89), speed of processing (r = 0.65), and working memory (r = 0.52) associated with regional GMV in crus II (r = 0.57) and lobule X (r = 0.59) and a second map including the crus I (r = 0.49) and lobule VI (r = 0.49) associated with working memory (r = 0.51). We show evidence for a structural subspecialization of the cerebellum topography for cognitive function in a transdiagnostic sample.

Learning and memory processes in behavioural addiction: A systematic review

Similar to addictive substances, addictive behaviours such as gambling and gaming are associated with maladaptive modulation of key brain areas and functional networks implicated in learning and memory. Therefore, this review sought to understand how different learning and memory processes relate to behavioural addictions and to unravel their underlying neural mechanisms. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched four databases - PsycINFO, PubMed, Scopus, and Web of Science using the agreed-upon search string. Findings suggest altered executive function-dependent learning processes and enhanced habit learning in behavioural addiction. Whereas the relationship between working memory and behavioural addiction is influenced by addiction type, working memory aspect, and task nature. Additionally, long-term memory is incoherent in individuals with addictive behaviours. Consistently, neurophysiological evidence indicates alterations in brain areas and networks implicated in learning and memory processes in behavioural addictions. Overall, the present review argues that, like substance use disorders, alteration in learning and memory processes may underlie the development and maintenance of behavioural addictions.

Neurocognitive functioning in adults with trichotillomania: Predictors of treatment response and symptom severity in a randomized control trial

Trichotillomania (TTM) is associated with impairments in response inhibition and cognitive flexibility, but it is unclear how such impairments relate to treatment outcome. The present study examined pre-treatment response inhibition and cognitive flexibility as predictors of treatment outcome, change in these domains from pre-to post-treatment, and associations with TTM severity. Participants were drawn from a randomized controlled trial comparing acceptance-enhanced behavior therapy (AEBT) to psychoeducation and supportive therapy (PST) for TTM. Adults completed assessments at pre-treatment (n = 88) and following 12 weeks of treatment (n = 68). Response inhibition and cognitive flexibility were assessed using the Stop Signal Task and Object Alternation Task, respectively. Participants completed the MGH-Hairpulling Scale. Independent evaluators administered the NIMH-Trichotillomania Severity Scale and Clinical Global Impressions-Improvement Scale. Higher pre-treatment TTM severity was associated with poorer pre-treatment cognitive flexibility, but not response inhibition. Better pre-treatment response inhibition performance predicted positive treatment response and lower post-treatment TTM symptom severity, irrespective of treatment assignment. Cognitive flexibility did not predict treatment response. After controlling for age, neither neurocognitive variable changed during treatment. Response inhibition and cognitive flexibility appear uniquely related to hair pulling severity and treatment response in adults with TTM. Implications for treatment delivery and development are discussed.

The future of neuropsychology is digital, theory-driven, and Bayesian: a paradigmatic study of cognitive flexibility

Introduction

This study explores the transformative potential of digital, theory-driven, and Bayesian paradigms in neuropsychology by combining digital technologies, a commitment to evaluating theoretical frameworks, and Bayesian statistics. The study also examines theories of executive function and cognitive flexibility in a large sample of neurotypical individuals (N = 489).

Methods

We developed an internet-based Wisconsin Card-Sorting Task (iWCST) optimized for online assessment of perseveration errors (PE). Predictions of the percentage of PE, PE (%), in non-repetitive versus repetitive situations were derived from the established supervisory attention system (SAS) theory, non-repetitive PE (%) < repetitive PE (%), and the novel goal-directed instrumental control (GIC) theory, non-repetitive PE (%) > repetitive PE (%).

Results

Bayesian t-tests revealed the presence of a robust error suppression effect (ESE) indicating that PE are less likely in repetitive situations than in non-repetitive situations, contradicting SAS theory with posterior model probability p < 0.001 and confirming GIC theory with posterior model probability p > 0.999. We conclude that repetitive situations support cognitive set switching in the iWCST by facilitating the retrieval of goal-directed, instrumental memory that associates stimulus features, actions, and outcomes, thereby generating the ESE in neurotypical individuals. We also report exploratory data analyses, including a Bayesian network analysis of relationships between iWCST measures.

Discussion

Overall, this study serves as a paradigmatic model for combining digital technologies, theory-driven research, and Bayesian statistics in neuropsychology. It also provides insight into how this integrative, innovative approach can advance the understanding of executive function and cognitive flexibility and inform future research and clinical applications.

Disentangling cognitive flexibility: a model-based assessment of women with anorexia nervosa

Cognitive flexibility (CF) has been proposed as a potential trait marker in anorexia nervosa (AN), although findings have been inconsistent. To address this inconsistency, we applied a model that distinguishes between three subtypes of CF: task switching, switching sets, and stimulus-response mapping, which we then assessed using a paradigm-based task battery. The aim of the study was to investigate how AN is associated with these three CF subtypes. Thirty-three women with AN and 37 age- and education-matched controls performed a battery of computerized cognitive tasks to assess the three CF subtypes. Compared to the control group, individuals with AN exhibited poorer performance on the task switching and switching sets subtypes, as measured by response time switch cost, but not on the stimulus-response mapping subtype. No differences were found between the groups in response accuracy. Furthermore, switching sets as compared to the task switching and stimulus-response mapping subtypes was found to better explain the differences between the groups. These findings indicate a domain-specific impairment in CF among patients with AN, reflecting deficits observed in subtypes related to the disorder's characteristics, particularly that associated with visual perception. Therefore, CF impairment in AN should not be viewed dichotomously, but rather as a relative impairment that varies depending on the specific CF subtype.