Culture and attention: evidence from brain and behavior

"Think positive and don't die alone" - Foreign-born, South Asian older adults' perceptions on healthy aging

South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults' ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens.

Psychometric properties of the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale

Aim: To validate the French version of the 37-item Functional Assessment of Cancer Therapy-Cognitive Function, including the four items related to multitasking, previously excluded from the scoring algorithm. Materials & methods: A cross-sectional study was carried out among 261 cancer patients. Validity was confirmed by factor analyses using the principal component analysis technique. Results: Construct validity was demonstrated, and items loaded on subscales with adequate sample adequacy to factor analyses outcomes. Better cognitive functioning was noted with age and in working patients, whereas lower functioning was observed in metastatic patients. Conclusion: The 37-item French tool is valid and reliable; questions related to multitasking could be included in the score.

Minimally Clinically Important Difference in Health Status Scores in Patients With HFrEF vs HFpEF

BACKGROUND

Differences in clinically important thresholds in patient-reported outcomes measures such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) remain less well-established in patients with heart failure with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF).

OBJECTIVES

The purpose of this study was to estimate meaningful thresholds for improvement or deterioration in the KCCQ-Total Symptom Score (TSS) in patients with HFrEF versus HFpEF.

METHODS

This secondary analysis of EMPERIAL program used anchor- and distribution-based approaches to estimate thresholds for improvement or deterioration in the KCCQ-TSS using Patient Global Impression of Severity (PGIS) as the primary anchor. Mean change in KCCQ-TSS from baseline to week 12 was calculated for each PGIS.

RESULTS

A total of 312 HFrEF and 315 HFpEF patients were enrolled. At week 12, mean changes in KCCQ-TSS corresponding to PGIS changes of "any improvement," "1-category improvement," and "1-category deterioration" were 13 ± 17, 12 ± 17, -3 ± 16 points in HFrEF, and 15 ± 18, 13 ± 17, -7 ± 18 points in HFpEF. Threshold for meaningful within-patient change in KCCQ-TSS was ≥9 points in HFrEF and ≥7 points in HFpEF patients. Sensitivity and specificity of ≥9 points/≥7 points change was 0.65 and 0.70 for HFrEF and 0.64 and 0.66 for HFpEF. Cumulative distribution function curves of KCCQ-TSS change from baseline to week 12 showed a shift to higher scores in both HFrEF and HFpEF patients.

CONCLUSIONS

In the EMPERIAL program, a change in KCCQ-TSS of ≥9 points in HFrEF and ≥7 points in HFpEF represents the minimal clinically important difference for improvement, confirming the broad range of 5-10 points as meaningful thresholds.

Chemotherapy-related cognitive impairment (CRCI) among early-stage breast cancer survivors in Malaysia

Introduction: Breast cancer survivors frequently develop cognitive impairment following chemotherapy which can significantly hamper their well-being, ability to function independently, and overall quality of life. Evidence of cognitive functioning in breast cancer survivors from lower and middle-income countries remains scarce. We examined the prevalence of cognitive impairment among Malaysian multiethnic early-stage breast cancer survivors one to three years post-chemotherapy.Methods: This cross-sectional study included 160 breast cancer survivors from the University Malaya Medical Center (UMMC). The cognitive assessments used included the Montreal Cognitive Assessment (MoCA-BM), the Rey Auditory and Verbal Learning Test (RAVLT-BM), and the digit span and arithmetic of the Working Memory Index (WMI) of Wechsler Adult Intelligence Scale-IV (WAIS-IV). Data were analyzed using independent sample t-tests and Pearson's correlation.Results: Our breast cancer survivors demonstrated poor performances in MoCA-BM (31.9%) RAVLT-BM, recall (53.8%), and WMI of WAIS-IV (51.3%) with 30.6% of them performed poorly in all three cognitive tests administered. There were no significant mean group differences in cognitive performances between <24 months after chemotherapy and ≥24 months after chemotherapy.Conclusions: A high proportion of breast cancer survivors exhibited poor performances in the cognitive assessments. Cognitive rehabilitation programmes tailored to the needs of these survivors should be incorporated into cancer care management.

Minimal clinically important difference in quality of life scores for patients with heart failure and reduced ejection fraction

AIMS

While the associations of health-related quality of life scores in heart failure (HF) [e.g. the Kansas City Cardiomyopathy Questionnaire (KCCQ)] with clinical outcomes are well established, their interpretation in the context of what magnitudes of change are clinically important to patients is less clear. The main objective of this study was to correlate the changes in the KCCQ and Patient Global Assessment (PGA) in patients with HF with reduced ejection fraction (HFrEF) to determine minimal clinically important difference (MCID).

METHODS AND RESULTS

We analysed data from 459 patients of the FAIR-HF trial. Both KCCQ and PGA were assessed at 4 and 24 weeks after enrolment. An anchor-based approach was used to calculate MCID at week 4 and 24. PGA was chosen as the clinical anchor against which changes in the KCCQ scores were calibrated. For each category of change in PGA, the corresponding differences were calculated by the mean scores of various domains of KCCQ along with 95% confidence intervals (CIs). There was fair correlation between PGA and changes in overall summary scores (OSS) (r = 0.31; P < 0.001), clinical summary scores (CSS) (r = 0.36; P < 0.001) and physical limitation scores (PLS) (r = 0.31; P < 0.001) from baseline to week 4. KCCQ OSS, CSS and PLS MCID for 'little improvement' at week 4 were 3.6 (1.0-6.2), 4.5 (1.8-7.2) and 4.7 (1.4-8.0) points, respectively. OSS, CSS and PLS MCID for 'little improvement' at week 24 were 4.3 (0.2-8.4), 4.5 (0.5-8.5) and 4.0 (-0.9-9.0) points, respectively.

CONCLUSION

The MCID threshold for KCCQ score was generally consistent and numerically lower than the threshold of 5-point change considered for clinical outcome prognosis and were stable between 4 and 24 weeks. This suggests that even changes smaller than the traditional 5-point improvements in KCCQ may be clinically meaningful. Also, these results can aid in the clinical interpretation of patient-reported outcomes, and better endpoint selection in future studies.

Improving fluid intelligence with training on working memory: a meta-analysis

Working memory (WM), the ability to store and manipulate information for short periods of time, is an important predictor of scholastic aptitude and a critical bottleneck underlying higher-order cognitive processes, including controlled attention and reasoning. Recent interventions targeting WM have suggested plasticity of the WM system by demonstrating improvements in both trained and untrained WM tasks. However, evidence on transfer of improved WM into more general cognitive domains such as fluid intelligence (Gf) has been more equivocal. Therefore, we conducted a meta-analysis focusing on one specific training program, n-back. We searched PubMed and Google Scholar for all n-back training studies with Gf outcome measures, a control group, and healthy participants between 18 and 50 years of age. In total, we included 20 studies in our analyses that met our criteria and found a small but significant positive effect of n-back training on improving Gf. Several factors that moderate this transfer are identified and discussed. We conclude that short-term cognitive training on the order of weeks can result in beneficial effects in important cognitive functions as measured by laboratory tests.

Culture and cognition

There is increasing interest in the nature and both environmental and cognitive origins of culturally associated differences in a range of behaviors. This special issue of Cognitive Neuroscience presents six empirical papers investigating diverse categories of potential culturally related effects as well as a review article, all of which provide timely updates of the current state of knowledge in this area.

Individual Differences in Capacity for Tolerating Information Overload Are Related to Differences in Culture and Temperament

Individual differences in the capacity for information processing in complex tasks can be predicted from both personality and temperament that derive from both the biological and social substrates of human development and behavior. If there are cultural differences in brain structure and function that govern information processing, then two different cultures may show biologically based temperamental differences in sensitivity to stimulation (e.g., Pavlov’s Strength of the Nervous System) which in turn may predict individual differences in capacity for tolerating environmentally determined stimulus overloads. We examined the relationship between biologically based measures of Pavlovian Temperament (Strength of Excitation, Inhibition, and Mobility) and an individual differences measure consisting of five dimensions of capacity for tolerating information load. Both direct and indirect effects of country of origin on capacity for information processing were tested in a mediated path analytic model in which Pavlovian Excitation, Inhibition, and Mobility were hypothesized to mediate the relationship between culture and self-reported information processing capacities.

Psychometric properties and measurement equivalence of the English and Chinese versions of the functional assessment of cancer therapy-cognitive in Asian patients with breast cancer

OBJECTIVE

This study was designed to examine the psychometric properties and measurement equivalence of the English and Chinese versions of the Functional Assessment of Cancer Therapy-Cognitive Function (Version 3) (FACT-Cog) in multiethnic Asian patients with breast cancer.

METHODS

This prospective study involved patients with breast cancer from the National Cancer Centre Singapore. The concurrent validity of the FACT-Cog was assessed according to its strength of correlation with the validated European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 cognitive functioning scale, and its association with fatigue, global health status, and anxiety. The known-group validity was assessed on the basis of receipt of chemotherapy. Factor analysis was conducted to ascertain the one-factor structure of each cognitive domain. The reliability was evaluated by using Cronbach's alpha and intraclass correlation coefficient within the cognitive domains. Multiple regression analyses were performed to compare the total scores between the two language versions, adjusting for covariates.

RESULTS

A total of 185 English-speaking and 143 Chinese-speaking patients were recruited. Both the English and Chinese FACT-Cog total scores correlated strongly with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 cognitive functioning scale scores (r = 0.725 and 0.646), whereas correlations with fatigue, anxiety, and global health status were weak to moderate (|r| = 0.376-0.589). Regarding the known-group validity, more severe perceived cognitive disturbance was observed among patients receiving chemotherapy than among those who were not for both versions (P = .010 and .008, respectively). Internal consistencies within the cognitive domains were high (Cronbach's α 0.707-0.929), and test-retest reliability was satisfactory for both versions (intraclass correlation coefficient 0.762 and 0.697). The measurement equivalence between the English and Chinese versions was established for all domains except the multitasking domain.

CONCLUSION

The English and Chinese versions of the FACT-Cog are valid, reliable, and equivalent for clinical and research use.

Culture, perception, and artistic visualization: a comparative study of children's drawings in three Siberian cultural groups

In a study of three indigenous and non-indigenous cultural groups in northwestern and northeastern Siberia, framed line tests and a landscape drawing task were used to examine the hypotheses that test-based assessments of context sensitivity and independence are correlated with the amount of contextual information contained in drawings, and with the order in which the focal and background objects are drawn. The results supported these hypotheses, and inspection of the regression relationships suggested that the intergroup variations in test performance were likely to result from differences in the attention accorded to contextual information, as revealed by the drawings. Social and environmental explanations for the group differences in context sensitivity are also discussed. The conclusions support the argument that cultural differences in artistic styles and perceptual tests reflect the same underlying perceptual tendencies, and they are consistent with the argument that these tendencies reflect corresponding differences in patterns of social and environmental interaction.

Reward and motivation systems: a brain mapping study of early-stage intense romantic love in Chinese participants

Early-stage romantic love has been studied previously in the United States and United Kingdom (Aron et al. [2005]: J Neurophysiol 94:327–337; Bartels and Zeki [2000]: Neuroreport 11:3829–3834; Ortigue et al. [2007]: J Cogn Neurosci 19:1218–1230), revealing activation in the reward and motivation systems of the brain. In this study, we asked what systems are activated for early-stage romantic love in Easterners, specifically Chinese participants? Are these activations affected by individual differences within a cultural context of Traditionality and Modernity? Also, are these brain activations correlated with later satisfaction in the relationship? In Beijing, we used the same procedure used by Aron et al. (Aron et al. [2005]: J Neurophysiol 94:327–337). The stimuli for 18 Chinese participants were a picture of the face of their beloved, the face of a familiar acquaintance, and a countback task. We found significant activations specific to the beloved in the reward and motivation systems, particularly, the ventral tegmental area and the caudate. The mid-orbitofrontal cortex and cerebellum were also activated, whereas amygdala, medial orbitofrontal, and medial accumbens activity were decreased relative to the familiar acquaintance. Self-reported Traditionality and Modernity scores were each positively correlated with activity in the nucleus accumbens, although in different regions and sides of the brain. Activity in the subgenual area and the superior frontal gyrus was associated with higher relationship happiness at 18-month follow-up. Our results show that midbrain dopamine-rich reward/motivation systems were activated by early-stage romantic love in Chinese participants, as found by other studies. Neural activity was associated with Traditionality and Modernity attitudes as well as with later relationship happiness for Chinese participants.

Neural differences in the processing of semantic relationships across cultures

The current study employed functional MRI to investigate the contribution of domain-general (e.g. executive functions) and domain-specific (e.g. semantic knowledge) processes to differences in semantic judgments across cultures. Previous behavioral experiments have identified cross-cultural differences in categorization, with East Asians preferring strategies involving thematic or functional relationships (e.g. cow-grass) and Americans preferring categorical relationships (e.g. cow-chicken). East Asians and American participants underwent functional imaging while alternating between categorical or thematic strategies to sort triads of words, as well as matching words on control trials. Many similarities were observed. However, across both category and relationship trials compared to match (control) trials, East Asians activated a frontal-parietal network implicated in controlled executive processes, whereas Americans engaged regions of the temporal lobes and the cingulate, possibly in response to conflict in the semantic content of information. The results suggest that cultures differ in the strategies employed to resolve conflict between competing semantic judgments.