Impaired memory retrieval after psychosocial stress in healthy young men

Decision-making under stress: A psychological and neurobiological integrative model

Understanding the impact of stress on cognitive processes, particularly decision-making, is crucial as it underpins behaviors essential for survival. However, research in this domain has yielded disparate results, with inconsistencies evident across stress-induction paradigms and drug administration protocols designed to investigate specific stress pathways or neuromodulators. Building upon empirical studies, this research identifies a multifaceted matrix of variables contributing to the divergent findings. This matrix encompasses factors such as the temporal proximity between stressors and decision tasks, the nature of stressors and decision contexts, individual characteristics including psychobiological profiles and affective states at the time of decision-making and even cultural influences. In response to these complexities, we propose a comprehensive model that integrates these relevant factors and their intricate interplay to elucidate the mechanisms governing decision-making during stressful events. By synthesizing these insights, our model not only refines existing paradigms but also provides a framework for future study designs, offering avenues for theoretical advancements and translational developments in the field of stress's impact on cognitive functions. This research contributes to a deeper understanding of the nuanced relationship between stress and decision-making, ultimately advancing our knowledge of cognitive processes under challenging conditions.

Impaired free recall of neutral but not negative material tested 105 min after cortisol administration

Pharmacological studies have consistently shown memory retrieval impairment after administration of cortisol, particularly pronounced for emotional laboratory material (i.e. list of emotional words). However, it is unclear how pharmacological elevation of cortisol affects memory retrieval of ecologically-relevant emotional material (i.e. similar to a newspaper article about an emotional event). In the present study, we aimed to explore whether cortisol administration affects the recall of ecologically-relevant emotional and neutral material, and when memory retrieval occurs after a longer delay (105 min). In this double-blind, pseudo-randomized, placebo-control study, 79 participants learned a negative text and a neutral text. Twenty-four hours later, they were administrated either 10 mg of hydrocortisone or placebo. After 105 min, participants engaged in free recall of both texts. The group with cortisol administration showed significantly reduced free recall compared to the placebo group. Interestingly, this memory retrieval impairment was driven by significantly lower recall after cortisol vs. placebo administration for neutral texts, but not negative texts. The current finding suggests that cortisol administration impairs neutral ecologically-relevant material while leaving emotional material unaffected. These divergent findings, compared to existing literature, emphasize the necessity of employing more ecologically validated material to gain a more comprehensive understanding of the intricate interplay between cortisol administration and memory for ecological material.

Acute Stress Enhances Memory and Preference for Smoking-Related Associations in Smokers

INTRODUCTION

Nicotine dependence follows a chronic course that is characterized by repeated relapse, often driven by acute stress and rewarding memories of smoking retrieved from related contexts. These two triggers can also interact, with stress influencing retrieval of contextual memories. However, the roles of these processes in nicotine dependence remain unknown.

AIMS AND METHODS

We investigated how acute stress biases memory for smoking-associated contexts among smokers (N = 65) using a novel laboratory paradigm. On day 1, participants formed associations between visual stimuli of items (either neutral or related to smoking) and places (background scenes). On day 2 (24 hours later), participants were exposed to an acute laboratory-based stressor (socially evaluated cold pressor test; N = 32) or a matched control condition (N = 33) prior to being tested on their memory recognition and preferences for each item and place. We distinguished the accuracy of memory into specific (ie, precisely correct) or gist (ie, lure items with similar content) categories.

RESULTS

Results demonstrated that the stressor significantly induced physiological and subjective perceived stress responses, and that stressed smokers exhibited a memory bias in favor of smoking-related items. In addition, the stressed group displayed greater preference for both smoking-related items and places that had been paired with the smoking-related items. We also found suggestive evidence that stronger smoking-related memory biases were associated with more severe nicotine dependence (ie, years of smoking).

CONCLUSIONS

These results highlight the role of stress in biasing smokers toward remembering contexts associated with smoking, and amplifying their preference for these contexts.

IMPLICATIONS

The current study elucidates the role of acute stress in promoting memory biases favoring smoking-related associations among smokers. The results suggest that the retrieval of smoking-biased associative memory could be a crucial factor in stress-related nicotine seeking. This may lead to a potential intervention targeting the extinction of smoking-related context memories as a preventive strategy for stress-induced relapse.

Exploring stress response's role in executive function impairments among adults with early adverse childhood experiences

Adverse childhood experiences (ACEs) are recognised as precursors to numerous physical and mental health challenges. However, research on their impact on inhibitory control and working memory, particularly among healthy young adults, remains limited. The role played by the stress response as a moderator in these effects is likewise underexplored. Our study addresses this gap by examining cognitive impairments in non-clinical adults with early childhood trauma, specifically trauma before the age of 13 years, and by assessing the influence of the stress response on these effects. A total of 15 participants with early ACEs were compared with a control group (n = 18) using the Corsi Block Tapping Test (CBTT) and Stroop Word Colour Test (SCWT). Results showed that participants with early ACEs exhibited lower scores on the SCWT but not the CBTT. The stress response emerged as a potential factor in the relationship between early ACEs and cognitive performance. The implications of these findings are then discussed in relation to the existing literature.

Effect of acute stress on working memory in pilots: Investigating the modulatory role of memory load

Many practitioners, such as pilots, frequently face working memory (WM) demands under acute stress environments, while the effect of acute stress on WM has not been conclusively studied because it is moderated by a variety of factors. The current study investigated how acute stress affects pilots' WM under different memory load conditions. There are 42 pilots conducting the experiments, consisting of 21 stress group participants experiencing the Trier Social Stress Test (TSST) and 21 control group participants experiencing the controlled TSST (C-TSST). Subsequently, both groups performed N-back tasks under three memory load conditions (0-back, 1-back, and 2-back). State Anxiety Inventory (S-AI), heart rate (HR), and salivary cortisol concentrations (SCC) were collected to analyze acute stress induction. The results revealed that (1) the TSST could effectively induce acute stress with higher S-AI, HR, and SCC; (2) higher memory load reduces WM accuracy (ACC) and delays response times (RT); (3) acute stress increases WM ACC under moderate load conditions (1-back task). These results suggest that acute stress may not necessarily impair WM and even improve WM performance under certain memory load conditions. Potential mechanisms of acute stress effects on WM and alternative explanations for the modulatory role of memory load consistent with the emotion and motivation regulation theory are discussed. These findings not only provide insight into the field of acute stress and WM but are also beneficial for pilot training and the development of stress management strategies.

Untapped resource: the simulation-based healthcare environment as a means to study human stress

The effects of 'stress' within the healthcare professions are wide-reaching, not least of all within the field of simulation-based healthcare education. Whilst this popular method of experiential learning offers a 'safe space' for participants to develop their skillset, it also has a more surreptitious action; namely, the incubation of simulation-related stress. Currently, research concerning the complex relationship between stress, learning, and performance is ambiguous, leaving fertile ground for simulationists to debate what level of stress is appropriate for an optimised educational experience. In this narrative review, we examine the human response to stress and outline the various methods that have been used by researchers to measure stress in a quantifiable and standardised way. We then provide a brief overview of simulation-based healthcare education before describing why stress responses have been of interest to healthcare educationalists for some time. Finally, we outline how simulation education environments might provide an ideal environment for studying the human response to stress generally, with ramifications extending beyond the field of medical education.

A Virtual Reality Courtroom for Survivors of Sexual Violence: A Mixed-Method Pilot Study on Application Possibilities

This mixed-method pilot study examined the application possibilities of a virtual courtroom to support survivors of sexual violence who may experience courtroom-associated distress. Female sexual violence survivors (n = 13) who had testified in court following victimization entered an interactive virtual courtroom replica. Their reactions were measured quantitatively and qualitatively. The virtual courtroom evoked both subjective and physiological stress. Participants perceived the virtual reality environment as similar to the real-life courtroom. Most reported negative experiences from interacting with the criminal justice system. The virtual courtroom is a possible future strategy to support survivors when reporting violence to the justice system.

A quality improvement project to improve the quality of medical emergency aide-mémoires

Introduction Medical emergencies occur within the dental setting and we have a duty of care to manage them appropriately. Due to perceived anxiety in handling medical emergencies, aide-mémoires were developed to improve staff confidence in the management of these stressful situations.Methods A survey was carried out at The Royal London Dental Hospital to assess knowledge and experience in use of existing supportive materials for medical emergency management. New colour-coded flashcards were subsequently developed, providing guidance to identifying and managing medical emergencies. A questionnaire was produced assessing clinicians' awareness of existing prompts and preferences in relation to the new flashcards. Updated cards were incorporated into simulated medical emergency teaching and evaluated afterwards through a questionnaire.Results A total of 50 responses were gathered across departments to the questionnaire regarding preliminary flashcards: 95% favoured the flashcard approach and felt they would be more helpful managing medical emergencies. The new flashcards were used by 18 clinicians in medical emergency simulation and 17 (94%) felt that using the cards improved their confidence in the handling of medical emergencies.Discussion The flashcards have been perceived to be useful in the handling of medical emergencies within our dental hospital. A similar project may be beneficial to clinical teams working across dental settings.

Increased hippocampal CREB phosphorylation after retrieval of remote contextual fear memories in Carioca high-conditioned freezing rats

The participation of the hippocampal formation in consolidation and reconsolidation of contextual fear memories has been widely recognized and known to be dependent on the activation of the cAMP response element (CRE) binding protein (CREB) pathway. Recent findings have challenged the prevailing view that over time contextual fear memories migrate to neocortical circuits and no longer require the hippocampus for retrieval of remote fearful memories. It has also recently been found that this brain structure is important for the maintenance and recall of remote fear memories associated with aversive events, a common trait in stress-related disorders such as generalized anxiety disorder (GAD), major depression, and post-traumatic stress disorder. In view of these findings, here we examined the putative role of CREB in the hippocampus of an animal model of GAD during the retrieval of remote contextual fear memories. Specifically, we evaluated CREB phosphorylation in the hippocampus of male Carioca High- and Low-conditioned Freezing rats (CHF and CLF, respectively) upon re-exposure of animals to contextual cues associated to footshocks weeks after fear conditioning. Age-matched male rats from a randomized crossbreeding population served as controls (CTL). Adrenal catecholamine levels were also measured as a biological marker of stress response. Seven weeks after contextual fear conditioning, half of the sample of CHF (n = 9), CLF (n = 10) and CTL (n = 10) rats were randomly assigned to return to the same context chamber where footshocks were previously administrated (Context condition), while the remaining animals were individually placed in standard housing cages (Control condition). Western blot results indicated that pCREB levels were significantly increased in the hippocampus of CHF rats for both Context and Control conditions when compared to the other experimental groups. CHF rats in the Context condition also exhibited significant more freezing than that observed for both CLF and CTL rats. Lastly, CHF animals in the Context condition displayed significantly higher adrenal catecholamine levels than those in the Control condition, whereas no differences in catecholamine levels were observed between Context and Control conditions for CLF and CTL rats. These findings are discussed from a perspective in which the hippocampus plays a role in the maintenance and recall of remote contextual fear memories via the CREB pathway.

A standardized Ashwagandha root extract alleviates stress, anxiety, and improves quality of life in healthy adults by modulating stress hormones: Results from a randomized, double-blind, placebo-controlled study

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic has resulted in a surge in stress, anxiety, and depression worldwide. Ashwagandha, an ayurvedic adaptogen has been traditionally used to manage stress, anxiety, and general well-being.

OBJECTIVE

We assessed the effect of Ashwagandha root extract (ARE-500 mg) standardized for 2.5% withanolides as per USP protocol with piperine (5 mg of 95% piperine) once daily for 60 days (12.5 mg withanolides/day) to alleviate stress and anxiety in healthy individuals with mild to moderate symptoms.

METHODS

A randomized, double-blind, placebo-controlled study was conducted for 60 days using ARE (n = 27) and placebo (n = 27) once daily at night at Narayana Institute of Cardiac Sciences, Bangalore, and Vijaya Super Specialty Hospital, Nellore, in India. The objectives of this study were to assess an improvement in perceived stress scale (PSS), generalized anxiety disorder (GAD-7), quality of life (QOL), cognitive scores in the Cambridge Neuropsychological Test Automated Battery (CANTAB), changes in salivary cortisol, urinary serotonin, dopamine, serum levels of nitric oxide (NO), glutathione (GSH) and malondialdehyde (MDA) from baseline to end of the study. Safety was evaluated by laboratory parameters, and by monitoring any incidence of adverse events.

RESULTS

54 individuals were randomized and 50 of them completed the study. The PSS, GAD-7, and QOL scores improved significantly in all the participants taking ARE compared to the placebo. The CANTAB analysis revealed a significant improvement in multitasking, concentration, and decision taking time in ARE compared to placebo. ARE was also associated with a greater reduction in the morning salivary cortisol and an increase in urinary serotonin compared to placebo. Serum levels of NO, GSH, and MDA were not significantly different. Biochemical and hematological parameters remained in the normal range in all participants and ARE was well tolerated during the study.

CONCLUSION

The results of the study suggest that ARE with 2.5% withanolides can effectively improve stress and anxiety by reducing cortisol and increasing serotonin in healthy individuals with mild to moderate symptoms.

The Neuroendocrine Impact of Acute Stress on Synaptic Plasticity

Stress induces changes in nervous system function on different signaling levels, from molecular signaling to synaptic transmission to neural circuits to behavior-and on different time scales, from rapid onset and transient to delayed and long-lasting. The principal effectors of stress plasticity are glucocorticoids, steroid hormones that act with a broad range of signaling competency due to the expression of multiple nuclear and membrane receptor subtypes in virtually every tissue of the organism. Glucocorticoid and mineralocorticoid receptors are localized to each of the cellular compartments of the receptor-expressing cells-the membrane, cytosol, and nucleus. In this review, we cover the neuroendocrine effects of stress, focusing mainly on the rapid actions of acute stress-induced glucocorticoids that effect changes in synaptic transmission and neuronal excitability by modulating synaptic and intrinsic neuronal properties via activation of presumed membrane glucocorticoid and mineralocorticoid receptors. We describe the synaptic plasticity that occurs in 4 stress-associated brain structures, the hypothalamus, hippocampus, amygdala, and prefrontal cortex, in response to single or short-term stress exposure. The rapid transformative impact of glucocorticoids makes this stress signal a particularly potent effector of acute neuronal plasticity.

A terrified-sound stress causes cognitive impairment in female mice by impairing neuronal plasticity

Stress is an important environmental factor affecting mental health that cannot be ignored. Moreover, due to the great physiological differences between males and females, the effects of stress may vary by sex. Previous studies have shown that terrified-sound stress, meaning exposed mice to the recorded vocalizations in response to the electric shock by their kind to induce psychological stress, can cause cognitive impairment in male. In the study, we investigated the effects of the terrified-sound stress on adult female mice.

METHODS

32 adults female C57BL/6 mice were randomly divided into control (n = 16) and stress group (n = 16). Sucrose preference test (SPT)was carried out to evaluate the depressive-like behavior. Using Open field test (OFT) to evaluate locomotor and exploratory alterations in mice. Spatial learning and memory ability were measured in Morris Water maze test (MWM), Golgi staining and western blotting showed dendritic remodeling after stress. In addition, serum hormone quantifications were performed by ELISA.

RESULTS

we found the sucrose preference of stress group was significantly decreased (p < 0.05) compared with control group; the escape latency of the stress group was significantly prolonged (p < 0.05), the total swimming distance and the number of target crossings(p < 0.05) were significantly increased (p < 0.05) in MWM; Endocrine hormone, Testosterone (T) (p < 0.05), GnRH (p < 0.05), FSH and LH levels was decreased; Golgi staining and western blotting showed a significant decrease in dendritic arborization, spine density and synaptic plasticity related proteins PSD95 and BDNF in the stress group.

CONCLUSION

Terrified-sound stress induced depressive-like behaviors, locomotor and exploratory alterations. And impaired cognitive by altering dendritic remodeling and the expression of synaptic plasticity-related proteins. However, females are resilient to terrified-sound stress from a hormonal point of view.

Development of the perceived miscommunication measure in the pediatric intensive care unit

PURPOSE

Miscommunication between parents and healthcare providers in the Pediatric Intensive Care Unit (PICU) can affect family-provider relationships and outcomes. This paper reports on the development and psychometric testing of a measure for parent perceived miscommunication, defined as the failure to communicate clearly as perceived by relevant stakeholders in the PICU.

DESIGN AND METHODS

Miscommunication items were identified through a review of the literature with interdisciplinary experts. In a cross-sectional quantitative survey, the scale was tested with 200 parents of children discharged from a PICU at a large Northeastern Level 1 Pediatric hospital. The psychometric properties of a 6-item miscommunication measure were assessed using exploratory factor analysis and internal consistency reliability.

RESULTS

Exploratory factor analysis yielded one factor explaining 66.09% of the variance. Internal consistency reliability in the PICU sample was α = 0.89. As hypothesized, there was a significant correlation between parental stress, trust, and perceived miscommunication in the PICU (p < .001). Confirmatory factor analysis supported good fit indices in testing the measurement model (χ2/df = 2.57, Goodness of Fit Index (GFI) = 0.979, Confirmatory Fit Index (CFI) =0.993 and Standardized Mean Residual (SMR) = 0.0136).

CONCLUSIONS

This new six-item miscommunication measure shows promising psychometric properties including content and construct validity, which can be further tested and refined in future studies of miscommunication and outcomes in PICU.

PRACTICE IMPLICATIONS

Awareness of perceived miscommunication in the PICU can benefit stakeholders within the clinical environment by recognizing the importance of clear and effective communication and how language affects the parent-child-provider relationship.

Associations between saliva alpha-amylase, heart rate variability, saliva cortisol and cognitive performance in individuals at ultra high-risk for psychosis

BACKGROUND

Cognitive impairments are present in individuals at ultra-high risk (UHR) of psychosis and UHR individuals exhibit a hyperactive and dysfunctional HPA-axis. Increasing stress levels could potentially lead to cognitive impairments and no previous studies have examined the association between physiological stress biomarkers and cognition in UHR individuals. This study aims to examine the association between saliva alpha amylase (SAA), heart rate variability (HRV), saliva cortisol, and cognition in UHR individuals.

METHOD

We included 72 UHR individuals, aged 18-40, fulfilling criteria of the comprehensive assessment of at-risk mental state (CAARMS). Cognitive tests indexed the 7 core domains as stated by Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS). Physiological stress levels were observed for one day: saliva was collected at awakening, 30 min and 60 min after awakening and at bedtime. HRV was measured during sleep and before awakening. We used generalized linear model and controlled for multiple testing using false discovery rate (FDR).

RESULTS

Higher levels of SAA were significantly associated with lower cognitive performance in the domains of verbal and visual learning and memory, sustained attention, working memory and global neurocognition looking at unadjusted data. Controlling for FDR visual memory, sustained attention and global neurocognition remained significant associated with SAA. We discovered no associations between cortisol and cognition.

CONCLUSION

Visual learning and memory, sustained attention and global neurocognition remained significantly associated with SAA. This finding supports our hypothesis that an association between abnormal stress biomarkers and impaired cognition might be present in UHR individuals.

Modern Paediatric Emergency Department: Potential Improvements in Light of New Evidence

The increasing attendance of paediatric emergency departments has become a serious health issue. To reduce an elevated burden of medical errors, inevitably caused by a high level of stress exerted on emergency physicians, we propose potential areas for improvement in regular paediatric emergency departments. In an effort to guarantee the demanded quality of care to all incoming patients, the workflow in paediatric emergency departments should be sufficiently optimised. The key component remains to implement one of the validated paediatric triage systems upon the patient's arrival at the emergency department and fast-tracking patients with a low level of risk according to the triage system. To ensure the patient's safety, emergency physicians should follow issued guidelines. Cognitive aids, such as well-designed checklists, posters or flow charts, generally improve physicians' adherence to guidelines and should be available in every paediatric emergency department. To sharpen diagnostic accuracy, the use of ultrasound in a paediatric emergency department, according to ultrasound protocols, should be targeted to answer specific clinical questions. Combining all mentioned improvements might reduce the number of errors linked to overcrowding. The review serves not only as a blueprint for modernising paediatric emergency departments but also as a bin of useful literature which can be suitable in the paediatric emergency field.

The Adult Difficult Intravenous Access (DIVA) Cognitive Aid: An Evidence-Based Cognitive Aid Prototype for Difficult Peripheral Venous Access

Difficult intravenous access (DIVA) is common, with imperfect solutions. Cognitive aids are widespread in anaesthesia; however, a standard DIVA cognitive aid is lacking. This article describes a cognitive aid for DIVA. It has been developed using evidence-based techniques for DIVA. The effects of heuristics, biases, and automatic thinking on procedural decision-making are briefly discussed. While often useful, shortcut decision-making can impair the performance of apparently simple tasks. Cognitive aids may lead to better outcomes by providing choice architecture. This resource is intended as a cognitive aid prototype for difficult peripheral venous access, incorporating both modern behavioural psychology principles and evidence-based medicine. It may be used as both an educational tool, or as a cognitive aid to assist in situations where DIVA is encountered or expected. The adult DIVA cognitive aid is intended for use in both elective and emergency scenarios by practitioners adequately trained in ultrasound-guided or ultrasound-assisted vascular access and Seldinger-based techniques. Clinical implementation and audit of the adult DIVA cognitive aid, or similar locally developed cognitive aids based on this prototype are recommended.

Rapid and delayed stress effects on recognition of female and male faces

Stress and the stress hormone cortisol typically impair memory recognition, especially for emotional words, scenes or objects. However, prior research almost exclusively focused on rapid non-genomic cortisol effects. Additionally, findings for stress hormone effects on face stimuli are contradictory and rare, although very relevant for everyday life. In this preregistered study, we investigated the rapid and delayed stress effects on memory recognition for faces. In a two-day design, 52 healthy men first encoded pictures of male and female faces with distinct emotional expressions. One day later, participants were exposed to a psychophysiological stress (Socially Evaluated Cold-Pressor Test) or a (warm water) control procedure. Memory for the faces was tested at two time points: 25 min after stress onset at the peak of the cortisol increase for stressed participants (rapid non-genomic cortisol effects, which presumably operate within minutes through membrane bound receptors), as well as 90 min after stress onset when cortisol concentrations were back to baseline (delayed genomic cortisol effects, which describe an altered gene transcription resulting in modified neural functions, acting supposedly via intracellular receptors). Rapid stress effects led to enhanced memory recognition for female faces selectively, whereas delayed stress effects led to enhanced memory recognition across male and female faces. Altogether, we observed a beneficial rather than detrimental impact of stress on face recognition with a differential impact on recognition of male and female faces over time. It remains to be determined if this beneficial stress effect relies on the interaction of participants' sex and the sex of facial stimuli. Future research should also more closely look at the underlying mechanisms of how stress exactly influences face recognition, which is for example critically relevant for testimonies.

Neurovascular adaptations modulating cognition, mood, and stress responses

The neurovascular unit (NVU) is a dynamic center for substance exchange between the blood and the brain, making it an essential gatekeeper for central nervous system (CNS) homeostasis. Recent evidence supports a role for the NVU in modulating brain function and cognition. In addition, alterations in NVU processes are observed in response to stress, although the mechanisms via which they can affect mood and cognitive functions remain elusive. Here, we summarize recent studies of neurovascular regulation of emotional processes and cognitive function, including under stressful conditions. We also highlight relevant RNA-sequencing (RNA-seq) databases aiming to profile the NVU along with innovative tools to study and manipulate NVU function that can be exploited in the context of cognition and stress research throughout development, aging, or brain disorders.

Effects of Acute Stress on Rigid Learning, Flexible Learning, and Value-Based Decision-Making in Spatial Navigation

The current study investigated how stress affects value-based decision-making during spatial navigation and different types of learning underlying decisions. Eighty-two adult participants (42 females) first learned to find object locations in a virtual environment from a fixed starting location (rigid learning) and then to find the same objects from unpredictable starting locations (flexible learning). Participants then decided whether to reach goal objects from the fixed or unpredictable starting location. We found that stress impairs rigid learning in females, and it does not impair, and even improves, flexible learning when performance with rigid learning is controlled for. Critically, examining how earlier learning influences subsequent decision-making using computational models, we found that stress reduces memory integration, making participants more likely to focus on recent memory and less likely to integrate information from other sources. Collectively, our results show how stress impacts different memory systems and the communication between memory and decision-making.

The Forward Testing Effect Is Resistant to Acute Psychosocial Retrieval Stress

The forward testing effect refers to the finding that testing of previously studied information improves memory for subsequently studied newer information. Recent research showed that the effect is immune to acute psychosocial encoding/retrieval stress, i.e., stress that is induced before initial encoding. The present study investigated whether the forward testing effect is also robust to acute psychosocial retrieval stress, i.e., stress that is induced after encoding but before retrieval of the critical item list. Participants (N = 128) studied three lists of words in anticipation of a final cumulative recall test. Participants were tested immediately on Lists 1 and 2 (testing condition) or restudied the two lists after initial study (restudy condition). After study of the critical List 3, psychosocial stress was induced in half of the participants (stress group), whereas no stress was induced in the other half (control group). The Trier Social Stress Test for Groups (TSST-G) was used for stress induction. Salivary cortisol, alpha amylase, and subjective stress were repeatedly measured. The results of the criterion test showed a generally detrimental effect of psychosocial retrieval stress on List 3 recall. Importantly, the forward testing effect was unaffected by retrieval stress. The findings are discussed with respect to current theories of the forward testing effect.

Short-term isolation effects on the brain, cognitive performance, and sleep-The role of exercise

Isolation is stressful and negatively affects sleep and mood and might also affect the structure and function of the brain. Physical exercise improves brain function. We investigated the influence of physical exercise during isolation on sleep, affect, and neurobehavioral function. N = 16 were isolated for 30 days with daily exercise routines (ISO₁₀₀) and n = 16 isolated for 45 days with every second day exercise (ISO₅₀). N = 27 were non-isolated controls who either exercised on a daily basis (CTRL_Ex) or refused exercise (CTRL_NonEx) for 30 days. At the beginning and the end of each intervention, intravenous morning cortisol, melatonin, brain-derived neurotrophic factor and IGF-1, positive and negative affect scales, electroencephalography, cognitive function, and sleep patterns (actigraphy) were assessed. High levels of cortisol were observed for the isolated groups (p < .05) without negative effects on the brain, cognitive function, sleep, and mood after 4 to 6 weeks of isolation, where physical exercise was performed regularly. An increase in cortisol and impairments of sleep quality, mood, cognitive function, and neurotrophic factors (p < .05) were observed after 4 weeks of absence of physical exercise in the CTRL_NonEx group. These findings raise the assumption that regular physical exercise routines are a key component during isolation to maintain brain health and function.

Acute stress and human spatial working memory strategy use

Acute stress can impair human working memory. Little is known, however, about the effects of acute stress on working memory strategies. The goal of this research was to investigate the effects of acute stress on use of a systematic spatial working memory search strategy. Participants (28 females and 20 males per group) completed the Trier Social Stress Test (TSST) or control tasks. Use of a systematic spatial working memory search strategy was measured through performance on the spatial working memory subtest of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The TSST was effective at producing subjective and cortisol stress responses, but there was no significant stress effect on use of a systematic search strategy or working memory search errors. There were also no significant relationships between subjective and cortisol stress responses and use of a systematic search strategy or working memory search errors within the stress group. These results suggest that acute stress does not impair the self-generation or execution of a systematic spatial working memory search strategy.

Screening for Cognitive Impairment with the Quick Memory Check: Validation of a Caregiver Administered Cognitive Screen

BACKGROUND

Self or home-administered cognitive screening instruments (CSIs) can reduce barriers to the early detection of mild cognitive impairment (MCI) and dementia.

OBJECTIVE

To examine the acceptability and diagnostic accuracy of a caregiver-administered CSI, the Quick Memory Check (QMC).

METHODS

Components of the Quick Mild Cognitive impairment (Qmci) screen (orientation, verbal fluency, and logical memory) were re-weighted to create the QMC, scored out of 100 points. Participants, attending a university hospital memory clinic, were provided administration instructions beforehand. Area under the curve (AUC) scores, adjusted for age and education, were compared with the Qmci screen and Montreal Cognitive Assessment (MoCA). Caregivers or family scored the QMC.

RESULTS

In all, 366 participants were recruited; 53 with subjective memory complaints (SMC), 74 with MCI, 193 with dementia, and 46 normal controls. Median QMC scores for controls were 70±13 versus 60±20 for SMC, 52±18 for MCI, and 31±21 for dementia. The QMC had excellent accuracy (AUC 0.97) for cognitive impairment (MCI/dementia from controls), similar to the Qmci screen (AUC 0.98, p = 0.17) and MoCA (AUC 0.95, p = 0.13). At a cut-off of <52/100, the QMC had 83% sensitivity and 100% specificity for cognitive impairment. The QMC had lower accuracy differentiating MCI from SMC (AUC 0.73), albeit similar to the MoCA (AUC 0.70).

CONCLUSION

The QMC, administered by caregivers in advance of clinic, compared favorably to established CSIs scored by trained raters. This caregiver, home-administered CSI is acceptable and can identify cognitive impairment, potentially improving efficiency by reducing testing time and patient stress in busy clinical settings.

Pharmacologically increased cortisol levels impair recall of associative background context memory in males, but not females

Laboratory studies have consistently shown that stress impairs memory retrieval of individual parts (items) of a memory. The stress-hormone cortisol has been particularly linked to this impairment. However, it is unclear whether cortisol similarly affects the binding of items to associative context information in memory, i.e. the constituents of episodic memory. Here, we examine memory retrieval of item and associative memory under pharmacologically elevated cortisol vs. normal levels. Given that previous studies have indicated potential sex differences in the stress- and cortisol-induced memory modulation, we additionally assessed whether there may be sex differences for the cortisol effect on memory retrieval. Eighty-four female and male participants were tested in a placebo controlled, double-blind between-subject design, assigned to either a cortisol (10 mg hydrocortisone) or a placebo group. Participants of both groups were presented foreground images of negative and neutral valence on different neutral background scenes. Twenty-four hours later, participants' memory for the images and their associated background scene was tested with a recognition task 20 min after substance administration. Among the 78 participants of both groups included in the final analysis, cortisol levels were higher in the cortisol group in comparison to the placebo group, and female participants had higher cortisol levels after hydrocortisone intake in comparison to male participants. Item memory did not differ between the placebo and cortisol group. In contrast, in males, but not females, associative memory for the background scene of emotional foreground images was lower in the cortisol vs. placebo group. Moreover, the individual cortisol increase during the recognition task was negatively correlated to memory for the background scenes of the emotional foreground images only in male participants of the cortisol group. This study shows that pharmacologically increased cortisol levels distinctly affect associative memory in female and male participants, but have no effect on item memory, indicating a complex interaction for the stress effects on memory.

Advances in the understanding and enhancement of the human cognitive functions of learning and memory

Learning and memory are among the key cognitive functions that drive the human experience. As such, any defective condition associated with these cognitive domains could affect our navigation through everyday life. For years, researchers have been working toward having a clear understanding of how learning and memory work, as well as ways to improve them. Many advances have been made, as well as some challenges that have also been faced in the process. That notwithstanding, there are prospects with regards to the frontier of the enhancement of learning and memory in humans. This review article selectively highlights four broad areas of focus in research into the understanding and enhancement of learning and memory. Brain stimulation, effects of sleep, effects of stress and emotion, and synaptic plasticity are the main focal areas of this review, in terms of some pivotal research works, findings and theories.

Adult newborn granule cells confer emotional state-dependent adaptability in memory retrieval

Achieving optimal behavior requires animals to flexibly retrieve prior knowledge. Here, we show that adult newborn granule cells (anbGCs) mediate emotional state-dependent adaptability of memory retrieval. We find that acute social reward (aSR) enhances memory retrieval by increasing the reactivation of engram cells, while acute social stress (aSS) weakens retrieval and reduces the reactivation. Such bidirectional regulation relies on the activation of distinct populations of anbGCs by aSR and aSS, triggering opposing modifications of dDG activity, which is sufficient to regulate and predict the performance of memory retrieval. Concordantly, in emotional disorder models, aSR-dependent memory adaptability is impaired, while the effect of aSS remains intact. Together, our data revealed that anbGCs mediate adaptability of memory retrieval, allowing animals to flexibly retrieve memory according to the current emotional state, and suggested the essential roles of anbGCs in translating emotional information to the regulation of memory expression.

Cortisol reactivity impairs suppression-induced forgetting

To some extent, we can shape our recollections by intentionally remembering certain experiences while trying to forget others, for example, by intentional suppression. Acute stress impairs suppression-induced forgetting of memories. It is unclear, however, whether these deficits are a direct consequence of the acute stress-induced cortisol response. The present study was designed to examine the stress-induced impairment in suppression-induced forgetting in a subgroup of cortisol responders. We exposed healthy participants to a stress (n = 55) or no-stress control (n = 32) version of the Maastricht Acute Stress Test before they performed the Think / No-Think task. Here, participants aimed to repeatedly retrieve or suppress memories of previously learned cue-target video clips to mimic the complexity of episodic memories. Results on the subsequent memory test revealed that, while the no-stress controls and cortisol non-responders demonstrated suppression-induced forgetting, this effect was absent in cortisol responders. Moreover, the magnitude of suppression-induced forgetting was negatively correlated to stress-induced cortisol increases. The current study extends findings on stress-induced impairments in suppression-induced forgetting by specifically focusing on cortisol reactivity. Furthermore, our findings show the importance of individual differences in cortisol responses as a driving mechanism behind stress-induced alterations in our capacity to actively control our memory.

Parental Attributions—Mothers’ Voices in Economically and Socially Disadvantaged Contexts

In the present study, the attributions of socially and economically disadvantaged mothers for their own negative parenting behavior and for their children’s undesirable behaviors as perceived by parents—understood as misbehavior—were analyzed. To this end, an exploratory study with a qualitative design was developed, in which 24 socially and economically disadvantaged mothers were individually interviewed. The data were analyzed following a thematic analysis approach, using software suited to qualitative analysis, namely NVIVO 12. The children’s undesirable behaviors as perceived by parents and some characteristics associated with parental performance (particularly the appraisal of the effectiveness of their negative practices) emerged respectively as external and internal factors, explaining mothers’ inadaptive behaviors—difficulties in behavior regulation, physical coercion, psychological control and paraverbal hostility. The parental subsystem and school emerged as the main external factors, and the psychological characteristics as the most relevant internal factors, explaining the children’s undesirable behaviors—challenge, immaturity, hostility, emotionally-based, school behavior/absenteeism and danger. The results also indicate weak self-critical reflexivity regarding some of the inadaptive behaviors. The comprehensive analysis of the results, based on the literature review, gave rise to an explanatory hypothesis on the dysfunctional circular process regarding the maintenance of inadaptive practices and children’s undesirable behaviors, considering the role played by parental attributions and by insufficient parental reflexivity.

The perception of e-learning during the SARS-CoV-2 pandemic by students of medical universities in Poland - a survey-based study

BACKGROUND

In March 2020 lockdown due to the COVID-19 pandemic forced Polish Medical Universities to implement e-learning. The aim of the study was to evaluate the perception of e-learning by students of Medical Universities in Poland.

MATERIAL AND METHODS

Survey was performed nationwide via the Internet from 30th November 2020 to 10th February 2021. Six hundred fifteen (615) medical students completed the survey. The study questionnaire included questions concerning sociodemographic data, perception of lecturers' effectiveness, assessment of stationary and online classes, changes in learning habits and restrictions on education, and advantages and disadvantages of e-learning.

RESULTS

The respondents reported that 96.1% of lectures, 85.5% of seminars, and 40.0% of clinical classes were implemented by e-learning. The lectures conducted by e-learning were assessed as good and very good by 78.4% and seminars by 51.2% of respondents. While the clinical classes conducted by e-learning were assessed as bad and very bad by 62.9% of respondents. The most frequently indicated limitations of e-learning were the quality of the content and available materials (26.9%), restrictions in direct contact with the lecturer (19.6%), Internet connection (16.8%), and home conditions (13.8%). Only 4% of the students had to buy or retrofit computer equipment. Any other limitations were indicated by 9.7% of the respondents.

CONCLUSIONS

Students were highly accepting of lectures and seminars conducted in the form of e-learning, but not laboratory and clinical classes. The main problems in e-learning are the quality of the classes conducted and the Internet connection. The students expect e-learning classes to be conducted in real-time, with direct, face-to-face contact with the lecturer.

Stress among medical students and its impact on academic performance

Introduction and Aim: Stress is the response given by the human body to various changes which needs physical, mental or physiological adaptation. The inordinate stress during medical education incline students in solving social conflicts, dropped attention, reduced mindfulness, decreased neutrality, increased errors and misconduct like negligence which leads to decrease in academic performance. Hence, this study was undertaken to know the prevalence and impact of stress in medical students’ academic performance.   Materials and Methods: This was a cross sectional study organized by the Department of Physiology, Great Eastern Medical School and Hospital, Srikakulam (AP). All medical students pursuing their 2nd  and 3rd  MBBS were included in the study. Students on any antipsychotic medicine; not willing to participate were excluded. Informed written consent was taken from subjects. Approval was taken from the Institutional Ethical Committee prior to the study. Data were collected using K-10 questionnaire for stress and academic performance.   Results: The prevalence of stress was mild, moderate, severe among 12%, 69%, 19% subjects respectively. Statistically significant negative association was found between stress and academic performance (p<0.05).   Conclusion: A high prevalence of stress was found amongst medical students. Poor academic performance was seen in students associated with higher level of stress.

Teaching to Empower: Leveraging the Neuroscience of Now to Help Students Become Self-Regulated Learners

In his book Descartes' Error, neurologist Antonio Damasio argues that humans do not make decisions by relying exclusively on the rational or reason-oriented parts of their brain (2008). Evidence from patients with brain damage reveal that our abilities to reason and make decisions are greatly influenced by our emotions (Damasio et al., 1990; Saver and Damasio, 1991). In fact, our emotions and how we feel act as a gateway to our thinking and learning by providing "the bridge between rational [prefrontal cortex] and nonrational processes" [brainstem and limbic structures]." (Damasio, 2008). Understanding the ways in which our brain processes sensory inputs and integrates those inputs into our ongoing emotional state is critical for helping students become self-regulated, sophisticated learners. In the following article, I will begin by briefly summarizing the role of emotions in learning and the impact of toxic stress on our students' ability to engage, learn, and thrive. I will then define and present a trauma-informed teaching and learning paradigm with practical strategies that empower students to continue to learn and succeed. I will address a few misconceptions about trauma-informed education. I will conclude by making a plea to you, members of the undergraduate neuroscience community, by presenting a case for the utility and moral imperative of educating our students about the basic functioning of their brains, especially as it relates to emotional regulation and learning.

Examining the relationship between working memory consolidation and long-term consolidation

An emerging area of research is focused on the relationship between working memory and long-term memory and the likely overlap between these processes. Of particular interest is how some information first maintained in working memory is retained for longer periods and eventually preserved in long-term memory. The process of stabilizing transient memory representations for lasting retention is referred to as consolidation in both the working memory and long-term memory literature, although these have historically been viewed as independent constructs. The present review aims to investigate the relationship between working memory consolidation and long-term memory consolidation, which both have rich, but distinct, histories. This review provides an overview of the proposed models and neural mechanisms of both types of consolidation, as well as clinical findings related to consolidation and potential approaches for the manipulation of consolidation. Finally, two hypotheses are proposed to explain the relationship between working memory consolidation and long-term memory consolidation.

Social reactivation of fear engrams enhances memory recall

Social interactions can bolster and protect memory performance. However, the relationship between social stimuli and individually learned memories remains enigmatic. Our work reveals that exposure to a stressed, naïve nonfamiliar conspecific or to the ambient olfactory–auditory cues of a recently stressed familiar conspecific induces reactivation of the cellular ensembles associated with a fear memory in the hippocampus. Artificially stimulating the hippocampal ensemble active during the social experience induces fearful behaviors in animals that have previously acquired a negative memory, revealing the interaction between individual history and social experience. The neural resurgence of fear-driving ensembles during social experiences leads to a context-specific enhancement of fear recall. Our findings provide evidence that unlike direct stressors, social stimuli reactivate and amplify an individual’s memories.

For group-living animals, the social environment provides salient experience that can weaken or strengthen aspects of cognition such as memory recall. Although the cellular substrates of individually acquired fear memories in the dentate gyrus (DG) and basolateral amygdala (BLA) have been well-studied and recent work has revealed circuit mechanisms underlying the encoding of social experience, the processes by which social experience interacts with an individual’s memories to alter recall remain unknown. Here we show that stressful social experiences enhance the recall of previously acquired fear memories in male but not female mice, and that social buffering of conspecifics’ distress blocks this enhancement. Activity-dependent tagging of cells in the DG during fear learning revealed that these ensembles were endogenously reactivated during the social experiences in males, even after extinction. These reactivated cells were shown to be functional components of engrams, as optogenetic stimulation of the cells active during the social experience in previously fear-conditioned and not naïve animals was sufficient to drive fear-related behaviors. Taken together, our findings suggest that social experiences can reactivate preexisting engrams to thereby strengthen discrete memories.

Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood

Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.

The association of basal cortisol levels with episodic memory in older adults is mediated by executive function

Elevated basal cortisol levels in elderly may indicate dysregulation of the internal stress-related system, as well as dysfunction and structural alterations in brain structures necessary for cognition, such as hippocampus and prefrontal cortex. Because of the close relation of executive functions and episodic memory processing, in this study we explored whether the association of elevated cortisol levels on episodic memory could be partly attributed to cortisol effects on executive functions. In this cross-sectional study we analyzed data from a sample of 236 community-dwelling older adults from the Cretan Aging Cohort aged 75.56 ± 7.21 years [53 with dementia due to probable Alzheimer's disease, 99 with Mild Cognitive Impairment (MCI) and 84 cognitively non-impaired participants (NI)]. Morning serum cortisol levels were higher in the probable AD as compared to the NI group (p = .031). Mediated regression models in the total sample supported the hypothesis that the negative association of basal cortisol levels with delayed memory was fully mediated by the relation of basal cortisol levels with executive functions and immediate memory (adjusted for age and self-reported depression symptoms). Moderated mediation regression models revealed that the direct effect of cortisol on executive function and the effect of executive function on delayed memory performance were statistically significant among participants diagnosed with MCI, while the immediate memory effect on delayed memory was more pronounced in AD patients, as compared to the NI group. The current findings corroborate neuroimaging research highlighting cortisol effects on executive functions and immediate memory and further suggest that dysregulation of systems involved in these functions may account for the purported detrimental long-term effects of high cortisol levels on delayed memory.

Influence of noise manipulation on retention in a simulated ICU ward round: an experimental pilot study

Background

Noise exposure leads to a reduction in cognitive abilities in diverse settings, however, only limited data exist examining the effects of environmental ICU noise on the cognitive performance of ICU professionals. A frequently occurring and demanding retention task in ICUs are ward rounds, which are considered key for the provision of medical care. Here, we investigate the influence of noise on information retention in a simulated ward round.

Methods

ICU professionals were exposed to a recorded, ICU ward round, simulated partly with and partly without environmental ICU noise. Ward rounds were followed by specific questions about previously provided information.

Results

56 ICU professionals (aged 26–59 years) were included. A logistic mixed model showed a reduction of 27% (P < 0.001) in the ward round test performance when participants were exposed to environmental ICU noise. Furthermore, advanced age was associated with reduced retention (− 28%, P < 0.001), questions containing important information performed better (+ 36%, P < 0.001), and higher stress led to better performance in retention (+ 24%, P = 0.01).

Conclusions

Our data showed a considerable negative influence of environmental ICU noise during a simulated ward round. Therefore, reduction of environmental ICU noise is recommended. The influence of additional factors, including stress, priorities, and demographic factors should be pursued in subsequent investigations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40635-022-00430-1.

Neuropsychological correlates of evocative multimodal speech: The combined roles of fearful prosody, visuospatial attention, cortisol response, and anxiety

Past research reveals left-hemisphere dominance for linguistic processing and right-hemisphere dominance for emotional prosody processing during auditory language comprehension, a pattern also found in visuospatial attention studies where listeners are presented with a view of the talker's face. Is this lateralization pattern for visuospatial attention and language processing upheld when listeners are experiencing a stress response? To investigate this question, participants completed the Trier Social Stress Test (TSST) between administrations of a visuospatial attention and language comprehension dual-task paradigm. Subjective anxiety, cardiovascular, and saliva cortisol measures were taken before and after the TSST. Higher language comprehension scores in the post-TSST neutral prosody condition were associated with lower cortisol responses, differences in blood pressure, and less subjective anxiety. In this challenging task, visuospatial attention was most focused at the mouth region, both prior to and after stress induction. Greater visuospatial attention on the left side of the face image, compared to the right side, indicated greater right hemisphere activation. In the Fear, but not the Neutral, prosody condition, greater cortisol response was associated with greater visuospatial attention to the left side of the face image. Results are placed into theoretical context, and can be applied to situations where stressed listeners must interpret emotionally evocative language.

The key to superior memory encoding under stress: the relationship between cortisol response and mnemonic discrimination

Some previous studies have shown that increased stress hormone levels have beneficial effects on memory encoding; however, there is no clear consensus on which encoding-related processes are affected by stress hormones. In the present study, we investigated the relationship between interindividual differences in neuroendocrine response to acute stress and interference resolution (i.e., mnemonic discrimination). Participants were healthy young adults who were exposed to physical and psychological stressors (Socially Evaluated Cold Pressor Test). Then participants completed the modified version of the Mnemonic Similarity Task. Specifically, they were presented with photographs of emotionally arousing (negative and positive) and nonarousing (neutral) scenes followed by a recognition memory test where they saw a mixture of old and new stimuli. Crucially, participants were also presented with critical lure items, that is, visually similar stimuli to ones presented at encoding. We found that participants who had higher cortisol response to the stressors were better in discriminating between the studied items and their visually similar lures. This effect was present for the arousing and nonarousing materials as well. These findings suggest that increased hormonal response to acute stress has a beneficial impact on the formation of distinct, nonoverlapping, unique memory representations, and consequently, on episodic memory encoding processes.

Parental status in later life and parents' risk of cognitive impairment

Parental status can influence parents’ well-being in significant ways, but little research has examined its impact on older adults’ cognitive health in the U.S. Using data from the National Health and Aging Trends Study (NHATS) 2011–2019, this study examines whether parental status is related to the risk of cognitive impairment among older adults in the U.S. We found that the presence of adult children (i.e., having at least one living adult child) was associated with a lower risk of cognitive impairment for older parents. Moreover, compared to childless older adults, older parents who had three and more children, who had adult daughter(s), and who had biological/adopted adult children displayed a significantly lower risk of cognitive impairment. This study highlights the importance of adult children as resources of support and caring that may benefit older parents’ cognitive health. The findings can help to identify the most vulnerable subpopulations among aging adults so that medical workers and policy makers can design effective strategies to protect cognitive function for those “at risk” older adults.

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Parental status is an important factor related to older adults’ cognitive health.

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Presence of adult children was associated with a lower risk of cognitive impairment than being childlessness.

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Having 3+ children, adult daughter(s), or biological children was associated with lower risk of cognitive impairment.

Psychosocial stress has weaker than expected effects on episodic memory and related cognitive abilities: A meta-analysis

The impact of stress on episodic memory and related cognitive abilities is well documented in both animal and human literature. However, it is unclear whether the same cognitive effects result from all forms of stress - in particular psychosocial stress. This review systematically explored the effects of psychosocial stress on episodic memory and associated cognitive abilities. PubMed, PsycInfo, and Web of Science databases were searched. Fifty-one studies were identified and compared based on the timing of stress induction. A small positive effect of post-learning psychosocial stress with a long retention interval was shown. No other effects of psychosocial stress were seen. Re-analysis of previous meta-analyses also showed no significant effect of psychosocial stress on episodic memory, highlighting potentially different effects between stressor types. Psychosocial stress also had a moderately different effect when emotional vs. neutral stimuli were compared. Finally, psychosocial stress also decreased performance on executive function, but not working memory tasks. Our findings demonstrate that psychosocial stress may not have the clear effects on episodic memory previously ascribed to it.

Current psychosocial stress, childhood trauma and cognition in patients with schizophrenia and healthy participants

BACKGROUND

Cognitive difficulties are experienced frequently in schizophrenia (SZ) and are strongly predictive of functional outcome. Although severity of cognitive difficulties has been robustly associated with early life adversity, whether and how they are affected by current stress is unknown. The present study investigated whether acute stress reactivity as measured by heart rate and mood changes predict cognitive performance in patients with schizophrenia and healthy individuals, and whether this is moderated by diagnosis and previous childhood trauma exposure.

METHODS

One hundred and four patients with schizophrenia and 207 healthy participants were administered a battery of tasks assessing cognitive performance after psychosocial stress induction (Trier Social Stress Test; TSST). Mood states (Profile of Mood States; POMS) and heart rate were assessed at baseline, immediately before, and after the TSST.

RESULTS

Both healthy participants and patients showed increases in POMS Tension and Total Mood Disturbance scores between Time Point 2 (pre-TSST) and Time Point 3 (post-TSST). These changes were not associated with variation in cognition. Although childhood trauma exposure was associated with higher stress reactivity and poorer cognitive function in all participants, childhood trauma did not moderate the association between stress reactivity and cognition. Neither was diagnosis a moderator of this relationship.

DISCUSSION

These findings suggest that while chronic stress exposure explains significant variation in cognition, acute stress reactivity (measured by changes in Tension and Total Mood Disturbance) did not. In the context of broader developmental processes, we conclude that stressful events that occur earlier in development, and with greater chronicity, are likely to be more strongly associated with cognitive variation than acute transient stressors experienced in adulthood.

A simulation-based pilot study of crisis checklists in the emergency department

Checklists can improve adherence to standardized procedures and minimize human error. We aimed to test if implementation of a checklist was feasible and effective in enhancing patient care in an emergency department handling internal medicine cases. We developed four critical event checklists and confronted volunteer teams with a series of four simulated emergency scenarios. In two scenarios, the teams were provided access to the crisis checklists in a randomized cross-over design. Simulated patient outcome plus statement of the underlying diagnosis defined the primary endpoint and adherence to key processes such as time to commence CPR represented the secondary endpoints. A questionnaire was used to capture participants' perception of clinical relevance and manageability of the checklists. Six teams of four volunteers completed a total of 24 crisis sequences. The primary endpoint was reached in 8 out of 12 sequences with and in 2 out of 12 sequences without a checklist (Odds ratio, 10; CI 1.11, 123.43; p = 0.03607, Fisher's exact test). Adherence to critical steps was significantly higher in all scenarios for which a checklist was available (performance score of 56.3% without checklist, 81.9% with checklist, p = 0.00284, linear regression model). All participants rated the checklist as useful and 22 of 24 participants would use the checklist in real life. Checklist use had no influence on CPR quality. The use of context-specific checklists showed a statistically significant influence on team performance and simulated patient outcome and contributed to adherence to standard clinical practices in emergency situations.

Cross-sectional case-control study on medical students' psychosocial stress during COVID-19 pandemic in Hong Kong

INTRODUCTION

COVID-19 pandemic has resulted in significant changes in pedagogy for undergraduate medical curriculum. Many physical clinical teachings have been replaced by online pedagogy. This study aims to evaluate the relation between medical students' stress during COVID-19 pandemic and their academic performance at the final examination.

METHODS

This is a cross-sectional questionnaire-based study. Student's stress level were evaluated by the COVID-19 Student Stress Questionnaire (CSSQ). Correlation of stress level and students' performance at the final examination was performed.

RESULTS

110 out of 221 (49.8%) final-year medical students responded to the questionnaire, 13 students failed in the final examination (case) while 97 students passed in the final MBBS examination (control).Baseline demographic data between case and control were comparable. The median age for both cases and controls were 24 years.Compared to controls, cases reported higher levels of stress in all domains, namely in relation to risk of contagion, social isolation, interpersonal relationships with relatives, university colleagues and professors, academic life, and sexual life. Notably, a significantly higher proportion of cases reported academic-related stress compared to controls (p < 0.01), with 100% of cases perceiving their academic studying experience during the COVID-19 pandemic to be "very" or "extremely" stressful, compared to 35.1% of controls.

CONCLUSION

Increased stress to academic and study during COVID-19 was associated with worse examination outcome at the final examination. Extra academic support will be needed to cater students' need during the pandemic.

False recognitions in the DRM paradigm: the role of stress and warning

For the last decades, the factors increasing or decreasing the frequency of false memories have been of great interest. Some research also examined the effect of stress and warning on the true and false recognitions; however, so far most of the studies have yielded contradictory results or seems inadequate to understand the effect of these factors on false memory phenomenon. The purpose of this study is to examine the joint effects of stress and warning on the frequency of false and true memories elicited by the list-learning paradigm. The word lists derived from the Deese–Roediger–McDermott (DRM) paradigm were used in order to measure false and true recognition rates. Participants (N = 126) were exposed to either the Trier Social Stress Test (a stress condition) or a filler task at the beginning of the experiment (no-stress condition). Then, they were either subjected to a warning about false memories before DRM (pre-warning condition), subjected to a warning about false memories after DRM (post-warning condition), or given no warning at all (no-warning condition). Results showed that stress had a statistically significant effect on true recognition but not on false recognition. Furthermore, warning given after the DRM lists had a decreasing effect on the frequency of false memories. No significant interaction effect between stress and warning was found. Although our hypotheses were not confirmed, this study can contribute to the existing body of research by providing evidence that stress and warning have differential effects on both true and false memories derived from the DRM paradigm.

Facing stress: No effect of acute stress at encoding or retrieval on face recognition memory

Eyewitnesses may experience stress during a crime and when attempting to identify the perpetrator subsequently. Laboratory studies can provide insight into how acute stress at encoding and retrieval affects memory performance. However, previous findings exploring this issue have been mixed. Across two preregistered experiments, we examined the effects of stress during encoding and retrieval on face and word recognition performance. We used the Maastricht Acute Stress Test (MAST) to induce stress and verified the success of the stress manipulation with blood pressure measures, salivary cortisol levels, and negative affect scores. To examine differences in stressor timing, participants encoded target faces or words both when confronted with the stressor and during the subsequent cortisol peak and retrieved these stimuli 24 h later. We found neither effects of acute stress on face recognition memory during encoding or retrieval (Experiments 1 and 2), nor effects of encoding stress on word recognition memory (Experiment 2). Bayesian analyses largely provided substantial or strong evidence for the null hypotheses. We emphasize the need for well-powered experiments using contemporary methodology for a more complete understanding of the effect of acute stress on face recognition memory.

Using the WHO safe childbirth checklist to improve essential care delivery as part of the district-wide maternal and newborn health quality improvement initiative, a time series study

Background

Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care.

This study evaluates the effect of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by “clinical bundle” adherence over-time.

Methods

The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three “clinical bundles” were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.

A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime.

Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.

Findings

Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four MNH collaborative. In Tankua Abergele collaborative (Tigray Region), the overall mean adherence to “On Admission” bundle was 86% with β = 1.39 (95% CI; 0.47–2.32; P <  0.005) on average monthly.

Similarly, the overall mean adherence to the “Before Pushing” bundle in Dugna Fango collaborative; Southern Nations, Nationalities and People’s (SNNP) region was 80% with β = 2.3 (95% CI; 0.89–3.74; P <  0.005) on average monthly.

Conclusion

Using WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.

Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

OBJECTIVES

We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.

METHODS

We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS

The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001).

DISCUSSION

The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

A national longitudinal study of marital quality and cognitive decline among older men and women

We provide one of the first national longitudinal studies of the association between trajectories of marital quality and cognitive functioning among older adults, with close attention paid to gender differences. Data were drawn from the Health and Retirement Study (HRS) 2006-2016. Marital quality trajectories were assessed at three waves: 2006/2008, 2010/2012, and 2014/2016. Cognitive trajectories were assessed at five waves: 2008, 2010, 2012, 2014, and 2016. The final analytic sample included 7901 respondents age 50 and older (4334 men and 3567 women) who were either married or cohabiting during the study period. Results from parallel linear growth curve models suggest that among older adults, initial positive marital quality was associated with better initial cognition, and initial negative marital quality was associated with worse initial cognition. Results from multiple group analysis further suggest that marital quality was significantly associated with men's cognitive trajectories but not women's. Among men, an increase in positive marital quality was associated with a slower rate of cognitive decline, whereas an increase in negative marital quality was associated with a faster rate of cognitive decline. These findings suggest that older men who experience a decline in marital quality may be vulnerable to cognitive decline and that reducing marital strain and improving marital quality may protect men's cognitive health in later life.