Focusing on cognitive potential as the bright side of mental atypicality

Patients' Cognitive Potential Is Associated With Cognitive Performance After an Acute Course of Electroconvulsive Therapy

OBJECTIVES

Cognitive function after an acute treatment of electroconvulsive therapy (ECT) can highly vary between individuals. This study aimed to extend prior research on individual factors, which influence outcomes by assessing whether a combination of 2 individual factors, level of education and lifetime occupational attainment, may be informative.

METHODS

A retrospective study was conducted using data from 24 patients with major depressive episode who underwent acute treatment with ECT. Cognitive functioning was assessed at pretreatment, during the acute course and 1-3 days after acute treatment. Participants were divided into higher and lower function groups based on a combination of their highest educational level and lifetime occupational attainment.

RESULTS

Statistically significant differences were observed between the 2 groups in retrograde memory function after ECT, assessed as percentage of consistency scores of the Columbia Autobiographical Memory Short Form (F(1,15) = 4.66, P < 0.05) and recovery of orientation during the acute ECT course (F(1,25.33) = 7.99, P = 0.009). No significant differences were found between groups for the other outcomes, which included verbal and visual anterograde memory, verbal fluency, and processing speed.

CONCLUSIONS

Results from this preliminary study suggest that patients with higher educational and lifetime occupational attainment may experience less retrograde amnesia and have faster recovery of orientation after ECT. Identifying markers of higher and lower 'cognitive potential' before ECT may assist in customizing ECT treatment for each patient.

Neurophysiological avenues to better conceptualizing adaptive cognition

We delve into the human brain's remarkable capacity for adaptability and sustained cognitive functioning, phenomena traditionally encompassed as executive functions or cognitive control. The neural underpinnings that enable the seamless navigation between transient thoughts without detracting from overarching goals form the core of our article. We discuss the concept of "metacontrol," which builds upon conventional cognitive control theories by proposing a dynamic balancing of processes depending on situational demands. We critically discuss the role of oscillatory processes in electrophysiological activity at different scales and the importance of desynchronization and partial phase synchronization in supporting adaptive behavior including neural noise accounts, transient dynamics, phase-based measures (coordination dynamics) and neural mass modelling. The cognitive processes focused and neurophysiological avenues outlined are integral to understanding diverse psychiatric disorders thereby contributing to a more nuanced comprehension of cognitive control and its neural bases in both health and disease.

Rethinking Movement Disorders

At present, clinical practice and research in movement disorders (MDs) focus on the "normalization" of altered movements. In this review, rather than concentrating on problems and burdens people with MDs undoubtedly have, we highlight their hidden potentials. Starting with current definitions of Parkinson's disease (PD), dystonia, chorea, and tics, we outline that solely conceiving these phenomena as signs of dysfunction falls short of their complex nature comprising both problems and potentials. Such potentials can be traced and understood in light of well-established cognitive neuroscience frameworks, particularly ideomotor principles, and their influential modern derivatives. Using these frameworks, the wealth of data on altered perception-action integration in the different MDs can be explained and systematized using the mechanism-oriented concept of perception-action binding. According to this concept, MDs can be understood as phenomena requiring and fostering flexible modifications of perception-action associations. Consequently, although conceived as being caught in a (trough) state of deficits, given their high flexibility, people with MDs also have high potential to switch to (adaptive) peak activity that can be conceptualized as hidden potentials. Currently, clinical practice and research in MDs are concerned with deficits and thus the "deep and wide troughs," whereas "scattered narrow peaks" reflecting hidden potentials are neglected. To better delineate and utilize the latter to alleviate the burden of affected people, and destigmatize their conditions, we suggest some measures, including computational modeling combined with neurophysiological methods and tailored treatment. © 2024 International Parkinson and Movement Disorder Society.

Overcoming the phenomenological Perpetuum mobile in clinical cognitive neuroscience for the benefit of replicability in research and the societal view on mental disorders

Cognitive neuroscience comes in many facets, and a particularly large branch of research is conducted in individuals with mental health problems. This article outlines why it is important that cognitive neuroscientists re-shape their role in mental health research and re-define directions of research for the next decades. At present, cognitive neuroscience research in mental health is too firmly rooted in categorial diagnostic definitions of mental health conditions. It is discussed why this hampers a mechanistic understanding of brain functions underlying mental health problems and why this is a problem for replicability in research. A possible solution to these problems is presented. This solution affects the strategy of research questions to be asked, how current trends to increase replicability in research can or cannot be applied in the mental health field and how data are analyzed. Of note, these aspects are not only relevant for the scientific process, but affect the societal view on mental disorders and the position of affected individuals as members of society, as well as the debate on the inclusion of so-called WEIRD and non-WEIRD people in studies. Accordingly, societal and science political aspects of re-defining the role of cognitive neuroscientists in mental health research are elaborated that will be important to shape cognitive neuroscience in mental health for the next decades.

Developmental Dyslexia: Disorder or Specialization in Exploration?

We raise the new possibility that people diagnosed with developmental dyslexia (DD) are specialized in explorative cognitive search, and rather than having a neurocognitive disorder, play an essential role in human adaptation. Most DD research has studied educational difficulties, with theories framing differences in neurocognitive processes as deficits. However, people with DD are also often proposed to have certain strengths - particularly in realms like discovery, invention, and creativity - that deficit-centered theories cannot explain. We investigate whether these strengths reflect an underlying explorative specialization. We re-examine experimental studies in psychology and neuroscience using the framework of cognitive search, whereby many psychological processes involve a trade-off between exploration and exploitation. We report evidence of an explorative bias in DD-associated cognitive strategies. High DD prevalence and an attendant explorative bias across multiple areas of cognition suggest the existence of explorative specialization. An evolutionary perspective explains the combination of findings and challenges the view that individuals with DD have a disorder. In cooperating groups, individual specialization is favored when features that confer fitness benefits are functionally incompatible. Evidence for search specialization suggests that, as with some other social organisms, humans mediate the exploration-exploitation trade-off by specializing in complementary strategies. The existence of a system of collective cognitive search that emerges through collaboration would help to explain our species' exceptional adaptiveness. It also aligns with evidence for substantial variability during our evolutionary history and the notion that humans are adapted not to a particular habitat but to variability itself. Specialization creates interdependence and necessitates balancing complementary strategies. Reframing DD therefore underscores the urgency of changing certain cultural practices to ensure we do not inhibit adaptation. Key improvements would remove cultural barriers to exploration and nurture explorative learning in education, academia, and the workplace, as well as emphasize collaboration over competition. Specialization in complementary search abilities represents a meta-adaptation; through collaboration, this likely enables human groups (as a species and as cultural systems) to successfully adapt. Cultural change to support this system of collaborative search may therefore be essential in confronting the challenges humanity now faces.

The metacontrol hypothesis as diagnostic framework of OCD and ADHD: A dimensional approach based on shared neurobiological vulnerability

Obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are multi-faceted neuropsychiatric conditions that in many aspects appear to be each other's antipodes. We suggest a dimensional approach, according to which these partially opposing disorders fall onto a continuum that reflects variability regarding alterations of cortico-striato-thalamo-cortical (CSTC) circuits and of the processing of neural noise during cognition. By using theoretical accounts of human cognitive metacontrol, we develop a framework according to which OCD can be characterized by a chronic bias towards exaggerated cognitive persistence, equivalent to a high signal-to-noise ratio (SNR)-which facilitates perseverative behaviour but impairs mental flexibility. In contrast, ADHD is characterized by a chronic bias towards inflated cognitive flexibility, equivalent to a low SNR-which increases behavioural variability but impairs the focusing on one goal and on relevant information. We argue that, when pharmacology is not feasible, novel treatments of these disorders may involve methods to manipulate the signal-to-noise ratio via non-invasive brain stimulation techniques, in order to normalize the situational imbalance between cognitive persistence and cognitive flexibility.

A Metacontrol Perspective on Neurocognitive Atypicality: From Unipolar to Bipolar Accounts

Standard clinical and psychiatric thinking follows a unipolar logic that is centered at "normal" conditions characterized by optimal performance in everyday life, with more atypical conditions being defined by the (degree of) absence of "normality." A similar logic has been used to describe cognitive control, assuming that optimal control abilities are characterized by a strong focus on the current goal and ignorance of goal-irrelevant information (the concept of willpower), while difficulties in focusing and ignoring are considered indications of the absence of control abilities. However, there is increasing evidence that willpower represents only one side of the control coin. While a strong focus on the current goal can be beneficial under some conditions, other conditions would benefit from a more open mind, from flexibility to consider alternative goals and information related to them. According to the metacontrol model, people can vary in their cognitive processing style, on a dimension with the extreme poles of "persistence" on the one hand and "flexibility" on the other. Whereas a high degree of persistence corresponds to the original idea of cognitive control as willpower, with a strong focus on one goal and the information related to it, a high degree of flexibility is characterized by a more integrative, less selective and exclusive processing style, which facilitates switching between tasks, ideas, and actions, and taking into consideration a broader range of possibilities. We argue that this approach calls for a more bipolar account in the clinical sciences as well. Rather than considering individuals as typical or atypical, it would theoretically and practically make more sense to characterize their cognitive abilities in terms of underlying dimensions, such as the persistence/flexibility dimension. This would reveal that possible weaknesses with respect to one pole, such as persistence, and tasks relying thereupon, may come with corresponding strengths with respect to the other pole, such as flexibility, and respective tasks. We bolster our claim by discussing available evidence suggesting that neurodevelopmental atypicality often comes with weaknesses in tasks related to one pole but strengths in tasks related to the other.