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Moore MJ, Byrne J, Gibson EC, Ford L, Robinson GA. Hayling and stroop tests tap dissociable deficits and network-level neural correlates. Brain Struct Funct 2024; 229:879-896. [PMID: 38478051 PMCID: PMC11004053 DOI: 10.1007/s00429-024-02767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/24/2024] [Indexed: 04/10/2024]
Abstract
Although many executive function screens have been developed, it is not yet clear whether these assessments are equally effective in detecting post-stroke deficits of initiation and inhibition. This study presents a comparative analysis of the Stroop and Hayling tests aiming to evaluate whether these tests measure the same underlying cognitive functions and to identify the neural correlates of the deficits detected by both tasks. Sixty six stroke survivors and 70 healthy ageing controls completed the Hayling and Stroop tests. Stroke patients were found to exhibit qualitative performance differences across analogous Stroop and Hayling Test metrics intended to tap initiation and inhibition. The Stroop test was found to have high specificity to abnormal performance, but low sensitivity relative to the Hayling Test. Minimal overlap was present between the network-level correlates of analogous Stroop and Hayling Test metrics. Hayling Task strategy use metrics were significantly associated with distinct patterns of disconnection in stroke survivors, providing novel insight into the neural correlates of fine-grained behavioural patterns. Overall, these findings strongly suggest that the functions tapped by the Stroop and Hayling Test are both behaviourally and anatomically dissociable. The Hayling Test was found to offer improved sensitivity and detail relative to the Stroop test. This novel demonstration of the Hayling Test within the stroke population suggests that this task represents an effective measure for quantifying post-stroke initiation and inhibition deficits.
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Affiliation(s)
- Margaret Jane Moore
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia
| | - Jessica Byrne
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Emily C Gibson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Lucy Ford
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia.
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
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Hanley CJ, Burns N, Thomas HR, Marstaller L, Burianová H. The effects of age bias on neural correlates of successful and unsuccessful response inhibition in younger and older adults. Neurobiol Aging 2023; 131:1-10. [PMID: 37535985 DOI: 10.1016/j.neurobiolaging.2023.07.004] [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: 11/09/2022] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
Facilitating communication between generations has become increasingly important. However, individuals often demonstrate a preference for their own age group, which can impact social interactions, and such bias in young adults even extends to inhibitory control. To assess whether older adults also experience this phenomenon, a group of younger and older adults completed a Go/NoGo task incorporating young and old faces, while undergoing functional magnetic resonance imaging. Within the networks subserving successful and unsuccessful response inhibition, patterns of activity demonstrated distinct neural age bias effects in each age group. During successful inhibition, the older adult group demonstrated significantly increased activity to other-age faces, whereas unsuccessful inhibition in the younger group produced significantly enhanced activity to other-age faces. Consequently, the findings of the study confirm that neural responses to successful and unsuccessful inhibition can be contingent on the stimulus-specific attribute of age in both younger and older adults. These findings have important implications in regard to minimizing the emergence of negative consequences, such as ageism, as a result of related implicit biases.
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Affiliation(s)
| | - Natasha Burns
- School of Psychology, Swansea University, Swansea, UK; Department of Psychology, Bournemouth University, Bournemouth, UK
| | - Hannah R Thomas
- School of Psychology, Swansea University, Swansea, UK; Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK
| | - Lars Marstaller
- Department of Psychology, Bournemouth University, Bournemouth, UK
| | - Hana Burianová
- School of Psychology, Swansea University, Swansea, UK; Department of Psychology, Bournemouth University, Bournemouth, UK; Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
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Tjokrowijoto P, Phillips M, Ceslis A, Henderson RD, McCombe PA, Robinson GA. Sensitivity and specificity of the ECAS in identifying executive function and social cognition deficits in MND. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:466-474. [PMID: 36967700 DOI: 10.1080/21678421.2023.2188053] [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: 10/14/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
Objective: Motor neurone disease [MND] encompasses broad cognitive impairments, which are not fully captured by most screening tools. This study evaluated the specificity and sensitivity of the Edinburgh Cognitive and Behavioral ALS Screen [ECAS] in detecting impairments in executive function and social cognition. Methods: Participants (MND = 64; Healthy Controls = 45) completed the ECAS and standard neuropsychology tests of executive function and social cognition. Sensitivity and specificity of the ECAS were assessed at three levels (ALS-Specific score, executive function domain score, individual subtests: social cognition, inhibition, working memory, alternation). Results: MND patients were impaired on standard social cognition, initiation, visuomotor alternation, and verbal learning tests but not on inhibition or working memory tests, relative to controls. ECAS results revealed that the ALS-Specific score was high in specificity but low-to-moderately sensitive in identifying social cognition, inhibition, and working memory deficits, and that both sensitivity and specificity were high for identifying alternation deficits. The ECAS executive function domain score was high in specificity but poor in sensitivity for all four executive function domain subtests. The individual ECAS subtests were highly specific with good sensitivity, but the social cognition subtest lacked sensitivity. Conclusions: Impairments in social cognition may go undetected when using the ECAS as a screening tool. Thus, social cognition may need to be considered as a standalone component, distinct from the other executive functions. In addition, the test itself may need to be adjusted to encompass other aspects of social cognition that are affected in MND.Key messagesCognitive screening tools are key to detect cognitive changes in MND, with the domains most affected being executive functions, language, and social cognition.The ECAS measure, developed for MND, has good specificity but lacks sensitivity to impairments in social cognition.Clinical implications are that cognitive impairments in social cognition may not be identified in MND patients by the ECAS.Adjustment to the ECAS cognitive screening tool widely-used in MND is suggested.
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Affiliation(s)
- Priscilla Tjokrowijoto
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Mia Phillips
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Amelia Ceslis
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Robert D Henderson
- Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Wesley Medical Research, The Wesley Hospital, Brisbane, Australia, and
| | - Pamela A McCombe
- Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Wesley Medical Research, The Wesley Hospital, Brisbane, Australia, and
| | - Gail A Robinson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane, Australia
- Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
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The Use of Executive Fluency Tasks to Detect Cognitive Impairment in Individuals with Subjective Cognitive Decline. Behav Sci (Basel) 2022; 12:bs12120491. [PMID: 36546974 PMCID: PMC9774264 DOI: 10.3390/bs12120491] [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: 11/01/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVE Although evidence has indicated that subjective cognitive decline (SCD) may be an early sign of Alzheimer's disease (AD), the objectification of cognitive impairment in SCD is challenging, mainly due to the lack of sensitivity in assessment tools. The present study investigated the potential contribution of two verbal fluency tasks with high executive processing loads to the identification of cognitive impairment in SCD. METHODS A total of 60 adults with SCD and 60 healthy controls (HCs) performed one free action (verb) fluency task and two fluency tasks with more executive processing load-an alternating fluency task and an orthographic constraint fluency task-and the results were compared. RESULT In the free action fluency task, the performance of the participants with SCD and the HCs was similar. However, HCs performed significantly better than SCD in the alternating fluency task, which required mental flexibility, and the orthographic constraint fluency task, which required inhibition. DISCUSSION The study findings suggest that verbal fluency tasks with high executive processing load could be useful in detecting cognitive deficits at the preclinical stage of AD. The inclusion of such tests in assessment batteries should be considered in order to improve the detection of subtle cognitive impairment in preclinical major neurocognitive disorder populations.
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Schumacher R, Halai AD, Lambon Ralph MA. Assessing executive functions in post-stroke aphasia-utility of verbally based tests. Brain Commun 2022; 4:fcac107. [PMID: 35602650 PMCID: PMC9118101 DOI: 10.1093/braincomms/fcac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/16/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
It is increasingly acknowledged that, often, patients with post-stroke aphasia not only have language impairments but also deficits in other cognitive domains (e.g. executive functions) that influence recovery and response to therapy. Many assessments of executive functions are verbally based and therefore usually not administered in this patient group. However, the performance of patients with aphasia in such tests might provide valuable insights both from a theoretical and clinical perspective. We aimed to elucidate (i) if verbal executive tests measure anything beyond the language impairment in patients with chronic post-stroke aphasia, (ii) how performance in such tests relates to performance in language tests and nonverbal cognitive functions, and (iii) the neural correlates associated with performance in verbal executive tests. In this observational study, three commonly used verbal executive tests were administered to a sample of patients with varying aphasia severity. Their performance in these tests was explored by means of principal component analyses, and the relationships with a broad range of background tests regarding their language and nonverbal cognitive functions were elucidated with correlation analyses. Furthermore, lesion analyses were performed to explore brain-behaviour relationships. In a sample of 32 participants, we found that: (i) a substantial number of patients with aphasia were able to perform the verbal executive tests; (ii) variance in performance was not explained by the severity of an individual's overall language impairment alone but was related to two independent behavioural principal components per test; (iii) not all aspects of performance were related to the patient's language abilities; and (iv) all components were associated with separate neural correlates, some overlapping partly in frontal and parietal regions. Our findings extend our clinical and theoretical understanding of dysfunctions beyond language in patients with aphasia.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Ajay D. Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Matthew A. Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
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Clustering of indicators of the cognitive status in cardiac surgery patients to assess the risk of postoperative decline. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of the study. To determine the informational value of psychometric indicators used for the integral assessment of cognitive status in cardiac patients, and to find those that would help differentiate the individual sensibility to postoperative cognitive dysfunction (POCD).Materials and methods. The clustering methods were analyzed the extended psychometric testing data in 256 cardiac surgery patients. The psychometric testing carried out 3–5 days before and on days 7–10 after surgery using the psychophysiological complex program “Status PF”.Results. The cluster analysis revealed that the most informative tests for a screening risk assessment of POCD are the testing the speed of response to visual stimuli with feedback of changes in the stimuli exposition according to the individual reaction time and the testing short-term memory (memorized words). While the analysis of postoperative psychometric indicators, the patients in a modified clustering group were characterized by a deterioration of verbal memory and a decrease of the time reaction to visual stimuli whereas that its observed acceleration in the general “stable” group.Conclusion. The clustering methods enabled the identification of cardiac surgery patients in the preoperative stage who had less cognitive reserve for recovery after surgery. The changes in the relationship of complex visual and motor response, attention, and memory indicators, which depended on the belonging to the identified clusters, suggest that the preoperative period is characterized by the dedifferentiation of cognitive functions indicating a cognitive deficit.
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1653-1661. [DOI: 10.1093/arclin/acac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/14/2022] Open
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Gonzalez-Gomez R, Rodríguez-Villagra OA, Schulte M, Torralva T, Ibáñez A, Huepe D, Fittipaldi S. Neurocognitive factorial structure of executive functions: Evidence from neurotypicals and frontotemporal dementia. Cortex 2021; 145:79-96. [PMID: 34689034 PMCID: PMC11168581 DOI: 10.1016/j.cortex.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/01/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
The latent structure of executive functions (EFs) remains controversial. Confirmatory factorial analysis (CFA) has provided support for both multidimensional (assumes EFs to be functionally separable but related components) and bifactor (proposes all components are nested within a common factor) models. However, these CFA models have never been compared in patient samples, nor regarding their neuroanatomical correlates. Here, we systematically contrast both approaches in neurotypicals and in a neurodegenerative lesion model (patients with the behavioral variant frontotemporal dementia, bvFTD), characterized by executive deficits associated with frontal neurodegeneration. First, CFA was used to test the models' fit in a sample of 341 neurotypicals and 29 bvFTD patients based on performance in an executive frontal screening battery which assesses working memory, motor inhibition, verbal inhibition, and abstraction capacity. Second, we compared EFs factor and observed scores between patients and matched controls. Finally, we used voxel-based morphometry (VBM) to compare the grey matter correlates of factor and observed scores. CFA results showed that both models fit the data well. The multidimensional model, however, was more sensitive than the bifactor model and the observed scores to detect EFs impairments in bvFTD patients. VBM results for the multidimensional model revealed common and unique grey matter correlates for EFs components across prefrontal-insular, posterior, and temporal cortices. Regarding the bifactor model, only the common factor was associated with prefrontal-insular hubs. Observed scores presented scant, non-frontal grey matter associations. Converging behavioral and neuroanatomical evidence from healthy populations and a neurodegenerative model of EFs supports an underlying multidimensional structure.
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Affiliation(s)
- Raul Gonzalez-Gomez
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Odir Antonio Rodríguez-Villagra
- Institute for Psychological Research, University of Costa Rica, Sabanilla, Costa Rica; Neuroscience Research Center, University of Costa Rica, San Pedro, Costa Rica
| | - Michael Schulte
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Global Brain Health Institute, University of California San Francisco (UCSF), US and Trinity College Dublin (TCD), Ireland
| | - David Huepe
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile.
| | - Sol Fittipaldi
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Facultad de Psicología, Universidad Nacional de Córdoba, Argentina.
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Robinson GA, Campbell L, Ceslis A. A Goal Intervention Improves Language Fluency: Evidence from Parkinson's Disease and Healthy Aging. MEDICINES 2021; 8:medicines8030015. [PMID: 33810201 PMCID: PMC8004843 DOI: 10.3390/medicines8030015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 12/04/2022]
Abstract
Background: Parkinson’s disease [PD] is associated with reduced motor and cognitive initiation, and decreased goal-directed behavior including language generation. The current study investigated a novel goal intervention for language generation impairments in PD patients. Methods: Twenty-one PD patients and 22 healthy controls, matched for gender, age, and education, completed a cognitive baseline and language generation tasks (complex scene descriptions and phonemic/semantic word fluency) with standard and adapted instructions, which implements a target ‘goal’. In addition, participants completed self-report questionnaires for apathy and mood. Results: PD patients performed more poorly on two of three language generation tasks. The goal intervention was effective in increasing both the PD patient and healthy control groups’ language generation. However, there was no differential benefit of increased goal specificity and difficulty for PD patients. As a group, PD patients reported higher levels of apathy and depression than healthy controls. Specifically, PD patients with executive apathy were more likely to have language generation impairments than PD patients without executive apathy and controls. Apathy subscales and goal benefit were unrelated. Conclusions: The goal intervention was effective for PD patients and older adults, suggesting that enhanced goal specificity and difficulty may benefit individuals with PD or those aging naturally.
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Affiliation(s)
- Gail A. Robinson
- Queensland Brain Institute, The University of Queensland, Brisbane 4072, Australia
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane 4072, Australia; (L.C.); (A.C.)
- Correspondence: ; Tel.: +61-(0)7-3365-6401
| | - Lara Campbell
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane 4072, Australia; (L.C.); (A.C.)
| | - Amelia Ceslis
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane 4072, Australia; (L.C.); (A.C.)
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Belghali M, Statsenko Y, Laver V. Stroop switching card test: brief screening of executive functions across the lifespan. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 29:14-33. [PMID: 33161873 DOI: 10.1080/13825585.2020.1844865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to: (1) propose a novel version of the Stroop switching test, namely the Stroop Switching Card Test (SSCT), to assess the overall efficiency of executive functions (EF) and its underlying cognitive processes (conflict resolution and conflict adaptation); (2) examine the utility of the SSCT in the assessment of EF in different age groups (age range 15-75 years), compare its results with standard neuropsychological tests (SNT), and (3) examine the contribution of both the processing speed and cognitive reserve on the performance of all used tests. The SSCT showed more sensitivity to detect subtle executive dysfunction in the middle age (~50 years). Going further, the SSCT revealed a progressive decline in conflict adaptation over two life periods. The first period of decline started at ~50 years and the second at~ 65 years. The processing speed and cognitive reserve had a prominent role in our results, notably in SSCT.
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Affiliation(s)
- Maroua Belghali
- INSERM, COMETE, GIP CYCERON, Normandie Univ, UNICAEN, Caen, Research Unit: Aging, Health & Diseases, Caen, France.,College of Education, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Yauhen Statsenko
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Vasyl Laver
- Department of Informative and Operating Systems and Technologies, Uzhhorod National University, Uzhhorod, Ukraine
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Varkovetski M, Pihkanen K, Shanker S, Parris BA, Gurr B. What type of inhibition underpins performance on Luria's Fist-Edge-Palm task? J Clin Exp Neuropsychol 2020; 42:544-555. [PMID: 32586188 DOI: 10.1080/13803395.2020.1776846] [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: 10/24/2022]
Abstract
OBJECTIVE The Fist-Edge-Palm task is a motor sequencing task believed to be sensitive to frontal lobe impairment. The present study aimed to investigate the inhibitory processes underlying successful execution of this task. METHOD Seventy-two healthy participants were asked to perform the Fist-Edge-Palm task paced at 120 bpms, 60 bpms and self-paced. They also completed assessments sensitive to recently dissociated forms of inhibition (the Hayling Sentence Completion Test and the Stroop Color-Word Test) that have recently been shown to be differentially lateralized (the right and left Prefrontal Cortex, respectively), and Cattell's Culture Fair Intelligence test. RESULTS Analysis revealed that performance on the Hayling Sentence Completion Test predicted the amount of crude errors and the overall score on the Fist-Edge-Palm task, and that pacing condition had no effect on this outcome. Neither the Stroop Color-Word Test nor Cattell's Culture Fair Intelligence Test predicted performance on the Fist-Edge-Palm task. CONCLUSIONS Consistent with some previous neuroimaging findings, the present findings suggest that Fist-Edge-Palm task performance relies on right lateralized inhibitory processes.
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Affiliation(s)
| | - Kaisla Pihkanen
- Department of Psychology, Bournemouth University , Poole, UK
| | - Shanti Shanker
- Department of Psychology, Bournemouth University , Poole, UK.,Community Brain Injury and Adult Neuropsychology Poole Hospital, Dorset Healthcare University NHS Foundation Trust , Poole, UK
| | | | - Birgit Gurr
- Community Brain Injury and Adult Neuropsychology Poole Hospital, Dorset Healthcare University NHS Foundation Trust , Poole, UK
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