Association of self-reported executive function and mood with executive function task performance across adult populations

Moderating Role of Self-Regulation Difficulties in the Momentary Associations Between Depressive Symptoms and Participation Poststroke

IMPORTANCE

Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations.

OBJECTIVE

To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke.

DESIGN

This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables.

SETTING

Community.

PARTICIPANTS

39 people with stroke.

OUTCOMES AND MEASURES

We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities).

RESULTS

We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (β = -0.05 to -0.07, p < .001) and satisfaction (β = -0.04 to -0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (β = -0.01, p < .001) and emotion regulation (β = -0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities.

CONCLUSIONS AND RELEVANCE

Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke. Plain-Language Summary: Depressive symptoms have immediate and real-time associations with lower levels of participation in daily activities in people with stroke. Self-regulation, including cognitive regulation (e.g., goal setting, planning strategies), behavioral regulation (e.g., controlling impulsive behaviors), and emotion regulation (e.g., managing negative feelings), may be an intervention target for reducing the immediate associations between depressive symptoms and lower levels of participation poststroke. Thus, we investigated whether difficulties in self-regulation variables magnify the negative real-time associations between depressive symptoms and participation poststroke. To obtain real-time data on difficulties in self-regulation variables, depressive symptoms, and participation (i.e., performance and satisfaction), we asked 39 community-dwelling people with stroke to answer smartphone surveys. The results showed that difficulties in total self-regulation and emotion regulation magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Our findings suggest that self-regulation and emotion regulation strategies may be a target for real-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.

Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE): A randomized controlled trial

BACKGROUND

As the prevalence of chemotherapy-related cognitive impairment rises, investigation into treatment options is critical. The objectives of this study were to test the effects of an aerobic exercise intervention initiated during chemotherapy compared to usual care (wait list control condition) on (1) objectively measured cognitive function and self-reported cognitive function, as well as on (2) the impact of cognitive impairment on quality of life (QOL) postintervention (commensurate with chemotherapy completion).

METHODS

The Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE) trial was a two-arm, two-center randomized controlled trial conducted in Ottawa and Vancouver (Canada). Fifty-seven women (Mage, 48.8 ± 10 years) diagnosed with stage I-III breast cancer and awaiting chemotherapy were randomized to aerobic exercise initiated with chemotherapy (nEX = 28) or usual care during chemotherapy with aerobic exercise after chemotherapy completion (nUC = 29). The intervention lasted 12-24 weeks and consisted of supervised aerobic training and at-home exercise. The primary outcome was objective cognitive function measured via 13 neuropsychological tests (standardized to M ± SD, 0 ± 1); secondary outcomes of self-reported cognitive function and its impact on QOL were assessed via questionnaires. Data collected pre- and postintervention (the primary end point) were analyzed.

RESULTS

Although no significant differences between groups were found for objective cognitive function outcomes postintervention after accounting for multiple testing, four of six self-reported cognitive function outcomes showed significant differences favoring the aerobic exercise group.

CONCLUSIONS

Among women initiating chemotherapy for breast cancer, aerobic exercise did not result in significant differences in objective cognitive function postintervention after chemotherapy completion; however, the results do support the use of this intervention for improving self-reported cognitive function and its impact on QOL.

Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study

BACKGROUND

The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation.

METHODS

N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates.

RESULTS

The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five.

CONCLUSIONS

Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.

The Association Between Executive Functioning and Personal Recovery in People With Psychotic Disorders

Background

Recovery in psychotic disorder patients is a multidimensional concept that can include personal, symptomatic, societal, and functional recovery. Little is known about the associations between personal recovery (PR) and functional recovery (FR). FR involves a person's ability to recover or compensate for impaired cognition, such as executive functions, and the loss of skills.

Method

In this cross-sectional study (the UP'S study), we used measures of executive functioning and personal recovery to assess a cohort of people with a psychotic disorder. PR was measured using the Recovering Quality of Life (ReQOL) and Individual Recovery Outcomes (I.ROC). FR was assessed using two forms of assessment. The Behavioral Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used for self-rated executive functioning, and the Tower of London (TOL) for performance-based executive functioning. Regression models were calculated between executive functioning (BRIEF-A and TOL) and PR (ReQOL and I.ROC). Model selection was based on the Wald test.

Results

The study included data on 260 participants. While total scores of BRIEF-A had a small negative association with those of the ReQOL (β = -0.28, P > .001) and the I.ROC (β = -0.41, P > .001), TOL scores were not significantly associated with the ReQOL scores (β = 0.03, P = .76) and the I.ROC scores (β = 0.17, P = 0.17).

Conclusion

Self-reported EF, which measures the accomplishment of goal pursuit in real life was associated with PR. However, processing efficiency and cognitive control as measured by performance-based EF were not.

Characteristics associated with the discrepancy between subjective and objective executive functioning in depression

Major depressive disorder (MDD) is associated with both self-reported (subjective) cognitive complaints and deficits in neurocognitive (objective) measures, but the correspondence between subjective and objective measures of cognition is low. This cross-sectional study aimed to (1) assess the association between subjective and objective measures of executive functions (EFs), and (2) explore factors associated with the discrepancy between subjective and objective EFs in MDD. Sixty-two participants with current or previous mild to moderate MDD and subjective EF complaints completed a clinical trial baseline assessment. An objective EF composite score was drawn from six neurocognitive measures, while the Behavior Rating Inventory of Executive Function-Adult version was applied as a measure of subjective EF. The association between the subjective and objective composites was evaluated using Spearman's rank order correlation. A discrepancy score was calculated to quantify the difference between subjective and objective EF. Factors associated with the discrepancy score were analyzed using regression analysis (p < .05). Participants reported extensive EF difficulties, but most performed in the normal range on objective EF measures. A weak correlation was detected between the subjective and objective measures (r_s = .015). More rumination (β = -.364) and higher IQ (β = -.420) were associated with reporting more subjective complaints than was evident from objective measures of EF (i.e., underestimation). Subjective and objective EF measures are weakly overlapping in MDD. Findings underscore recommendations to include both subjective and objective measures when assessing EFs in depression. In addition, findings suggest that targeting ruminative processes could help correct underestimation.