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Suchy Y, DesRuisseaux LA, Gereau Mora M, Brothers SL, Niermeyer MA. Conceptualization of the term "ecological validity" in neuropsychological research on executive function assessment: a systematic review and call to action. J Int Neuropsychol Soc 2024; 30:499-522. [PMID: 38251679 DOI: 10.1017/s1355617723000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE "Ecological validity" (EV) is classically defined as test's ability to predict real-world functioning, either alone or together with test's similarity to real-world tasks. In neuropsychological literature on assessment of executive functions (EF), EV is conceptualized inconsistently, leading to misconceptions about the utility of tests. The goal of this systematic review was to examine how EV is conceptualized in studies of EF tests described as ecologically valid. METHOD MEDLINE and PsychINFO Databases were searched. PRISMA guidelines were observed. After applying inclusion and exclusion criteria, this search yielded 90 articles. Deductive content analysis was employed to determine how the term EV was used. RESULTS About 1/3 of the studies conceptualized EV as the test's ability to predict functional outcomes, 1/3 as both the ability to predict functional outcome and similarity to real-world tasks, and 1/3 were either unclear about the meaning of the term or relied on notions unrelated to classical definitions (e.g., similarity to real-world tasks alone, association with other tests, or the ability to discriminate between populations). CONCLUSIONS Conceptualizations of the term EV in literature on EF assessment vary grossly, subsuming the notions of criterion, construct, and face validity, as well as sensitivity/specificity. Such inconsistency makes it difficult to interpret clinical utility of tests that are described as ecologically valid. We call on the field to require that, at minimum, the term EV be clearly defined in all publications, or replaced with more concrete terminology (e.g., criterion validity).
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Madison A Niermeyer
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
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Ruffini C, Osmani F, Bigozzi L, Pecini C. Semantic fluency in 3-6 years old preschoolers: which executive functions? Child Neuropsychol 2024; 30:563-581. [PMID: 37401450 DOI: 10.1080/09297049.2023.2230637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
Semantic Fluency (SF) increases with age, along with the lexicon and the strategies to access it. Among the cognitive processes involved in controlling lexical access, Executive Functions (EF) play an essential role. Nevertheless, which EF, namely inhibition, working memory, and cognitive flexibility, are specifically tapped by SF during preschool years, when these basic EF components are developing and differentiating, is still unknown. The study had a two-fold aim: 1. to analyze in preschoolers the role of EF basic components on SF; 2. to investigate if EF mediated the effect of age on SF. A total of 296 typically developing preschoolers (M age = 57.86; SD = 9.91; month range = 33-74) were assessed with an SF task and EF tasks measuring the main EF basic components. Results showed that during preschool, response inhibition, working memory, and cognitive flexibility were significant predictors of SF, explaining 27% of its variance. Moreover, the effect of age on the SF task performance correlated with the improvement of these EF components. This study supports the importance of considering cognitive control processes in 3-6 year-old preschoolers as they underline important competencies for the child's development, such as the ability to quickly access vocabulary.
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Affiliation(s)
- Costanza Ruffini
- Department of Education, Languages, Intercultures, Literature and Psychology (FORLILPSI), University of Florence, Firenze, Italy
| | - Fatbardha Osmani
- Department of Education, Languages, Intercultures, Literature and Psychology (FORLILPSI), University of Florence, Firenze, Italy
| | - Lucia Bigozzi
- Department of Education, Languages, Intercultures, Literature and Psychology (FORLILPSI), University of Florence, Firenze, Italy
| | - Chiara Pecini
- Department of Education, Languages, Intercultures, Literature and Psychology (FORLILPSI), University of Florence, Firenze, Italy
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Abbott CC, Miller J, Farrar D, Argyelan M, Lloyd M, Squillaci T, Kimbrell B, Ryman S, Jones TR, Upston J, Quinn DK, Peterchev AV, Erhardt E, Datta A, McClintock SM, Deng ZD. Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes. Neuropsychopharmacology 2024; 49:640-648. [PMID: 38212442 PMCID: PMC10876627 DOI: 10.1038/s41386-023-01780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT's antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-threshold (STa), E-field magnitude, and clinical outcomes in older adults (age range 50 to 80 years) with depression. Subjects received brain imaging, depression assessment, and neuropsychological assessment pre-, mid-, and post-ECT. STa was determined during the first treatment with a Soterix Medical 4×1 High Definition ECT Multi-channel Stimulation Interface (Investigation Device Exemption: G200123). Subsequent treatments were completed with right unilateral electrode placement (RUL) and 800 mA. We calculated Ebrain defined as the 90th percentile of E-field magnitude in the whole brain for RUL electrode placement. Twenty-nine subjects were included in the final analyses. Ebrain per unit electrode current, Ebrain/I, was associated with STa. STa was associated with antidepressant outcomes at the mid-ECT assessment and bitemporal electrode placement switch. Ebrain/I was associated with changes in category fluency with a large effect size. The relationship between STa and Ebrain/I extends work from preclinical models and provides a validation step for ECT E-field modeling. ECT with individualized amplitude based on E-field modeling or STa has the potential to enhance neuroscience-based ECT parameter selection and improve clinical outcomes.
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Affiliation(s)
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Danielle Farrar
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Miklos Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Taylor Squillaci
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Brian Kimbrell
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Sephira Ryman
- Mind Research Network, Albuquerque, NM, USA
- Department of Neurology, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | | | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Pinto JO, Dores AR, Peixoto B, Barbosa F. Ecological validity in neurocognitive assessment: Systematized review, content analysis, and proposal of an instrument. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-18. [PMID: 36755377 DOI: 10.1080/23279095.2023.2170800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES The main objectives of this study are to identify the dimensions of Ecological Validity (EV) within the definitions of this concept, understand how they are operationalized in neurocognitive tests, and propose a checklist for EV attributes in neurocognitive tests. METHOD A systematized review was combined with content analysis of the selected papers, using the inductive method. We analyzed 82 studies on the EV of neurocognitive tests, 19 literature reviews and 63 empirical studies. Based on this review, we identified the relevant criteria for evaluating EV. RESULTS EV is a multidimensional concept with two main dimensions: representativeness and generalization. Representativeness involves the subdimensions simplicity-complexity and artificial-natural and several criteria organized on a continuum from low EV to high EV. Generalization is dependent on representativeness and is influenced by different cognitive and non-cognitive factors. We propose six stages for operationalizing EV, from defining the objectives of the neurocognitive assessment to the methodology for scoring and interpreting the results. CONCLUSION This systematized review helps to operationalize the concept of EV by providing a tool for evaluating and improving EV while developing new tests. Further studies with a longitudinal design can compare the predictive value of tests with higher versus lower EV-checklist scores.Key pointsQuestion: Understand the definition of EV, its dimensions and subdimensions, how EV is operationalized in neurocognitive tests and propose a checklist for the EV attributes of neurocognitive tests.Findings: The primary findings were that representativeness and generalization are the main dimensions of EV. Representativeness involves several subdimensions, whereas generalization is dependent on representativeness and is influenced by cognitive and non-cognitive factors. We provided an EV-checklist organized into six parts.Importance: The EV-checklist can be used to guide the development of ecologically valid neurocognitive tests and/or assess the EV of existing ones.Next steps: Examine the predictive value of tests that have higher EV-checklist scores.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- CESPU, University Institute of Health Sciences, Gandra, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Bruno Peixoto
- CESPU, University Institute of Health Sciences, Gandra, Portugal
- NeuroGen, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- TOXRUN - Toxicology Research Unit, University Institute of Health Sciences, CESPU, Gandra, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Rosenblum S, Meyer S, Richardson A, Hassin-Baer S. Early identification of subjective cognitive functional decline among patients with Parkinson's disease: a longitudinal pilot study. Sci Rep 2022; 12:22242. [PMID: 36564494 PMCID: PMC9789081 DOI: 10.1038/s41598-022-26280-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
Practical methods for early identification of Parkinson's disease (PD) mild cognitive impairment (PD-MCI) through changes in real-life daily functioning are scarce. The aim of the study was to examine whether the cognitive functional (CF) feature, comprising of seven self-reported Movement Disorder Society's (MDS) Unified Parkinson's Disease Rating Scale (UPDRS) items, predicts PD patients' cognitive functional status after a year. We conducted a 1-year follow-up of 34 PD patients (50-78 year; 70.6% men) suspected of MCI using the following measures: the MDS-UPDRS, UPDRS-CF feature, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Parkinson's Disease Cognitive Functional Rating Scale (PD-CFRS), and Daily Living Questionnaire (DLQ). The first and second UPDRS-CF feature scores, and additional measures at the 1-year follow-up significantly correlated. Hierarchical regression revealed that the initial MoCA, TMT, and BDI scores predicted the second UPDRS-CF, and the first UPDRS-CF predicted 31% of the second PD-CFRS score variance. Depression moderated the relationship between the first UPDRS-CF score and the DLQ Part A. These results suggest practical, self-reported, daily functional markers for identifying gradual decline in PD patients. They consider the patients' heterogeneity, underlying cognitive pathology, and implications on daily functioning, health, and well-being.
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Affiliation(s)
- Sara Rosenblum
- grid.18098.380000 0004 1937 0562Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, 3498838 Israel
| | - Sonya Meyer
- grid.411434.70000 0000 9824 6981Department of Occupational Therapy, Ariel University, Ariel, 4077603 Israel
| | - Ariella Richardson
- grid.419646.80000 0001 0040 8485Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, 9372115 Israel
| | - Sharon Hassin-Baer
- grid.413795.d0000 0001 2107 2845Movement Disorders Institute, Sheba Medical Centre, Ramat-Gan, 5262000 Israel ,grid.413795.d0000 0001 2107 2845Department of Neurology, Sheba Medical Centre, Ramat-Gan, 5262000 Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
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Schaeffer MJ, Weerawardhena H, Becker S, Callahan BL. Capturing daily-life executive impairments in adults: Does the choice of neuropsychological tests matter? APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-11. [PMID: 35979845 DOI: 10.1080/23279095.2022.2109970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Standardized executive functioning (EF) measures do not reliably capture EF-related difficulties reported in daily life. We aim to determine if an ecologically relevant neuropsychological battery is more strongly associated with self-reported everyday EF impairments than classically used tests. METHOD Fifty-nine adults aged 18-49 self-rated their EF abilities using the Barkley Deficits in EF Scale (BDEFS) and were randomly assigned to complete either a test battery composed of EF measures with hypothesized ecological relevance (Six Elements, Zoo Map, Hayling Sentence Completion, Iowa Gambling, and Auditory Startle Tasks) or one composed of traditional EF tasks (Card Sorting, Trail Making, Color-Word Interference, and Verbal Fluency). Associations were examined using linear regression. RESULTS There were no strong associations between BDEFS subscales and performance on either test battery. Only the regression model predicting Emotional Regulation from ecological tasks was significant. Iowa Gambling Task performance and corrugator muscle contraction in the Auditory Startle Task individually contributed significantly to the model, with small and moderate effect sizes respectively. CONCLUSION Results align with evidence that self-reported EF difficulties are not adequately captured by formal neuropsychological measures, even for performance-based measures which directly tap everyday constructs. Findings are interpreted cautiously in the context of a small, high-functioning sample.
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Affiliation(s)
| | - Himanthri Weerawardhena
- Department of Psychology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Sara Becker
- Department of Psychology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
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Van Patten R, Mahmood Z, Nguyen TT, Maye J, Kim HC, Jeste DV, Twamley EW. Rates of Cognitive and Functional Impairments in Older Adults Residing in a Continuing Care Senior Housing Community. J Int Neuropsychol Soc 2022; 28:62-73. [PMID: 33749570 PMCID: PMC8455703 DOI: 10.1017/s1355617721000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current cross-sectional study examined cognition and performance-based functional abilities in a continuing care senior housing community (CCSHC) that is comparable to other CCSHCs in the US with respect to residents' demographic characteristics. METHOD Participants were 110 older adult residents of the independent living unit. We assessed sociodemographics, mental health, neurocognitive functioning, and functional capacity. RESULTS Compared to normative samples, participants performed at or above expectations in terms of premorbid functioning, attention span and working memory, processing speed, timed set-shifting, inhibitory control, and confrontation naming. They performed below expectation in verbal fluency and verbal and visual learning and memory, with impairment rates [31.4% (>1 SD below the mean) and 18.49% (>1.5 SD below the mean)] well above the general population (16% and 7%, respectively). Within the cognitive test battery, two tests of delayed memory were most predictive of a global deficit score. Most cognitive test scores correlated with performance-based functional capacity. CONCLUSIONS Overall, results suggest that a subset of older adults in the independent living sector of CCSHCs are cognitively and functionally impaired and are at risk for future dementia. Results also argue for the inclusion of memory tests in abbreviated screening batteries in this population. We suggest that CCSHCs implement regular cognitive screening procedures to identify and triage those older adults who could benefit from interventions and, potentially, a transition to a higher level of care.
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Affiliation(s)
- Ryan Van Patten
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Zanjbeel Mahmood
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA
| | - Tanya T. Nguyen
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Jacqueline Maye
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Ho-Cheol Kim
- Scalable Knowledge Intelligence, IBM Research – Almaden, San Jose, CA, United States
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
| | - Elizabeth W. Twamley
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161
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Physical activity moderates the association between executive function and functional connectivity in older adults. AGING BRAIN 2022; 2:100036. [PMID: 36908885 PMCID: PMC9999439 DOI: 10.1016/j.nbas.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
Recent evidence suggests that physical activity may influence the functional connectivity of the aging brain. The purpose of this study was to examine the influence of physical activity on the association between executive function and functional connectivity of key brain networks and graph theory metrics in community-dwelling older adults. Participants were 47 older adults (M = 73 years; SD = 5.92) who participated in neuropsychological testing, physical activity measurements, and magnetic resonance imaging (MRI). Seed-to-voxel moderation analyses and graph theory analyses were conducted. Physical activity was significantly positively associated with default mode network functional connectivity (DMN FC; Posterior Cingulate Gyrus, p-FDR = 0.005; Frontal Pole (L), p-FDR = 0.005; Posterior Cingulate Gyrus, p-FDR = 0.006; Superior Frontal Gyrus (L), p-FDR = 0.016) and dorsal attention network functional connectivity (DAN FC; Inferior Frontal Gyrus Pars Opercularis (R), p-FDR = 0.044). The interaction between physical activity and executive function on the DMN FC and DAN FC was analyzed. The interaction between executive function and physical activity was significantly associated with DMN FC. When this significant interaction was probed, the association between physical activity and DMN FC differed between levels of high and low executive function such that the association was only significant at levels of high executive function. These results suggest that greater physical activity in later life is associated with greater DMN and DAN FC and provides evidence for the importance of physical activity in cognitively healthy older adults.
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Abstract
Males and females are subject to differences in cognitive processing strategies, i.e. the way males and females solve cognitive tasks. So far primarily reported for younger adults, this seems to be especially important in older adults, who also show sex differences in cognitive impairments. Therefore, the aim of the current study was to examine the older adult population with respect to cognitive profiles derived from a large variety of cognitive functions. Using an exploratory component analysis with consecutive confirmatory factor analysis in a sample of 676 older adults, neuropsychological performance data in a variety of cognitive domains was decomposed into cognitive components. A general cognitive profile based on the whole group fits unequally well on the two sexes. Importantly, cognitive profiles based on either males or females differ in terms of their composition of cognitive components, i.e. three components in males versus four components in females, with a generally better model fit in females. Thus, related to the established differences in processing styles between males and females the current study found a rather decomposed (or local) cognitive profile in females while males seem to show a holistic (or global) cognitive profile, with more interrelations between different cognitive functions.
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Suchy Y, Mullen CM, Brothers S, Niermeyer MA. Interpreting executive and lower-order error scores on the timed subtests of the Delis-Kaplan Executive Function System (D-KEFS) battery: Error analysis across the adult lifespan. J Clin Exp Neuropsychol 2020; 42:982-997. [PMID: 33267731 DOI: 10.1080/13803395.2020.1832203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Delis-Kaplan Executive Function System (D-KEFS) is a battery of tests designed to measure executive functions (EF). Additionally, the D-KEFS contains lower-order tasks, designed to control for speed of visual scanning, sequencing, and verbal and graphomotor output. The construct and criterion validities of D-KEFS scores that are time-based are well established. However, the constructs measured by the D-KEFS error scores are poorly understood, making clinical interpretations of such scores difficult. This study examined the construct validity of D-KEFS errors committed on EF tasks and tasks designed to measure lower-order processes (i.e., non-EF tasks), across the adult lifespan. METHOD Participants were 427 adults (18-93 years) who completed the timed subtests of the D-KEFS. Four hundred two participants also completed the Push-Turn-Taptap (PTT; a separate measure of EF) to allow cross-validation. RESULTS General linear regressions showed that D-KEFS errors committed on the EF tests were associated with EF timed performance (assessed using the D-KEFS time-based scores and the PTT), but only among older adults. Importantly, errors committed on the D-KEFS tasks of lower-order processes were also associated with D-KEFS time-based EF performance, and this relationship held across the adult lifespan. CONCLUSIONS These findings suggest that among older adults EF errors on the D-KEFS can be interpreted as indices of EF, but such interpretations are not automatically warranted for younger adults. Additionally, errors committed on non-EF tasks contained within the D-KEFS battery can be interpreted as reflecting EF weaknesses across the adult lifespan.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah , Salt Lake City, Utah
| | - Christine M Mullen
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, Utah
| | - Stacey Brothers
- Department of Psychology, University of Utah , Salt Lake City, Utah
| | - Madison A Niermeyer
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, Utah
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Duda BM, Keith CM, Sweet LH. CHA2DS2-VASc Stroke Risk Index and Executive Functioning in Older Adults. Arch Clin Neuropsychol 2020; 35:155-164. [PMID: 31423534 DOI: 10.1093/arclin/acz031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/29/2019] [Accepted: 06/13/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE CHA2DS2-VASc is a stroke risk classification system developed to improve the precision of stroke risk classification. The current study examined the validity of CHA2DS2-VASc in a sample of healthy older adults using executive function measures of processing speed, working memory, and cognitive flexibility that are sensitive to cerebrovascular risk factors. METHODS Participants included 51 community-dwelling, healthy older adults (ages 53-86) recruited from both the community and cardiology clinics. CHA2DS2-VASc was utilized as a measure of stroke risk. Measures of executive functioning and processing speed included the Paced Auditory Serial Addition Test (PASAT), Delis-Kaplan Executive Function System (DKEFS) Number-Letter Switching, and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Coding. RESULTS CHA2DS2-VASc scores significantly predicted scores on the PASAT, DKEFS Number-Letter Switching, and RBANS Coding, such that greater stroke risk was associated with poorer performances on tests of executive functioning and processing speed. These relationships were observed over and above the potential influence of educational attainment and symptoms of depression. CONCLUSION Significant relations between stroke risk classification and performance on several measures of executive functioning provide support for a wider and more generalized use of CHA2DS2-VASc with healthy older adults. These findings further highlight the importance of early identification and treatment of stroke risk factors associated with cognitive decline. Findings suggest that CHA2DS2-VASc is a practical and useful tool for patients and their providers in the early detection of stroke risk and development of individualized treatment plans.
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Affiliation(s)
- Bryant M Duda
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Psychology, University of Georgia, Athens, GA, USA
| | - Cierra M Keith
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Lawrence H Sweet
- Department of Psychology, University of Georgia, Athens, GA, USA
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Lim AC, Grodin EN, Green R, Venegas A, Meredith LR, Courtney KE, Moallem NR, Sayegh P, London ED, Ray LA. Executive function moderates naltrexone effects on methamphetamine-induced craving and subjective responses. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:565-576. [PMID: 32343625 PMCID: PMC7920534 DOI: 10.1080/00952990.2020.1741002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
Background: Emerging evidence suggests that opioid receptor antagonists, such as naltrexone, are effective pharmacotherapies for alcohol, opioid, and possibly stimulant use disorders. It is posited that naltrexone exerts its effects, in part, by increasing functional connectivity between neural reward circuitry and frontal systems implicated in executive function. Yet no studies had examined whether executive function moderates these effects. Objectives: This study examined whether a composite measure of executive function (EF) moderates the effect of naltrexone on craving for methamphetamine and subjective responses following infusion of the drug. Methods: Individuals with methamphetamine use disorder (N = 30; 27% female) completed baseline neurocognitive assessments of premorbid and executive function, and an executive function factor was computed. Participants then underwent a randomized, double-blind, cross-over study of titration with naltrexone and placebo. Participants then received a 30-mg intravenous methamphetamine infusion and completed subjective response questionnaires at 8 times in the 120 minutes post-infusion. Results: Multilevel mixed models indicated a significant EF × medication interaction, reflecting greater effects of naltrexone to decrease "desire to access the drug", "want more of the drug", "crave the drug", "feel drug effects" and "feel high" in participants with low EF compared to those with high EF (Bs = .36-1.29, SEs = .14-.17, ps<0.01). These effects remained significant after controlling for premorbid cognitive functioning, baseline responses to methamphetamine, severity of methamphetamine use, and methamphetamine-related functional problems. Conclusion: Naltrexone may be especially effective in methamphetamine-dependent individuals with low EF. Neuropsychological assessments may also provide predictive clinical utility not captured by traditional measures of substance use severity.
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Affiliation(s)
- Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kelly E. Courtney
- Department of Psychology, University of California, San Diego, San Diego, CA, USA
| | - Nathasha R. Moallem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip Sayegh
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences
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13
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Patel RA, Wharton W, Bay AA, Nid L, Barter JD, Hackney ME. Association between anti-inflammatory interleukin-10 and executive function in African American women at risk for Alzheimer's disease. J Clin Exp Neuropsychol 2020; 42:647-659. [PMID: 32781877 PMCID: PMC9747330 DOI: 10.1080/13803395.2020.1798879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION African-Americans (AAs) are 64% more likely to be diagnosed with AD than non-Hispanic Whites. AAs with elevated AD biomarkers exhibit greater neurodegeneration in AD signature regions compared to non-Hispanic Whites with elevated AD biomarkers. This pilot trial examined whether normal or elevated plasma levels of interleukin (IL)-10 are associated with changes in executive function and short-term memory in AA women at risk for developing AD due to parental history. METHOD Observational study comparing groups with elevated and normal plasma IL-10 levels. Study included 31 AA women (age=58.9±8 years) with parental history of AD. Measures included inflammatory blood biomarkers, executive function and visuospatial short-term memory tests. Multivariate linear regression with adjustment for comorbidities, and Bonferroni corrections for multiple comparisons were used to compare groups. Effect sizes (Cohen's d) were generated. Using endpoints with moderate-large effects between groups, Pearson correlations determined associations between biomarker levels and cognitive performance. RESULTS The elevated IL-10 group performed worse on the Trail-Making Test proportional score ((B-A)/A) (effect size (d =-0.87 (-1.6, -.1)). Moderate effects with large confident intervals were noted in inhibition, set-switching, and body position spatial memory. Significant differences between groups in levels of other inflammatory markers were noted, including IL-7 (p=0.002) and interferon γ (p=0.02). IL-7 remained significant after Bonferroni correction. Correlation matrices revealed moderate-large, significant correlations (yet with wide confidence intervals) between levels of IL-10 and IL-9 with BPST total correct trials, and between interferon γ and delayed recall. CONCLUSIONS Interleukins may incite inflammation, leading to impaired aspects of executive function and short-term memory in this sample of African American women at risk for developing AD. This research provides effect sizes that will be used to power future research that will further investigate the relationship between inflammation, AD biomarkers, and cognitive function in an understudied population.
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Affiliation(s)
- Ruhee A. Patel
- Emory University College of Arts and Sciences, Atlanta, USA
| | - Whitney Wharton
- Emory University School of Nursing, Atlanta, USA,Department of Neurology, Emory University School of Medicine, Atlanta, USA
| | - Allison A. Bay
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Liang Nid
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA,Emory University Rollins School of Public Health, Atlanta, USA
| | - Jolie D. Barter
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Madeleine E. Hackney
- Emory University School of Nursing, Atlanta, USA,Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, USA,Birmingham/Atlanta VA Geriatric Research Clinical and Education Center, Atlanta, USA
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14
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Gogniat MA, Hyatt CS, Jean KR, Rodriguez VJ, Robinson TL, Miller LS. A Multi-method Investigation of the Personality Correlates of Functional Ability in Older Adults. Clin Gerontol 2020; 43:420-429. [PMID: 31906809 DOI: 10.1080/07317115.2019.1709239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study evaluated the role of personality in predicting functional ability (FA) in older adults using self-report, collateral report, and performance-based measures of FA. METHODS Participants included older adults (N = 131) who completed a personality measure (NEO-FFI), a self-report of FA (OARS ADL), and participated in a performance-based assessment of FA (DAFS-R). In addition, each participant had a collateral complete a collateral report of FA (OARS ADL). Bivariate correlations were computed to assess how Five Factor Model traits were related to self-report, collateral, and performance-based measures of FA. RESULTS Neuroticism was negatively related to self-reported FA (r = - .27) and collateral-reported FA (r = - .18) and Conscientiousness was positively related to self-reported FA (r = .25). None of the traits were significantly related to the performance-based measure of FA. CONCLUSIONS These results suggest that personality traits can impact self-reported FA in older adults and underscore the importance of assessing FA in older adults using multiple methods, particularly performance-based measures. CLINICAL IMPLICATIONS Clinicians should consider how personality may impact FA in older adults and multiple methods of FA performance should be examined to better tailor recommendations.
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Affiliation(s)
- Marissa A Gogniat
- Department of Psychology, University of Georgia , Athens, Georgia, USA
| | - Courtland S Hyatt
- Department of Psychology, University of Georgia , Athens, Georgia, USA
| | - Kharine R Jean
- Department of Psychology, University of Georgia , Athens, Georgia, USA
| | | | - Talia L Robinson
- Department of Psychology, University of Georgia , Athens, Georgia, USA
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15
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Lace JW, Merz ZC, Grant AF, Teague CL, Aylward S, Dorflinger J, Gfeller JD. Relationships Between the BRIEF/BRIEF-SR and Performance-Based Neuropsychological Tests in Adolescents with Mild Traumatic Brain Injury. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-019-00074-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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McDougall GJ, Han A, Staggs VS, Johnson DK, McDowd JM. Predictors of instrumental activities of daily living in community-dwelling older adults. Arch Psychiatr Nurs 2019; 33:43-50. [PMID: 31711593 PMCID: PMC10613508 DOI: 10.1016/j.apnu.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/22/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.
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Affiliation(s)
- Graham J McDougall
- Florida State University, College of Nursing, Tallahassee, FL 32306-4310, USA.
| | - Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL 35294-1212, USA
| | - Vincent S Staggs
- Health Services & Outcomes Research, Children's Mercy Hospitals and Clinics, and School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - David K Johnson
- Department of Psychology, University of Kansas, Lawrence, KS 66045, USA
| | - Joan M McDowd
- Department of Psychology, University of Missouri - Kansas City, Kansas City, MO 64110, USA
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17
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Using the Delis–Kaplan Executive Function System Tower Test to Examine ADHD Sensitivity in Children: Expanding Analysis Beyond the Summary Score. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-019-00068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Naturally Occurring Expressive Suppression is Associated with Lapses in Instrumental Activities of Daily Living Among Community-Dwelling Older Adults. J Int Neuropsychol Soc 2019; 25:718-728. [PMID: 31148529 DOI: 10.1017/s1355617719000328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Expressive suppression (i.e., effortful regulation of overt affect) has a deleterious impact on executive functioning (EF). This relationship has potential ramifications for daily functioning, especially among older adults, because a close relationship exists between EF and functional independence. However, past research has not directly examined whether expressive suppression impacts instrumental activities of daily living (IADL). The present study examined this association among older adults. METHODS One hundred ten community-dwelling older adults completed a self-report measure of acute (past 24 hr) and chronic (past 2 weeks) expressive suppression, a timed test of IADL, and the Behavioral Dyscontrol Scale as a measure of EF. RESULTS High chronic expressive suppression was related to slow IADL performance beyond covariates (age, IQ, depression), but only for individuals with low EF. High acute expressive suppression was associated with lower accuracy on IADL tasks beyond covariates (IQ, depression), but this association was fully explained by EF. CONCLUSIONS The current results suggest that expressive suppression is associated with less efficient and more error-prone IADL performance. EF fully accounted for the relationship between acute expressive suppression and IADL performance, showing that suppression is a risk factor for both poorer EF performance and functional lapses in daily life. Furthermore, individuals with weaker EF may be particularly vulnerable to the effect of chronic expressive suppression. (JINS, 2019, 25, 718-728).
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Cerino ES, Hooker K, Stawski RS, McClelland M. A New Brief Measure of Executive Function: Adapting the Head-Toes-Knees-Shoulders Task to Older Adults. THE GERONTOLOGIST 2019; 59:e258-e267. [PMID: 29648598 DOI: 10.1093/geront/gny028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Executive function (EF) abilities are recognized as components of cognition most likely to show age-related declines. Measurement of EF in older adults is often computer-based, takes place in a laboratory setting, and thus lacks ecological validity. We sought to investigate a new way of measuring EF in older adults by adapting a brief, behavioral measure of EF in children, the Head-Toes-Knees-Shoulders task (HTKS). RESEARCH DESIGN AND METHODS A sample of 150 community-dwelling older adults (Mean age = 68.55, SD = 6.34) completed the HTKS, NIH Toolbox: Cognition Battery (NIHTB-CB) and Positive and Negative Affect Schedule. RESULTS The HTKS showed adequate internal consistency, α = .84. Significant associations between HTKS variables and measures of attention and inhibitory control were robust to the influences of age, processing speed, and subjective health ratings. HTKS completion time exhibited the strongest associations to NIHTB-CB measures, suggesting that the time it takes older adults to complete the HTKS may be a better measure of EF than the total score. Nonsignificant associations between HTKS variables and positive and negative affect demonstrated discriminant validity. DISCUSSION AND IMPLICATIONS These results provide initial evidence for use of the HTKS as a brief, low-cost, easy to administer measure of EF in older adults. Further research is needed to determine its potential to identify individuals at risk for poor cognitive outcomes. A brief, valid measure may allow for wider screenings aimed at early intervention, when cognitive interventions are most effective.
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Affiliation(s)
- Eric S Cerino
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Karen Hooker
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Robert S Stawski
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Megan McClelland
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
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20
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Goverover Y, Toglia J, DeLuca J. The weekly calendar planning activity in multiple sclerosis: A top-down assessment of executive functions. Neuropsychol Rehabil 2019; 30:1372-1387. [PMID: 30810484 DOI: 10.1080/09602011.2019.1584573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Deficits in executive functioning are detrimental to employment, daily functioning and quality of life, however their precise nature in multiple sclerosis (MS) remains underspecified. The aims of this study were to: (1) describe the executive processes affected in MS, using a top-down (Weekly Calendar Planning Activity; WCPA) and bottom-up (Delis-Kaplan Executive Function System; DKEFS) assessment tools; (2) explore relationships between performance on the WCPA and DKEFS with a test of everyday functional performance, Actual RealityTM (AR). Methods: Sixty two participants with MS with and without cognitive impairments (n = 21 and 41, respectively) and 38 Healthy Controls (HC) completed the WCPA, two selected subtests of the DKEFS, and AR. Results: The MS group with cognitive impairments performed worse compared with the MS with no cognitive impairments and HC on both the WCPA and DKEFS. Better scores on the DKEFS were associated with better performance of the WCPA. WCPA was a significant predictor of three of the four AR variables. The DKEFS was a significant predictor of time to perform the AR. The results support the use of the WCPA as an assessment of executive functions in persons with MS. It embodies processes such as environmental monitoring, planning and problem solving, and self-regulation.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, USA.,Kessler Foundation, West Orange, NJ, USA
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
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21
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Loughan AR, Braun SE, Lanoye A. Executive dysfunction in neuro-oncology: Behavior Rating Inventory of Executive Function in adult primary brain tumor patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:393-402. [PMID: 30714410 DOI: 10.1080/23279095.2018.1553175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adult primary brain tumor (PBT) survivors report persistent cognitive difficulties before, during, and after treatment, which are problematic for everyday functioning. Cognitive domains often affected by cancer treatment appear to be attention and executive functioning (EF). One validated measure developed to assess an individual's EF within daily living is the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). To date, no published research has investigated the EF profile of PBT patients using the BRIEF-A. Seventy-four PBT patients completed the BRIEF-A. Descriptive analyses were conducted to determine the self-reported EF profile in PBT patients. T-tests preliminarily compared the performance of PBT patients to four other comparison groups: mild cognitive impairment (MCI; n = 23), attention-deficit/hyperactivity disorder-unmedicated (ADHD-U; n = 27), traumatic brain injury (TBI; n = 23), and healthy controls (HC; n = 26). PBT BRIEF-A group means were average across subscales and indexes, yet the prevalence of significant elevations ranged from 12 to 50%. The Metacognition Index demonstrated 38% elevation prevalence compared to 22% in Behavioral Regulation. Approximately 61% of the sample had at least one clinically elevated scaled score. PBT patients reported significantly more EF impairment than HC and significantly less than ADHD-U. No significant differences were found between the PBT and MCI groups or PBT and TBI groups. Despite group means not reaching clinical impairment, a substantial proportion of patients with PBTs endorse executive dysfunction. Elevations were most prominent in metacognitive abilities over behavioral dysregulation. Notably, the EF profile of PBT patients was remarkably similar to that of MCI and TBI, increased when compared to HC, and well below ADHD-U.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA
| | - Sarah E Braun
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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22
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Craun E, Lachance K, Williams C, Wong MM. Parent depressive symptoms and offspring executive functioning. J Clin Exp Neuropsychol 2018; 41:147-157. [PMID: 30102109 DOI: 10.1080/13803395.2018.1504893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Previous research has found mixed results when assessing the association between a parent's history of depressive symptoms and a child's abilities on measures of executive functioning. The purpose of this study was to replicate and expand upon these findings by evaluating the influence of a parent's depressive symptoms on a young person's executive functioning. Method: As part of a larger study, 135 children (54.8% female, aged 8-12) and one biological parent completed diagnostic screening interviews. Children then completed a brief executive functioning battery. Symptoms endorsed under the past major depressive episode module of the MINI International Neuropsychiatric Interview was used to measure depressive symptoms of parents. Results: While controlling for parent alcohol status and age, gender, intelligence, and current depressive symptoms of the child, linear regression models revealed that the parent's depressive symptoms significantly predicted deficits in Letter-Number Sequencing [b = -0.15 (0.07), p < .05] and Motor Speed [b = -0.17 (0.05), p < .005] on the Delis-Kaplan Executive Function System (D-KEFS) Trails Test. Parent depressive symptoms had no relationship with inhibition on the D-KEFS Color-Word Interference Test [b = -0.04 (0.14), p = .74] or the Verbal Working Memory subtest of the Stanford-Binet [b = 0.14 (0.12) p = .43]. Greater depressive symptoms in parents were associated with fewer perseverative errors on the Wisconsin Card Sorting Task (WCST) [b = 0.73 (0.32), p < .05]. Conclusion: In sum, a parent's depressive symptomatology was differentially associated with a young person's neurocognitive abilities. Clinical implications were discussed.
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Affiliation(s)
- Elizabeth Craun
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Kathryn Lachance
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Catherine Williams
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Maria M Wong
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
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23
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Spencer M, Cho SJ, Cutting LE. Item response theory analyses of the Delis-Kaplan Executive Function System card sorting subtest. Child Neuropsychol 2018; 25:198-216. [PMID: 29393770 DOI: 10.1080/09297049.2018.1433156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the current study, we examined the dimensionality of the 16-item Card Sorting subtest of the Delis-Kaplan Executive Functioning System assessment in a sample of 264 native English-speaking children between the ages of 9 and 15 years. We also tested for measurement invariance for these items across age and gender groups using item response theory (IRT). Results of the exploratory factor analysis indicated that a two-factor model that distinguished between verbal and perceptual items provided the best fit to the data. Although the items demonstrated measurement invariance across age groups, measurement invariance was violated for gender groups, with two items demonstrating differential item functioning for males and females. Multigroup analysis using all 16 items indicated that the items were more effective for individuals whose IRT scale scores were relatively high. A single-group explanatory IRT model using 14 non-differential item functioning items showed that for perceptual ability, females scored higher than males and that scores increased with age for both males and females; for verbal ability, the observed increase in scores across age differed for males and females. The implications of these findings are discussed.
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Affiliation(s)
- Mercedes Spencer
- a Vanderbilt University Medical Center , Vanderbilt University , Nashville , TN , USA
| | - Sun-Joo Cho
- b Department of Psychology and Human Development , Vanderbilt University , Nashville , TN , USA
| | - Laurie E Cutting
- a Vanderbilt University Medical Center , Vanderbilt University , Nashville , TN , USA
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24
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Namaky N, Beltzer ML, Werntz AJ, Lambert AE, Isaacowitz DM, Teachman BA. Moderators of age effects on attention bias toward threat and its association with anxiety. J Affect Disord 2017; 216:46-57. [PMID: 27855961 DOI: 10.1016/j.jad.2016.10.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The current study used a research domain criteria (RDoC) approach to assess age differences in multiple indicators of attention bias and its ties to anxiety, examining stimulus domain and cognitive control as moderators of older adults' oft-cited positivity effect (bias towards positive and away from negative stimuli, when compared to younger adults). METHOD 38 Younger adults and 38 older adults were administered a battery of cognitive control and trait and state anxiety measures, and completed a dot-probe task to assess attention bias, during which reaction time and fixation duration (using eye-tracking) were recorded for negative and neutral social (a salient threat domain for younger adults) and physical (a salient threat domain for older adults) stimuli. RESULTS Mixed-effects models demonstrated that older adults were faster to react to dot-probe trials when the probe appeared in the place of negative (vs. neutral) physical stimuli, but displayed no difference in reaction time for social stimuli. Also, older (vs. younger) adults with lower levels of cognitive control were less negatively biased in their visual fixation to social stimuli. A negative reaction time attention bias on the dot-probe task predicted greater trait anxiety among participants with low levels of cognitive control, with a more complex pattern predicting state anxiety. CONCLUSION Older adults do attend to social and physical stimuli differently. When stimuli concern a social threat, older adults do not preferentially attend to either neutral or negative stimuli. However, when stimuli concern physical threat, older adults preferentially attend to negative stimuli. Threat biases are associated with anxiety at all ages for those with low cognitive control.
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25
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Karzmark P, Deutsch GK. Accuracy statistics in predicting Independent Activities of Daily Living (IADL) capacity with comprehensive and brief neuropsychological test batteries. APPLIED NEUROPSYCHOLOGY. ADULT 2017. [PMID: 28631986 DOI: 10.1080/23279095.2017.1286347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This investigation was designed to determine the predictive accuracy of a comprehensive neuropsychological and brief neuropsychological test battery with regard to the capacity to perform instrumental activities of daily living (IADLs). Accuracy statistics that included measures of sensitivity, specificity, positive and negative predicted power and positive likelihood ratio were calculated for both types of batteries. The sample was drawn from a general neurological group of adults (n = 117) that included a number of older participants (age >55; n = 38). Standardized neuropsychological assessments were administered to all participants and were comprised of the Halstead Reitan Battery and portions of the Wechsler Adult Intelligence Scale-III. A comprehensive test battery yielded a moderate increase over base-rate in predictive accuracy that generalized to older individuals. There was only limited support for using a brief battery, for although sensitivity was high, specificity was low. We found that a comprehensive neuropsychological test battery provided good classification accuracy for predicting IADL capacity.
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Affiliation(s)
- Peter Karzmark
- a Department of Neurology and Neurological Sciences, Stanford Health Care , Palo Alto , California , USA
| | - Gayle K Deutsch
- a Department of Neurology and Neurological Sciences, Stanford Health Care , Palo Alto , California , USA
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26
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Abstract
OBJECTIVES Accurate detection of executive dysfunction in neuropsychological assessments is complicated by the fact that executive functioning (EF) is vulnerable to temporary disruption (i.e., lapses), with more frequent lapses in older adulthood. Effortful regulation of affect (i.e., expressive suppression) is a well-known source of executive lapses in younger adults, but the generalizability of this depleting effect to older adults is unknown. The purpose of this study was to (1) determine whether EF is subject to depletion via expressive suppression and (2) to examine whether this effect is unique to EF, or whether it also applies to lower-order component processes in older adults. METHODS Ninety-seven non-demented, community-dwelling older adults were randomly assigned to either an expressive suppression group or control group. We compared performance of the groups on a battery of tests measuring EF and component processes both before and after exposure to emotionally evocative stimuli. RESULTS Consistent with the hypothesized depletion effect, suppressing participants showed an attenuated practice effect on post-manipulation EF relative to controls, while performance on lower-order component processes was unaffected by suppression. CONCLUSIONS These results suggest that depletion contributes to executive lapses in older adulthood. (JINS, 2017, 23, 341-351).
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27
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Lewis MW, Babbage DR, Leathem JM. Systematic behavioural observation of executive performance after brain injury. Brain Inj 2017; 31:639-648. [DOI: 10.1080/02699052.2017.1283535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mark W. Lewis
- School of Psychology, Massey University, Wellington, New Zealand
| | - Duncan R. Babbage
- Centre for eHealth, Auckland University of Technology, Auckland, New Zealand
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Janet M. Leathem
- School of Psychology, Massey University, Wellington, New Zealand
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Leyva A, Balachandran A, Britton JC, Eltoukhy M, Kuenze C, Myers ND, Signorile JF. The development and examination of a new walking executive function test for people over 50 years of age. Physiol Behav 2017; 171:100-109. [DOI: 10.1016/j.physbeh.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 12/01/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Gavett BE, Zhao R, John SE, Bussell CA, Roberts JR, Yue C. Phishing suspiciousness in older and younger adults: The role of executive functioning. PLoS One 2017; 12:e0171620. [PMID: 28158316 PMCID: PMC5291531 DOI: 10.1371/journal.pone.0171620] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/23/2017] [Indexed: 11/21/2022] Open
Abstract
Phishing is the spoofing of Internet websites or emails aimed at tricking users into entering sensitive information, with such goals as financial or identity theft. The current study sought to determine whether age is associated with increased susceptibility to phishing and whether tests of executive functioning can predict phishing susceptibility. A total of 193 cognitively intact participants, 91 younger adults and 102 older adults, were primarily recruited through a Psychology department undergraduate subject pool and a gerontology research registry, respectively. The Executive Functions Module from the Neuropsychological Assessment Battery and the Iowa Gambling Task were the primary cognitive predictors of reported phishing suspiciousness. Other predictors included age group (older vs. younger), sex, education, race, ethnicity, prior knowledge of phishing, prior susceptibility to phishing, and whether or not browsing behaviors were reportedly different in the laboratory setting versus at home. A logistic regression, which accounted for a 22.7% reduction in error variance compared to the null model and predicted phishing suspiciousness with 73.1% (95% CI [66.0, 80.3]) accuracy, revealed three statistically significant predictors: the main effect of education (b = 0.58, SE = 0.27) and the interactions of age group with prior awareness of phishing (b = 2.31, SE = 1.12) and performance on the Neuropsychological Assessment Battery Mazes test (b = 0.16, SE = 0.07). Whether or not older adults reported being suspicious of the phishing attacks used in this study was partially explained by educational history and prior phishing knowledge. This suggests that simple educational interventions may be effective in reducing phishing vulnerability. Although one test of executive functioning was found useful for identifying those at risk of phishing susceptibility, four tests were not found to be useful; these results speak to the need for more ecologically valid tools in clinical neuropsychology.
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Affiliation(s)
- Brandon E. Gavett
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, United States of America
- * E-mail:
| | - Rui Zhao
- Division of Computer Science, Colorado School of Mines, Golden, CO, United States of America
| | - Samantha E. John
- Alzheimer’s Disease Research Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Cara A. Bussell
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, United States of America
| | - Jennifer R. Roberts
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, United States of America
| | - Chuan Yue
- Division of Computer Science, Colorado School of Mines, Golden, CO, United States of America
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Wesson J, Clemson L, Brodaty H, Reppermund S. Estimating functional cognition in older adults using observational assessments of task performance in complex everyday activities: A systematic review and evaluation of measurement properties. Neurosci Biobehav Rev 2016; 68:335-360. [DOI: 10.1016/j.neubiorev.2016.05.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/19/2016] [Accepted: 05/23/2016] [Indexed: 12/01/2022]
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31
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Mlinac ME, Feng MC. Assessment of Activities of Daily Living, Self-Care, and Independence. Arch Clin Neuropsychol 2016; 31:506-16. [PMID: 27475282 DOI: 10.1093/arclin/acw049] [Citation(s) in RCA: 365] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/15/2022] Open
Abstract
Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.
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Affiliation(s)
- Michelle E Mlinac
- VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
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32
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Lindbergh CA, Dishman RK, Miller LS. Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2016; 26:129-59. [PMID: 27393566 DOI: 10.1007/s11065-016-9321-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
Accumulating evidence suggests that the pre-dementia syndrome mild cognitive impairment (MCI) is characterized by decrements in instrumental activities of daily living (IADL). The current review was a quantitative synthesis of the available literature to objectively characterize IADL disability in MCI while clarifying inconsistencies in findings across studies. It was hypothesized that individuals with MCI would display significantly greater functional impairment relative to cognitively intact controls. Candidate moderators specified a priori included functional assessment approach, MCI subtype, depressive symptoms, and language conducted. Online databases (PubMed/MEDLINE and PsycINFO) and reference lists were searched to identify peer-reviewed publications assessing IADL in MCI compared to normal aging. A total of 151 effect sizes derived from 106 studies met inclusionary criteria (N = 62,260). Random effects models yielded a large overall summary effect size (Hedges' g = 0.76, 95 % confidence interval: 0.68 - 0.83, p < .001) confirmed in multi-level analyses adjusted for nesting of effect sizes within studies (g = 0.78, 95 % confidence interval: 0.69 - 0.87). Functional assessment strategy and MCI subtype were significant moderators of effect size, whereas depressive symptoms and language were not. Results convincingly demonstrate that MCI is associated with significant difficulties in the performance of complex everyday tasks. It appears that functional decline, like cognitive decline, exists on a continuum from healthy aging to dementia onset. Implications for clinical practice and research priorities are discussed.
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Affiliation(s)
- Cutter A Lindbergh
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.
| | - Rodney K Dishman
- Department of Kinesiology, University of Georgia, Athens, GA, 30602, USA
| | - L Stephen Miller
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.,Bio-Imaging Research Center, Paul D. Coverdell Center, University of Georgia, Athens, GA, 30602, USA
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Roberts W, Milich R, Fillmore MT. The Effects of Preresponse Cues on Inhibitory Control and Response Time in Adults With ADHD. J Atten Disord 2016; 20:317-24. [PMID: 23881558 PMCID: PMC4026333 DOI: 10.1177/1087054713495737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effects of preresponse cues on behavioral control in adults with ADHD. METHOD Eighty-eight adults with ADHD and 67 adults with no history of ADHD completed a cued go/no-go task. This task requires participants to respond or inhibit a response to go and no-go targets, respectively, and preresponse cues provide participants with predictive information about the upcoming target. RESULTS Overall, participants with ADHD made more inhibitory failures and responded more slowly than controls. These group differences were only present in the valid-cue condition, and there were no significant group differences in the invalid-cue conditions. CONCLUSION These findings suggest that adults with ADHD are less able to utilize predictive environmental information to facilitate behavioral control.
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Puente AN, Lindbergh CA, Miller LS. Personality's association with IADLs in community dwelling older adults. Int J Geriatr Psychiatry 2015; 30:950-6. [PMID: 25565648 DOI: 10.1002/gps.4243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Extant research has established several predictors of functional ability (FA) in older adults (OAs); however, one factor that has been relatively ignored is personality. Preliminary evidence suggests that openness and agreeableness are associated with instrumental activities of daily living (IADLs). However, how personality is related to IADLs remains unclear. We aimed to determine how personality factors predict performance of IADLs, which we hypothesized, was because of executive functioning (EF). METHODS To best understand the relationship between personality and IADLs, we recruited and ran 65 independent community dwelling OAs. Bivariate correlations and hierarchical regressions were completed to determine the associations between openness and agreeableness with IADLs. Lastly, mediation analyses were completed to examine our hypothesis that EF would mediate this relationship RESULTS Correlation and regression findings support the relationship between openness and IADLs but not agreeableness and IADLs. As hypothesized, the relationship between openness and IADLs was mediated by EF. CONCLUSIONS We replicated the relationship between openness and IADLs and extend the literature by showing the mechanism of action for this relationship is EF. While our mediation results support this perspective, future research should determine if interventions that increase OAs' EF, in turn, increase or attenuate decline in IADLs over time.
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Affiliation(s)
- Antonio Nicolas Puente
- Department of Psychology, The University of Georgia, Athens, GA, USA.,Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | | | - L Stephen Miller
- Department of Psychology, The University of Georgia, Athens, GA, USA.,Division of Neuroscience, Biomedical Health Sciences Institute, The University of Georgia, Athens, GA, USA
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35
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Assessment of planning performance in clinical samples: Reliability and validity of the Tower of London task (TOL-F). Neuropsychologia 2015. [DOI: 10.1016/j.neuropsychologia.2015.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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36
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Donders J, Strong CAH. Latent Structure of the Behavior Rating Inventory of Executive Function—Adult Version (BRIEF–A) After Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Archer KR, Coronado RA, Haislip LR, Abraham CM, Vanston SW, Lazaro AE, Jackson JC, Ely EW, Guillamondegui OD, Obremskey WT. Telephone-based goal management training for adults with mild traumatic brain injury: study protocol for a randomized controlled trial. Trials 2015; 16:244. [PMID: 26031289 PMCID: PMC4454274 DOI: 10.1186/s13063-015-0775-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to address these impairments, especially cognitive deficits in executive functioning. Goal management training (GMT) is a structured cognitive rehabilitation program that has been found to improve executive functioning in patients with moderate to severe TBI. The current study adapted the GMT program for telephone delivery in order to improve the accessibility of rehabilitation services in a patient population with multiple barriers to care and significant yet unrecognized cognitive impairment. The primary objective of this study is to examine the efficacy of telephone-based GMT for improving executive functioning, functional status, and psychological health in trauma survivors with mild TBI. METHODS/DESIGN This study is a three-group randomized controlled trial being conducted at a Level I trauma center. Ninety trauma survivors with mild TBI and cognitive deficits in executive functioning will be randomized to receive telephone-based GMT, telephone-based education, or usual care. GMT and education programs will be delivered by a physical therapist. The first in-person session is 1 h and the remaining six telephone sessions are 30 min. A battery of well-established cognitive tests will be conducted and validated questionnaires will be collected that measure executive functioning, functional status, and depressive and posttraumatic stress disorder symptoms at 6 weeks, 4 months, and 7 months following hospital discharge. DISCUSSION This study supports a telephone-delivery approach to rehabilitation services in order to broaden the availability of evidence-based cognitive strategies. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov on 10 October 2012, registration number: NCT01714531.
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Affiliation(s)
- Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA.
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Lori R Haislip
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Christine M Abraham
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Anthony E Lazaro
- School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN, 37208, USA.
| | - James C Jackson
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. .,Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue, Nashville, TN, 37212, USA. .,Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA.
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. .,Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA.
| | - Oscar D Guillamondegui
- Division of Trauma and Surgical Critical Care, Department of Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, 404 MAB 1750, Nashville, TN, 37232, USA.
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
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Puente AN, Lindbergh CA, Miller LS. The relationship between cognitive reserve and functional ability is mediated by executive functioning in older adults. Clin Neuropsychol 2015; 29:67-81. [PMID: 25664575 DOI: 10.1080/13854046.2015.1005676] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It has been noted in the literature that cognitive reserve (CR) predicts future functional ability (FA), but the association between CR and current FA is rather limited. This investigation aimed to explicate this relationship, and hypothesized it would be mediated by executive functioning (EF). To best understand the relationship between CR and FA, we recruited and tested independent community-dwelling older adults (OAs). Bivariate correlations and hierarchical regressions were completed to determine the association between CR and FA. Both individual CR measures and a composite CR score were used. Mediation analyses were completed to examine our hypothesis that EF would mediate the CR and FA relationship. All measures of CR were positively related to and predictive of FA. Although the highest zero-order correlation across the independent CR proxies was between income and FA (r = .417), education accounted for the greatest amount of variance in FA, 8.3% after controlling for age and Mini-Mental State Examination performance. Furthermore, the CR composite had a higher correlation (r = .447) and accounted for more variance than any of the independent proxies. Complete mediation was found between a CR composite and FA via an internally consistent D-KEFS composite score (Cronbach's α = .795). This suggests that as CR increases so does EF, which in turn improves FA. Thus, future investigations could determine the effect on FA in OAs by improving EF.
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39
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Puente AN, Terry DP, Faraco CC, Brown CL, Miller LS. Functional impairment in mild cognitive impairment evidenced using performance-based measurement. J Geriatr Psychiatry Neurol 2014; 27:253-8. [PMID: 24763070 DOI: 10.1177/0891988714532016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Older adults (OAs) with mild cognitive impairment (MCI) are traditionally thought to have preservation of activities of daily living (ADLs). However, recent evidence suggests OAs with MCI may have difficulty completing ADLs and specifically instrumental ADLs (IADLs). The ADLs are frequently evaluated through self- or collateral report questionnaires, while performance-based measures are infrequently utilized, despite the decreased bias and increased accuracy and sensitivity associated with these instruments. This investigation compared ADLs between community-dwelling OAs with (n = 20) and without MCI (n = 30) using a self-report questionnaire (Older American Resources and Services Activities of Daily Living Scale; OARS), a collateral report questionnaire (OARS), and a performance-based measure (the Direct Assessment of Functional Status-Revised). Consistent with our hypothesis, OAs with MCI had decreased ADLs and IADLs on the performance-based measure compared to cognitively intact OAs, while there were no differences in ADLs or IADLs on self-report questionnaires or collateral report questionnaires. Our results suggest OAs with MCI have decreased ability to complete IADLs. However, this investigation suggests these deficits may not be detected by questionnaires and are more likely to be found with performance-based testing.
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Affiliation(s)
- Antonio Nicolas Puente
- Department of Psychology, The University of Georgia, Psychology Building, Athens, GA, USA
| | - Douglas P Terry
- Department of Psychology, The University of Georgia, Psychology Building, Athens, GA, USA
| | - Carlos C Faraco
- Department of Psychology, The University of Georgia, Psychology Building, Athens, GA, USA Division of Neuroscience, The University of Georgia, Coverdell Building, Athens, GA, 30602, USA
| | - Courtney L Brown
- Department of Psychology, The University of Georgia, Psychology Building, Athens, GA, USA
| | - L Stephen Miller
- Department of Psychology, The University of Georgia, Psychology Building, Athens, GA, USA Division of Neuroscience, The University of Georgia, Coverdell Building, Athens, GA, 30602, USA
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40
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Campbell GB, Whyte EM, Sereika SM, Dew MA, Reynolds CF, Butters MA. Reliability and validity of the Executive Interview (EXIT) and Quick EXIT among community dwelling older adults. Am J Geriatr Psychiatry 2014; 22:1444-51. [PMID: 24119860 PMCID: PMC3980173 DOI: 10.1016/j.jagp.2013.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the psychometric properties of the Executive Interview (EXIT) and Quick EXIT in community dwelling older adults. DESIGN Secondary analysis of data obtained as part of a longitudinal study of cognitive function in late-life depression. SETTING A university hospital. PARTICIPANTS Community-dwelling adults (N = 422), aged 59 years and older, with current or recent history of non-psychotic unipolar major depression, and never-depressed comparison subjects. MEASUREMENTS The EXIT and other measures of executive control functions (ECF), non-executive cognitive domains, and global cognitive function. We calculated Quick EXIT scores from the EXIT. RESULTS The EXIT demonstrated high inter-rater reliability (Intraclass correlation coefficient = 0.978, F(7, 21) = 174.85, p <0.001), and both the EXIT and Quick EXIT demonstrated moderate internal consistency (α = 0.66 and α = 0.68, respectively). Both tests also demonstrated acceptable convergent validity against several standard tests of ECF (rs -0.399 to 0.322, except for the Trail Making Test B, where rs was 0.057 to 0.063) as well as against measures of multifactorial cognitive function (rs -0.432 to 0.491). Both tests, however, demonstrated inconsistent discriminant validity against a variety of standard non-ECF tests (rs -0.013 to 0.376). CONCLUSIONS Both the EXIT and the Quick EXIT have adequate reliability and appear to require ECF in this population. However, both the EXIT and the Quick EXIT also reflect non-ECF domains. The EXIT and Quick EXIT should be considered to be measures of global cognitive function rather than pure ECF measures. Given similar reliability and validity, the Quick EXIT is recommended clinically as it is briefer and less burdensome than the full EXIT.
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Affiliation(s)
- Grace B. Campbell
- University of Pittsburgh School of Nursing Department of Acute/Tertiary Care
| | - Ellen M. Whyte
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Susan M. Sereika
- University of Pittsburgh School of Nursing Department of Health and Community Systems,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
| | - Mary Amanda Dew
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology,University of Pittsburgh Department of Psychology
| | | | - Meryl A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry
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Yam A, Gross A, Prindle J, Marsiske M. Ten-year longitudinal trajectories of older adults' basic and everyday cognitive abilities. Neuropsychology 2014; 28:819-28. [PMID: 24885451 PMCID: PMC4227959 DOI: 10.1037/neu0000096] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To examine the longitudinal trajectories of everyday cognition and longitudinal associations with basic (i.e., laboratory and experimentally measured) cognitive abilities, including verbal memory, inductive reasoning, visual processing speed, and vocabulary. METHOD Participants were healthy older adults drawn from the no-treatment control group (N = 698) of the Advanced Cognitive Training for the Independent and Vital Elderly (Willis et al., 2006) randomized trial and were assessed at baseline and 1, 2, 3, 5, and 10 years later. Analyses were conducted using latent growth models. RESULTS Modeling revealed an overall inverted-U shape (quadratic) trajectory across cognitive domains. Among basic cognitive predictors, level and slope in reasoning demonstrated the closest association to level and slope of everyday cognition, and accounted for most of the individual differences in linear gain in everyday cognition. CONCLUSION Everyday cognition is not buffered against decline, and is most closely related to inductive reasoning in healthy older adults. To establish the clinical utility of everyday cognitive measures, future research should examine these associations in samples with more cognitive impairment.
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Affiliation(s)
- Anna Yam
- Department of Clinical and Health Psychology, University of Florida
| | - Alden Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center on Aging and Health
| | | | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
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42
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Ahmed FS, Miller LS. Adequate proverb interpretation is associated with performance on the Independent Living Scales. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:376-87. [DOI: 10.1080/13825585.2014.952613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Duda B, Puente AN, Miller LS. Cognitive reserve moderates relation between global cognition and functional status in older adults. J Clin Exp Neuropsychol 2014; 36:368-78. [PMID: 24611794 DOI: 10.1080/13803395.2014.892916] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The ability to perform instrumental activities of daily living (IADLs) is necessary for independent living. Research suggests that community-dwelling older adults are at risk for experiencing subtle decrements in the performance of IADLs. Neuropsychological tests have been used to account for differences in IADL status. Studies of the relationship between cognitive ability and functional status have produced variable results, however, and cognitive ability appears to be only a moderate predictor. Several studies of normal aging have revealed cognitive and functional benefits of higher cognitive reserve (CR) in healthy, nondemented older adults. The purposes of the present study were to: (a) examine the relationship between global cognitive ability and IADL performance among 53 community-dwelling older adults, and (b) determine whether formal education, as a proxy of CR, significantly moderates this relationship. Consistent with previous findings, global cognitive ability accounted for a considerable portion of variance in IADL performance [ΔR(2) = .54; ΔF(2, 53) = 67.96; p < .001]. Additionally, CR modestly but significantly attenuated this relationship [ΔR(2) = .044; ΔF(4, 53) = 5.98; p = .018; total R(2) = .65]. This finding suggests that community-dwelling older adults with lower levels of formal education may be at greater risk for functional decrements associated with age-related cognitive decline.
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Affiliation(s)
- Bryant Duda
- a Department of Psychology , University of Georgia , Athens , GA , USA
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Rasquin SMC, Welter J, van Heugten CM. Course of cognitive functioning during stroke rehabilitation. Neuropsychol Rehabil 2013; 23:811-23. [DOI: 10.1080/09602011.2013.821950] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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45
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Nelson WL, Suls J. New approaches to understand cognitive changes associated with chemotherapy for non-central nervous system tumors. J Pain Symptom Manage 2013; 46:707-21. [PMID: 23522517 DOI: 10.1016/j.jpainsymman.2012.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/05/2012] [Accepted: 12/07/2012] [Indexed: 01/01/2023]
Abstract
CONTEXT Researchers have described a constellation of cognitive deficits (e.g., impairments in executive functions, working memory, attention, and information-processing speed) associated with cancer treatment, and specifically chemotherapy, for non-central nervous system tumors. However, findings have been inconsistent, largely because of measurement and study design issues. OBJECTIVES To propose ways for researchers to more clearly delineate and characterize the mild cognitive deficits and related outcomes that appear to affect a subset of cancer patients and suggest methods to make more effective use of the existing data to understand risk factors for impaired neuropsychological functioning. METHODS We examined the literature on the relationship between chemotherapy and cognitive impairment, as well as related literature on neuropsychological measurement, structural and functional neuroimaging, alternative measures of health outcomes, and integrative data analysis. RESULTS A more comprehensive picture of cognitive functioning might be obtained by incorporating nontraditional ecological measures, self-reports, computational modeling, new neuroimaging methods, and markers of occupational functioning. Case-control and integrative data analytic techniques potentially could leverage existing data to identify risk factors for cognitive dysfunction and test hypotheses about the etiology of these effects. CONCLUSION There is a need to apply new research approaches to understand the real-world functional implications of the cognitive side effects of chemotherapy to develop and implement strategies to minimize and remediate these effects before, during, and after cancer treatment.
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Affiliation(s)
- Wendy L Nelson
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
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Martin S, Wolters P, Billings N, Toledo-Tamula MA, Hammoud DA, Welch P, Darnell D, Holland SM, Freeman AF. Neurobehavioral profiles in individuals with hyperimmunoglobulin E Syndrome (HIES) and brain white matter hyperintensities. J Clin Immunol 2013; 33:1175-84. [PMID: 23963745 PMCID: PMC5467306 DOI: 10.1007/s10875-013-9932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/08/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Individuals with hyperimmunoglobulin E Syndrome (HIES) have central nervous system abnormalities, including focal white matter hyperintensities (WMH), or unidentified bright objects. This cross-sectional study aimed to describe the cognitive and emotional functioning and quality of life of people with HIES. We also sought to explore the relationship between cognitive functioning and WMHs in this population. METHODS Twenty-nine individuals (13 males) with autosomal-dominant HIES (mean age = 35.1 years, range 16-55) were administered a comprehensive psychological assessment as part of a natural history protocol. The assessment included measures of global cognitive functioning (Wechsler Adult Intelligence Scale-III), memory (California Verbal Learning Test-II, Wechsler Memory Scale-III), executive skills (Delis Kaplan Executive Function System), and attention (Test of Everyday Attention). Emotional symptoms and quality of life also were assessed. RESULTS All mean cognitive scores were within normal limits. Mean scores on memory and executive functioning measures were significantly lower than Full Scale IQ scores (ps < .05). Substantial percentages of patients self-reported executive skills to be in the clinical range. Patients with fewer (1-20) versus more (21+) WMHs scored significantly better on measures of global cognitive skills, visual-perceptual skills, and working memory. Mean scores on emotional symptom and quality of life measures were in the average range and unrelated to WMHs. CONCLUSIONS Global cognitive functioning was average to high average in our sample of individuals with HIES. However, focal brain lesions were associated with lower scores in specific domains. Emotional functioning and quality of life are within normal limits in this sample.
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Affiliation(s)
- Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA,
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Neill E, Rossell SL. Executive functioning in schizophrenia: the result of impairments in lower order cognitive skills? Schizophr Res 2013; 150:76-80. [PMID: 23973320 DOI: 10.1016/j.schres.2013.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 06/28/2013] [Accepted: 07/14/2013] [Indexed: 10/26/2022]
Abstract
Executive functioning (EF) impairments are common in schizophrenia. There are two propositions regarding the causes of these impairments: (1) executive impairments are the result of the compounding effects of deficits in lower order cognitive skills (e.g. processing speed, attention) or (2) EF impairments exist in their own right regardless of lower order skills. It is difficult to examine the separable effects of lower order cognitive skills on EF given the overlap required to complete most neuropsychological measures. One battery designed to parcel out the contributions of lower order skills from EF is the Delis-Kaplan Executive Function System (D-KEFS). Inhibition and switching specifically were examined using the D-KEFS versions of the Stroop and Trails task. No group differences in task performance after controlling for lower level skills would provide evidence for a generalised cognitive deficit. Group differences remaining after controlling for these influences would suggest a disproportionate deficit. Results supported both propositions. On both tasks, group differences reflecting slowed reaction time in the schizophrenia group disappeared when lower order skills were controlled for. Differences between groups performance in errors were only evident on the most complex versions of each task with more errors made by the schizophrenia group. These results suggest that (1) both RT and error data are needed to provide a full picture of performance and (2) the relationship between lower order and EF is too complex to provide support for one or the other proposal.
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Affiliation(s)
- Erica Neill
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Level 4, 607 St Kilda Rd, Melbourne, VIC 3004 Australia.
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Miloyan BH, Razani J, Larco A, Avila J, Chung J. Aspects of Attention Predict Real-World Task Performance in Alzheimer's Disease. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 20:203-210. [PMID: 23406263 DOI: 10.1080/09084282.2012.685133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
More research is needed to examine the relationship between specific neuropsychological functions and observation-based daily activity tests in patients with Alzheimer's disease (AD). Fifty-six patients with AD were administered tests of attention and processing speed and an observation-based activities-of-daily-living (ADL) task. Complex short-term attention capacity best predicted real-world task performance, accounting for several domains of ADL functioning. These results suggest that complex attention requiring working-memory systems, but not simple attention or processing speed, account for moderate portions of variability in daily task performance. These results may aid in understanding the attentional processes required for performing daily activities and can be useful to health care professionals in treatment planning.
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Affiliation(s)
- Beyon H Miloyan
- a Department of Psychology , California State University , Northridge , California
| | - Jill Razani
- a Department of Psychology , California State University , Northridge , California
| | - Andrea Larco
- a Department of Psychology , California State University , Northridge , California
| | - Justina Avila
- a Department of Psychology , California State University , Northridge , California
| | - Julia Chung
- b Department of Psychiatry , Harbor-UCLA Medical Center , Torrance , California
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Cavaco S, Gonçalves A, Pinto C, Almeida E, Gomes F, Moreira I, Fernandes J, Teixeira-Pinto A. Trail Making Test: regression-based norms for the Portuguese population. Arch Clin Neuropsychol 2013; 28:189-98. [PMID: 23299183 DOI: 10.1093/arclin/acs115] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The main goal of this study was to produce normative data for the Portuguese population on the Trail Making Test (TMT). The study included 1,038 community-dwelling individuals aged between 18 and 93 years, who had educational backgrounds ranging from 3 to 22 years. The results showed that sex, age, and education were significantly associated with TMT performance. These demographic characteristics accounted for 57% of the performance variance at part A and 50% at part B. The normative data are presented as regression-based algorithms to adjust direct and derived test scores for sex, age, and education. The adjusted scores' percentile distributions and their correspondence with scaled scores are also provided.
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Affiliation(s)
- Sara Cavaco
- Laboratório de Neurobiologia do Comportamento Humano, Centro Hospitalar do Porto, Porto, Portugal
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Kraybill ML, Thorgusen SR, Suchy Y. The Push-Turn-Taptap Task Outperforms Measures of Executive Functioning in Predicting Declines in Functionality: Evidence-Based Approach to Test Validation. Clin Neuropsychol 2012; 27:238-55. [DOI: 10.1080/13854046.2012.735702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Yana Suchy
- a Department of Psychology , University of Utah , Salt Lake City , UT , USA
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