Impact of sociodemographic variables on executive functions

Executive functions and their relationship with age: Insights from a novel neuropsychological Assessment Battery in Children-a pilot study

Executive functions (EFs) are a set of cognitive processes that enable individuals to manage and coordinate their thoughts and actions toward achieving specific goals. EFs include planning, organizing, initiating, and monitoring actions, and have been found to improve with age due to the maturation of the brain, especially during childhood. Therefore, our correlational study sought to determine the relationship between the performance in executive functions and age in 79 children (36 girls, 45.6%) throughout development, between the ages of 6 and 12 (mean = 9.25; SD = 2.05), using a battery designed in Chile: BEFE (Batería de Evaluación de las Funciones Ejecutivas: Executive Function Assessment Battery) based on traditional neuropsychological tests to evaluate Working Memory, Inhibitory Control, Cognitive Flexibility, and Planning skills. Our results showed various correlations between the variables age and performance in various behavioral parameters, demonstrating an increase in the number of correct responses (positive correlation) and/or a decrease in errors (negative correlation) with age (6-12) in the subtests that correspond to dimensions of Cognitive Flexibility (Semantic and Phonological Fluency, Card Sorting Game, and Tracing Tasks), Inhibitory Control (ENA-F and Sentence Completion), Working Memory (Audio-verbal WM Forward and Ordering, and Visuospatial WM Forward and Backward), and Planning (La Portada de Antofagasta and FISA Maps). These results are consistent with previous empirical evidence and support the notion of a developmental relationship between EF performance and age. Additionally, this study contributes to understanding EF development in culturally specific contexts, highlighting the importance of contextually relevant assessment tools in evaluating cognitive development.

A biobehavioural and social-structural model of inflammation and executive function in pediatric chronic health conditions

Evidence indicates that pediatric chronic health conditions (CHCs) often impair executive functioning (EF) and impaired EF undermines pediatric CHC management. This bidirectional relationship likely occurs due to biobehavioural and social-structural factors that serve to maintain this feedback loop. Specifically, biobehavioural research suggests that inflammation may sustain a feedback loop that links together increased CHC severity, challenges with EF, and lower engagement in health promoting behaviours. Experiencing social and environmental inequity also maintains pressure on this feedback loop as experiencing inequities is associated with greater inflammation, increased CHC severity, as well as challenges with EF and engagement in health promoting behaviours. Amidst this growing body of research, a model of biobehavioural and social-structural factors that centres inflammation and EF is warranted to better identify individual and structural targets to ameliorate the effects of CHCs on children, families, and society at large. This paper proposes this model, reviews relevant literature, and delineates actionable research and clinical implications.

Perilesional and contralesional brain activations related to associative encoding of unfamiliar face-names pairs in adults with left chronic stroke with or without ischemic infarct on left inferior frontal gyrus

The study of an Ischemic stroke infarction allows verifying how the lesion produces alterations in the neuronal networks resulting in cognitive deficits. It also allows the verification of adaptive and maladaptive cerebral reorganization related to the injury. In our previous fMRI study, we found that patients without ischemic vascular lesions in left inferior frontal gyrus showed an efficient compensation mechanism during the associative encoding of face name pairs, by the increased activation of ventrolateral and dorsolateral areas of contralesional hemisphere associated with better memory performance. While patients with ischemic vascular lesions on left inferior frontal gyrus (IFG) demonstrated worse memory performance and no signs of compensation mechanism. The present study explores more of these findings by analyzing perilesional and contralesional activations related to unfamiliar face name associative encoding in adults with chronic ischemic stroke, with or without left IFG lesion, compared to healthy controls. The main results showed that stroke survivors without lesions in IFG demonstrated increased activation in perilesional and contralesional prefrontal regions associated with better associative memory recognition, which are indicative of adaptive compensatory mechanisms. However, they also showed a negative correlation between the activation of right anterior prefrontal and inferior parietal regions and the associative memory performance, which may indicate the presence of maladaptive interhemispheric disinhibition. On the other hand, stroke survivors with IFG lesions demonstrated negative correlations in activations of the ipsilesional inferior parietal cortex and positive correlations in activations of the left middle frontal gyrus and left precentral cortex, which demonstrate the simultaneous occurrence of adaptive and maladaptive brain reorganization mechanisms in this group. However, the increase in perilesional prefrontal regions, associated with bilateral activation of the hippocampus and amygdala, was not enough to compensate for the inefficiency of associative memory performance. Finally, the differences in activation observed in stroke survivors reflect their clinical heterogeneity and demonstrate that adaptive or maladaptive compensatory mechanisms can coexist in the same group of patients. Furthermore, they reinforce the importance of the left IFG in the associative encoding of unfamiliar face name pairs and may suggest a deficit in associative memory related to injury in this region.

Effect of Education on Discriminability of Montreal Cognitive Assessment Compared to Mini-Mental State Examination

Background and Purpose

The Montreal Cognitive Assessment (MoCA) has been known as a screening test for detecting mild cognitive impairment (MCI) better than Mini-Mental State Examination (MMSE). However, in previous domestic studies, no significant difference was found in the discriminability between MoCA and MMSE. Researchers have suggested that this might be because older Koreans are less educated than older Westerners. This study was conducted to examine the effect of education on the discriminability of MoCA compared to the MMSE.

Methods

Participants were 123 cognitively normal elderly, 118 with vascular MCI, 108 with amnestic MCI, 121 with vascular dementia, and 113 with dementia of the Alzheimer's type. The Korean-MoCA (K-MoCA) and Korean-MMSE (K-MMSE) were administered. Multiple regression analyses and receiver operating characteristic (ROC) curve analyses were performed.

Results

In all participants, education significantly affected both K-MoCA and K-MMSE scores along with age. The effect of education was re-examined by subgroup analysis after dividing subjects according to the level of education. Effect of education on K-MoCA and K-MMSE was only shown in the group with <9 years of education. ROC curve analyses revealed that the discriminability of K-MoCA to differentiate between vascular MCI and normal elderly was significantly higher than that of K-MMSE. When re-examining subgroups divided by education level, however, this higher discriminability of K-MoCA disappeared in the group with <9 years of education.

Conclusions

These results indicate no difference in discriminating cognitive deficits between K-MoCA and K-MMSE in Korean elderly with <9 years of education.

Executive functioning in adolescents and adults with Silver-Russell syndrome

Silver-Russell syndrome (SRS) is a rare imprinting disorder characterized by prenatal and postnatal growth retardation. The two principal causes of SRS are loss of methylation on chromosome 11p15 (11p15 LOM) and maternal uniparental disomy of chromosome 7 (UPD(7)mat). Knowledge of the neuropsychological profile of SRS remains sparse and incomplete even if several difficulties related to attention and learning have been reported both in the literature and by patients with SRS. These difficulties could be the result of troubles in different cognitive domains, but also of executive dysfunction. Nevertheless, executive functioning has never been investigated, even though executive functions play an essential role in psychological development, and are extensively involved in daily life. The present study explored the executive functioning of individuals with SRS due to UPD(7)mat or 11p15 LOM. A battery of executive tasks assessing cognitive flexibility, inhibitory control, and working memory, together with a task assessing sustained attention, was administered to 19 individuals with SRS (13-39 years) and 19 healthy controls. The Behavior Rating Inventory of Executive Function was also completed by the participants' families. The results showed that participants with SRS had similar performance (z-scores) to our controls, in a context of normal intellectual efficiency. Group comparisons with Bayesian statistics showed a single difference between the 11p15 LOM and control groups: the completion time for part A of the Trail Making Test appeared to be longer in the 11p15 LOM group than in the control group. However, at the clinical level, several participants with SRS had clinically significant scores on various measures of EFs. Thus, the cognitive phenotype of SRS did not appear to be characterized by executive dysfunction, but individuals with SRS could be at high risk of developing executive dysfunction or attention-deficit/hyperactivity disorder. These results provide new insights into the neuropsychological profile of individuals with SRS.

Cognitive dysfunction and serum levels of brain-derived neurotrophic factor (BDNF) in primary anti-phospholipid syndrome (PAPS)

OBJECTIVES

Cognitive dysfunction (CD) is a poorly understood non-stroke central neurological manifestation in anti-phospholipid syndrome (APS). Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in neural plasticity and could potentially be a biomarker of CD in primary APS (PAPS). The aim of the study is to assess CD in PAPS patients and to evaluate its association with clinical data, anti-phospholipid antibodies and serum BDNF levels.

METHODS

This cross-sectional study compared 44 PAPS patients and 20 healthy controls matched for age, gender and education. PAPS patients and controls underwent a standardized cognitive examination. The demographic, clinical and laboratory characteristics of patients were recorded. Serum BDNF was measured by Enzyme Linked Immunosorbent.

RESULTS

Fourteen (31.8%) of the 44 patients with PAPS had CD compared with only one (5%) healthy control (P =0.019). PAPS patients presented lower serum BDNF levels when compared with controls (P =0.007). Lower levels of BDNF were associated with CD in PAPS patients (P =0.032). In the univariate analysis, a positive association was found between CD and livedo reticularis, deep vein thrombosis, stroke, seizure, smoking as well as a negative association with Mini Mental State Examination and serum BDNF. According to multivariate analysis, the only independent predictor of CD in PAPS was stroke (OR 137.06; 95% CI: 4.73, 3974.32; P =0.004).

CONCLUSIONS

CD is commonly reported in PAPS patients; however, its assessment lacks in standards and objective screening tests. The association between CD and low serum BDNF suggests that this neurotrophin can be a promising biomarker for PAPS cognitive impairment.

Age, education and gender effects on Wisconsin card sorting test: standardization, reliability and validity in healthy Argentinian adults

The Wisconsin Card Sorting Test (WCST) is a widely used neuropsychological assessment of executive functioning. The aim of this study was to provide norm values and analyze the psychometric properties of WCST in healthy Argentinian adults aged from 18 to 89 years old (N = 235). Descriptive statistics are reported as means, standard deviations and percentiles, with the effects of age, education and gender being investigated by ANOVA, and with the effect sizes being calculated. The psychometrics were studied using the WCST structure, reliability, convergent validity, and discriminant validity, and WCST norms adjusted for age and educational level are proposed. This instrument is a reliable and valid tool for the assessment of executive functions. However, as the age- and educational-related effects were demonstrated, these characteristics need to be considered before interpreting WCST scores. Regarding gender, no differences were found. Our results expand the geographical and sociocultural applicability of WCST.

The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder

Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self-report questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.

Complex Task Performance Assessment (CTPA) and Functional Cognition in People With Parkinson's Disease

OBJECTIVE

The objective of this study was to determine how Parkinson's disease (PD) affects functional cognition as assessed by the Complex Task Performance Assessment (CTPA) and to examine the associations of CTPA performance with other indicators of executive function in people with PD.

METHOD

Volunteers with PD without dementia (n = 20) and community control participants (n = 19) completed neuropsychological testing, patient-reported outcome measures, and the CTPA.

RESULTS

There were no group differences for CTPA performance accuracy; however, the PD group took longer to complete the CTPA than did the control group. In the PD group, inefficient CTPA performance correlated with poorer cognitive flexibility and worse reported everyday shifting and task monitoring.

CONCLUSION

Decreased executive function, namely cognitive flexibility and attentional control, may impair functional cognition in people with PD. Future studies with larger, more diverse samples are warranted to determine the discriminant validity and sensitivity of the CTPA. Use of performance-based assessments such as the CTPA may increase the understanding of functional cognition in people with PD.

Executive functioning: perspectives on neurotrophic activity and pharmacology

Executive functioning is a high-level cognitive ability, regulating other abilities and behaviors to achieve desired goals. A typical executive task can be defined as the capacity to maintain one's attention on the current task, that is, responding only to the correct but not to distractive stimuli. Impairments of executive functions, or executive dysfunctions, have a growing impact on everyday life and academic achievement and are usually an early feature, and one of the core features, in brain injury and memory and behavioral disorders. Furthermore, emerging evidence indicates that memory therapeutics cannot achieve their clinical benefits in cognition if executive dysfunction is not effectively and simultaneously treated. Improvement of executive functions might be achieved through targeting some signaling pathways in the brain, including the brain-derived neurotrophic factor signaling pathways. These agents may be useful either as stand-alone interventions for patients with executive dysfunction and/or psychiatric and memory disorders or as essential adjuncts to drugs that target the underlying pathology in various brain injury and memory and behavioral disorders.