A new clinical tool for assessing numerical abilities in neurological diseases: numerical activities of daily living

Financial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases

The present work investigates whether financial abilities can be associated with numerical abilities and with general cognitive abilities. We compared performance on numerical and financial tests, and on tests routinely used to measure general cognitive performance, in healthy controls and in a group of people with heterogeneous pathological conditions including mild cognitive impairment, amyotrophic lateral sclerosis, traumatic brain injury, and schizophrenia. Patients showed lower performances in both numerical and financial abilities compared to controls. Numerical and financial skills were positively correlated in both groups, but they correlated poorly with measures of general cognitive functioning. Crucially, only basic financial tasks -such as counting currencies- but not advanced ones -like financial judgments- were associated with numerical or general cognitive functioning in logistic regression analyses. Conversely, advanced financial abilities, but not basic ones, were associated with abstract reasoning. At a qualitative analysis, we found that deficits in numerical and financial abilities might double dissociate. Similarly, we observed double dissociations between difficulties in financial abilities and cognitive deficits. In conclusion, financial abilities may be independent of numerical skills, and financial deficits are not always related to the presence of cognitive difficulties. These findings are important for both clinical and legal practice.

Numerosity comparison, cognitive strategies, and general cognitive functioning in older people

Introduction

Studies have shown age-related differences in numerical cognition, for example, in the level of numerosity comparison ability. Moreover, some studies point out individual differences in the cognitive strategies employed during the performance of numerosity comparison tasks and reveal that they are related to the aging process. One probable cause of these differences is the level of cognitive functioning. The aim of our study was to determine the relationships among numerosity comparison ability, the cognitive strategies utilized in the performance of numerosity comparison tasks and the general cognitive functioning in older people.

Methods

Forty-seven elderly people participated in the study. The participants were examined using overall cognitive functioning scales and computerized numerosity comparison task.

Results

The results showed many correlations between the participants' level of cognitive functioning and the percent of correct responses (PCR) and response time (RT) during numerosity comparison, as well as with the cognitive strategies applied by the participants. Task correctness was positively related to the level of performance in the attention and executive function tasks. In contrast, the long-term memory resources index and visuospatial skills level were negatively correlated with RT regarding numerosity comparison task performance. The level of long-term memory resources was also positively associated with the frequency of use of more complex cognitive strategies. Series of regression analyses showed that both the level of general cognitive functioning and the cognitive strategies employed by participants in numerosity comparison can explain 9-21 percent of the variance in the obtained results.

Discussion

In summary, these results showed significant relationships between the level of cognitive functioning and proficiency in numerosity comparison measured in older people. Moreover, it has been shown that cognitive resources level is related to the strategies utilized by older people, which indicates the potential application for cognitive strategy examinations in the development of new diagnostic tools.

Neurobiology of numerical learning

Numerical abilities are complex cognitive skills essential for dealing with requirements of the modern world. Although the brain structures and functions underlying numerical cognition in different species have long been appreciated, genetic and molecular techniques have more recently expanded the knowledge about the mechanisms underlying numerical learning. In this review, we discuss the status of the research related to the neurobiological bases of numerical abilities. We consider how genetic factors have been associated with mathematical capacities and how these link to the current knowledge of brain regions underlying these capacities in human and non-human animals. We further discuss the extent to which significant variations in the levels of specific neurotransmitters may be used as potential markers of individual performance and learning difficulties and take into consideration the therapeutic potential of brain stimulation methods to modulate learning and improve interventional outcomes. The implications of this research for formulating a more comprehensive view of the neural basis of mathematical learning are discussed.

The brain lateralization and development of math functions: progress since Sperry, 1974

In 1974, Roger Sperry, based on his seminal studies on the split-brain condition, concluded that math was almost exclusively sustained by the language dominant left hemisphere. The right hemisphere could perform additions up to sums less than 20, the only exception to a complete left hemisphere dominance. Studies on lateralized focal lesions came to a similar conclusion, except for written complex calculation, where spatial abilities are needed to display digits in the right location according to the specific requirements of calculation procedures. Fifty years later, the contribution of new theoretical and instrumental tools lead to a much more complex picture, whereby, while left hemisphere dominance for math in the right-handed is confirmed for most functions, several math related tasks seem to be carried out in the right hemisphere. The developmental trajectory in the lateralization of math functions has also been clarified. This corpus of knowledge is reviewed here. The right hemisphere does not simply offer its support when calculation requires generic space processing, but its role can be very specific. For example, the right parietal lobe seems to store the operation-specific spatial layout required for complex arithmetical procedures and areas like the right insula are necessary in parsing complex numbers containing zero. Evidence is found for a complex orchestration between the two hemispheres even for simple tasks: each hemisphere has its specific role, concurring to the correct result. As for development, data point to right dominance for basic numerical processes. The picture that emerges at school age is a bilateral pattern with a significantly greater involvement of the right-hemisphere, particularly in non-symbolic tasks. The intraparietal sulcus shows a left hemisphere preponderance in response to symbolic stimuli at this age.

A qualitative study into the experience of living with acalculia after stroke and other forms of acquired brain injury

Acalculia, an acquired disability following a brain injury, involves difficulty processing numerical information and/or calculations. Acalculia is not routinely screened for, and as a result there is a lack of understanding about the nature and prevalence and the impact of the condition. This qualitative study was initiated by stroke survivors with a strong interest in acalculia. Sixteen stroke/brain injury survivors with acalculia and seven carers were interviewed using semi-structured online interviews. Participants ranged in age, gender, time post-onset, country of residence and numeracy level prior to brain injury. Data were analysed using thematic analysis. Three main themes were identified: Awareness and Diagnosis; Emotional and Practical Impact (independence); Support, Coping Strategies and Self-training. Participants and carers repeatedly referred to the lack of awareness and treatment for acalculia and the impact acalculia has had on their lives and independence. Practical impacts included managing money, making appointments, using timetables, organizing social activities and employment, and managing medication. Our results highlight the urgent need to develop suitable assessments and interventions for acalculia and the scope for this to be Patient, Carer and Public involvement (PCPI)-led. The data also reveal useful strategies and suggestions regarding effective timing, targets and approaches for intervention.

Which blueberries are better value? The development and validation of the functional numeracy assessment for adults with aphasia

BACKGROUND

People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real-life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy.

AIMS

To develop, validate and pilot a wide-ranging, aphasia-friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy.

METHODS & PROCEDURES

To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric-style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia-friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform.

OUTCOMES & RESULTS

The FNA23 demonstrated acceptable internal consistency reliability (KR-20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls.

CONCLUSIONS & IMPLICATIONS

The FNA23 is a wide-ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys.

WHAT THIS PAPER ADDS

What is already known on this subject Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work? The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties.

Difficulties with mathematics experienced by adults with epilepsy in daily life: An online study

OBJECTIVE

Mathematics encompass a variety of skills, broadly grouped into basic numeracy to complex secondary mathematical skills. In children with epilepsy difficulties with mathematics are common and related to a multicomponent working memory capacity. Little is known about mathematical skills of adults with epilepsy in daily life. Hence, we aimed to compare basic and secondary mathematical skills of adults with epilepsy to controls, examine relations between mathematical skills and working memory, and explored relationships between mathematical skills and epilepsy variables (age of onset, seizure frequency, and anti-seizure medication).

METHODS

Eighty four people with epilepsy and 86 healthy controls completed questionnaires on their subjective experience of using mathematics and working memory skills in daily life: The Dyscalculia Checklist (DC) and Working Memory Questionnaire (WMQ; including attention, storage, and executive scales), respectively. Questionnaires also collected demographic and epilepsy variables.

RESULTS

Adults with epilepsy reported greater difficulties in basic and secondary mathematical skills on the DC compared with controls. Only one epilepsy variable, a younger age of epilepsy onset, related to higher DC scores (greater mathematical difficulties), but was not significantly related in regression analyses. Instead, the WMQ explained 33% of the variance on the DC; the poorer storage and attention (but not executive) on the WMQ were associated with the higher DC score, when demographic and epilepsy variables were accounted for.

SIGNIFICANCE

Adults with epilepsy reported significant difficulties with mathematics in daily life, which were not explained by epilepsy variables but by poor working memory. While our findings suggest that daily difficulties with mathematics may be comorbid with epilepsy rather than epilepsy related, it is important to be cognizant of mathematical difficulties experienced by patients with epilepsy as they have potential to impact understanding of numerical information provided in patient care, such as risks associated with different epilepsy treatments.

A Validation Study of the Hong Kong Brief Cognitive Test for Screening Patients with Mild Cognitive Impairment and Alzheimer’s Disease

Background: The Hong Kong Brief Cognitive Test (HKBC), a brief instrument designed to screen for cognitive impairment in older adults, has been validated in Cantonese-speaking populations and has shown better performance than the Mini-Mental State Examination (MMSE) in detecting both mild and major neurocognitive disorder (NCD). Objective: This study aimed to validate the HKBC for detecting patients with amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) in a Mandarin-speaking Chinese population. Methods: Two hundred forty-eight patients with aMCI, 67 patients with mild AD and 306 healthy controls (HCs) were recruited for this study and completed both the HKBC and the MMSE. The performance of the HKBC and MMSE in distinguishing patients with aMCI from HCs and distinguishing patients with AD from patients with aMCI was compared in the whole population and in age- and education-stratified subgroups. Results: The optimal HKBC cutoff score for distinguishing patients with aMCI from HCs was 23, and the optimal cutoff for distinguishing patients with AD from patients with aMCI was 17. The HKBC significantly outperformed the MMSE at differentiating patients with aMCI from HCs in the whole population (z = 12.38, p <  0.01) and all subgroups stratified by age or education. Regarding the discrimination of patients with AD from patients with aMCI, the HKBC showed better performance than the MMSE in the oldest subgroup (z = 2.18, p = 0.03). Conclusion: The HKBC is a sensitive and specific screening tool for detecting aMCI and AD in the Chinese population across age groups and educational levels.

Dyscalculia in Early Adulthood: Implications for Numerical Activities of Daily Living

Numerical abilities are fundamental in our society. As a consequence, poor numerical skills might have a great impact on daily living. This study analyzes the extent to which the numerical deficit observed in young adults with Developmental Dyscalculia (DD) impacts their activities of everyday life. For this purpose, 26 adults with DD and 26 healthy controls completed the NADL, a standardized battery that assesses numerical skills in both formal and informal contexts. The results showed that adults with DD had poorer arithmetical skills in both formal and informal settings. In particular, adults with DD presented difficulties in time and measure estimation as well as money usage in real-world numerical tasks. In contrast, everyday tasks regarding distance estimation were preserved. In addition, the assessment revealed that adults with DD were aware of their numerical difficulties, which were often related to emotional problems and negatively impacted their academic and occupational decisions. Our study highlights the need to design innovative interventions and age-appropriate training for adults with DD to support their numerical skills as well as their social and emotional well-being.

Aphasia and Math: Deficits with Basic Number Comprehension and in Numerical Activities of Daily Living

OBJECTIVE

In the present study, we explored numerical problems in individuals with aphasia. We investigate whether numerical deficits, usually accompanying aphasia, can be observed on number comprehension tasks that do not necessarily require an oral response.

METHOD

Individuals with aphasia were classified into anterior, posterior, and global subgroups according to the lesion type. To investigate numerical cognition, we used a relatively recent tool, the Numerical Activities of Daily Living (NADL).

RESULTS

The results showed that individuals with aphasia have problems with tasks of basic number comprehension as well as in most NADL. In the formal part of the NADL, anterior aphasic patients made comparatively more errors than the posterior aphasic patients. Global aphasic patients presented an invariably poor performance on almost all tasks.

CONCLUSION

The results provide insight into how numerical deficits may impair an individual with aphasia in activities of daily living. This study is a preliminary attempt to start the validation process of the NADL for the Greek population.

Numerical activities of daily living: a short version

Specific impairments in numerical functions may cause severe problems in everyday life that cannot be inferred from the available scales evaluating instrumental activities of daily living. The Numerical Activities of Daily living (NADL) is a battery designed to assess the patient's performance in everyday activities involving numbers (Informal Test) and in more scholastic capacities (Formal Test). A downside of this battery is its duration (45 min). The aim of the present study is to build a shorter version of NADL to make it more suitable for clinical and research purposes. The shortening procedure involved only the Formal test, and followed two steps: (i) a correlation of subtests with the general scores, and (ii) an item-analysis within the subtests previously showing higher correlations. Correlations between NADL-Short and NADL original version, and the new cut-offs were calculated. Lastly, the relationship between NADL-Short and other brief cognitive screening tests used in the clinical practice was evaluated in neurological patients and healthy controls. The NADL-Short includes the original Informal Test and the shortened Formal Test. It is a quick and easy clinical tool (15 min) to assess numerical abilities applied to informal and formal situations. It correlates highly with the original battery (Kendall's tau greater than 0.6 across tasks) and the cut-offs correctly identify impaired performance (accuracy of 95% or above). Correlation analysis showed a low positive correlation between NADL-Short and other brief cognitive scales. These findings suggest that it is appropriate to use specific tools to make inferences about a person's numerical abilities.

How well do people living with neurodegenerative diseases manage their finances? A meta-analysis and systematic review on the capacity to make financial decisions in people living with neurodegenerative diseases

Self and proxy reported questionnaires indicate that people living with a neurodegenerative disease (NDD) have more difficulties with financial decision-making (FDM) than healthy controls. Self-reports, however, rely on adequate insight into everyday functioning and might, therefore, be less reliable. The present study provides a comprehensive overview and meta-analysis of studies evaluating FDM in people living with an NDD. For this, the reliability of performance-based tests to consistently identify FDM difficulties in people living with an NDD compared to healthy controls is evaluated. Furthermore, the associations between FDM and disease severity, performances on standard measures of cognition and demographics are evaluated. All 47 included articles, consistently reported lower performances on performance-based FDM tests of people living with an NDD (including Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, Parkinson's disease, multiple sclerosis or Huntington's disease) compared to healthy controls. The majority of studies, however, focused on Alzheimer's disease and mild cognitive impairment (k = 38). FDM performance appears to be related to cognitive decline, specifically in working memory, processing speed and numeracy.

Predicting financial deficits from a standard neuropsychological assessment: preliminary evidence in mild cognitive impairment

Patients with mild cognitive impairment (MCI) might experience difficulties in numerical and financial abilities of daily living that compromise their autonomy. The aim of the present work was to examine whether specific tests of the standard neuropsychological assessment could be used to predict these deficits in the clinical practice. Thirty-four MCI patients underwent a comprehensive clinical and neuropsychological examination including (1) a complete assessment of financial abilities and (2) a traditional neuropsychological assessment including measures of language, memory, executive functioning, reasoning, attention, and visuospatial abilities. The neuropsychological tests were used as predictors of the performance in everyday financial tasks using logistic regression analysis. Deficits in financial tasks including calculating percentages, using financial concepts and applying financial judgments were significantly predicted by tests of executive functions, language and short-term memory, while deficits in frequently encountered financial tasks activities such as item purchase and reading numbers could not be predicted by standard neuropsychological evaluations. Contingency tables on performance above/below clinical cut-offs evidenced some cases of financial deficits in the absence of cognitive deficits and, vice versa, some patients with cognitive decline did not show financial impairments. These results suggest that while some cognitive functions might be crucial for taking financial decisions, an ad hoc test of financial capacity is essential to make overall inferences about the everyday financial autonomy of MCI patients. This has potential implications for clinical and legal decisions that directly impact the individuals and their families.

The role of cognitive reserve as mediator for addition and multiplication skills in late adulthood

BACKGROUND

The role played by cognitive reserve for the maintenance of numeracy skills in late adulthood is still not sufficiently explored.

AIMS

This study mainly investigated whether cognitive reserve (i.e., vocabulary) mediates on the relationship between non-verbal reasoning and addition and multiplication skills of older individuals. Moreover, the impact of schooling and gender on written calculation was examined, controlling for the effect of cognitive decline.

METHODS

One hundred and six 68-94-year-old participants completed a battery of tests assessing numeracy, executive functions, and cognitive reserve skills.

RESULTS

Significant correlations were found between age, cognitive reserve, numeracy, and executive functions measures. Besides, mediation analyses indicated that cognitive reserve and non-verbal reasoning explain 23% and 29% of the variance in written addition and multiplication conditions, respectively. Finally, more educated individuals performed better numeracy tasks, whereas the solution of additions and multiplications was not impact by gender.

CONCLUSIONS

Cognitive reserve impacts numeracy in late adulthood.

Differential Impact of Education on Cognitive Performance in Neurological Patients with Progressive Cognitive Decline

BACKGROUND

Education has a protective effect toward cognitive decline in advanced age and is an important factor contributing to cognitive reserve.

OBJECTIVE

To elucidate the interaction effect of education and global mental status on cognitive performance of older patients with progressive cognitive decline.

METHODS

This retrospective study included 1,392 patients. We performed moderation regressions to examine the interaction between education and global mental status (Mini-Mental State Examination (MMSE) score) on performance in episodic memory, executive functions (EF), language, and constructional praxis tests. Significant interaction effects were further explored through separate linear regressions by MMSE level (inferior: ≤24; intermediate: 25-27; superior: 28-30).

RESULTS

There was an interaction between MMSE and education for some but not all variables. At intermediate and superior MMSE levels, high-educated people had a clear advantage relative to low-educated people in verbal memory and EF tests. This advantage was not significant at an inferior MMSE level. In object naming, constructional praxis recall, and constructional praxis, high-educated people performed better than low-educated people, independently of MMSE level.

CONCLUSION

Education has a differential effect on cognitive performance in patients with cognitive decline. While high education is not helpful for episodic memory and EF at low cognitive levels, it is still beneficial for retrieving words or other semantic knowledge. These findings suggest an interaction between global mental status and education on different cognitive domains and have strong clinical implications. Diagnostic judgments should be based on the knowledge of such interaction. This study highlights the beneficial but selective effects of high education.

Numerical Activities of Daily Living - Financial: a short version

Financial capacity is the ability to manage money and finances according to a person's values and self-interests. In Italy, the first instrument specifically designed to assess financial capacity has recently been developed: the Numerical Activities of Daily Living - Financial (NADL-F). The aims of this study are (1) to prepare a shorter version of NADL-F and (2) to examine the relationship between the new short version and a measure of general cognitive functioning of comparable length, the MMSE. After an item analysis performed on NADL-F, the items presenting a higher internal consistency were selected. The resulting NADL-F Short is a reliable, easy to use, and quick to administer tool for assessing financial capacity both in clinical and legal practice. Correlation analysis showed a low positive correlation between four NADL-F Short tasks and the MMSE, for the healthy participants group. For the patient group, instead, a low-moderate correlation was found for all the NADL-F Short tasks, except one. Many participants scoring high in the MMSE (both healthy controls and neurological patients) showed low NADL-F Short scores. These findings suggest that it is not correct to use generic tools like the MMSE to make inferences on a person's financial capacity.

Numeracy Skills, Cognitive Reserve, and Psychological Well-Being: What Relationship in Late Adult Lifespan?

BACKGROUND

The capacity of understanding and manipulating numerical stimuli (i.e., numeracy) can impact decision making. This investigation was conducted to examine whether number comprehension and mental calculation predict hedonic (i.e., Scale of Positive and Negative Experience, SPANE) and eudaimonic (i.e., Flourishing Scale) well-being in late adulthood, and whether cognitive reserve (i.e., education, time spent for gardening, and time spent for leisure activities) and non-verbal reasoning predict numeracy skills of old adults. Additionally, the effect of age on numeracy was examined, controlling for the effect of education and cognitive efficiency.

METHODS

One hundred and fifty-eight (i.e., 65-94 years old) community-dwellers completed a battery of tools assessing numeracy, cognitive and metacognitive efficiency, and psychological well-being.

RESULTS

Number comprehension, metacognition, time spent for leisure, and perceived physical health accounted for 23% of the variance in the SPANE condition, whereas metacognition, perceived physical health, time for leisure, and education explained 15% of the variance in the Flourishing condition. Moreover, cognitive reserve assessed in terms of vocabulary and education predicted mental calculation. Finally, aging significantly impacted the mental calculation performance of older participants.

CONCLUSIONS

These findings suggest that numeracy skills can selectively impact the mental health and daily life of older adults.

Response to a Specific and Digitally Supported Training at Home for Students With Mathematical Difficulties

The present study evaluated the effectiveness of a shortened, specialized, and digitally supported training program for enhancing numerical skills in primary and secondary school children with mathematical difficulty (MD). The participants (n = 57) were randomly assigned to two groups: for the experimental group, the tasks were differentiated and adapted to each student's learning profile. Moreover, children of this group used a Web App (i.e., "I bambini contano" or "Children count" in English) for improving arithmetic fact retrieval at home; for the control group, the difficulty of the activities was graded according to the school curriculum, and this group did not use the Web App. Pre- to post-training measurements showed that children of the experimental group had an improvement significantly higher than the control group, in particular in arithmetic facts and written calculation. Moreover, a follow-up evaluation indicated that the efficacy of the experimental training program lasted up to 2 months after the intervention. The results indicate that a specialized face-to-face intervention along with a digitally supported training at home can benefit children with mathematical learning difficulties.

The role of limbic structures in financial abilities of mild cognitive impairment patients

Mild Cognitive Impairment (MCI) patients experience problems in financial abilities that affect everyday functioning. To date, the neural correlates of decline in this domain are unclear. This study aims at examining the correlation between the pattern of brain atrophy of MCI patients and performance on financial abilities. Forty-four MCI patients and thirty-seven healthy controls underwent structural magnetic resonance imaging, and assessment of financial abilitiesby means of the Numerical Activities of Daily Living Financial battery (NADL-F). As compared to healthy controls, MCI patients showed impaired performance in three out of the seven domains assessed by NADL-F: Item purchase, percentage, and financial concepts. The patients' performance in the NADL-F correlated with memory, language, visuo-spatial, and abstract reasoning composite scores. The analysis also revealed that volumetric differences in the limbic structures significantly correlated with financial abilities in MCI. Specifically, the patients' performance in the NADL-F was correlated with atrophy in the left medial and lateral amygdala and the right anterior thalamic radiation. These findings suggest that completing daily financial tasks involves sub-cortical regions in MCI and presumably also the motivational and emotional processes associated to them. Involvement of altered limbic structures in MCI patients suggests that impairment in financial abilities may be related to emotional and reflexive processing deficits.

Numeracy Skills and Self-Reported Mental Health in People Aging Well

This study investigated the relationship between numerical accuracy (i.e, number comprehension and mental calculation) and self-reported depression in late adulthood. Whether social context (i.e., marital status) and very early cognitive decline symptoms impacted numerical performance was also examined. Ninety-four community-dwelling elderly participants were recruited in Sardinia, an Italian island characterized by increased longevity. All participants were presented a battery of tests and questionnaires assessing general cognitive efficiency, lifestyle, perceived physical health, numeracy, metacognitive and depressive responses. Number comprehension skills, time spent for gardening, metacognitive performance, and physical health predicted 26% of variance in CES-D index. Furthermore, married participants outperformed single/widowed ones in both number comprehension and mental calculation tasks. The same pattern of results was replicated when cognitively healthy controls were contrasted with participants with some signs of cognitive decline. The assessment of numeracy skills can be very informative in order to promote mental health and life quality in late adult span.

A Functional Domain Based Approach in Neurocognitive Rehabilitation with Transcranial Direct Current Stimulation: A Case Report

Transcranial direct current stimulation (tDCS) is a novel brain stimulation technique which has kindled hope in alleviating motor, language as well as cognitive deficits in neuronal injury. Current case report describes application of tDCS in two phases using two different protocols in a patient with hypoxic injury. In the first phase anodal stimulation of dorsolateral prefrontal cortex improved the language fluency. Subsequently, after 6 months second phase application of anodal stimulation over posterior parietal region targeted arithmetic and working memory deficits. Individualising the treatment protocols of brain stimulation, based on the lesion and the functional deficits, for neuro-rehabilitation is emphasised.

Reassessing lateralization in calculation

The role of the left hemisphere in calculation has been unequivocally demonstrated in numerous studies in the last decades. The right hemisphere, on the other hand, had been traditionally considered subsidiary to the left hemisphere functions, although its role was less clearly defined. Recent clinical studies as well as investigations conducted with other methodologies (e.g. neuroimaging, transcranial magnetic stimulation and direct cortical electro-stimulation) leave several unanswered questions about the contribution of the right hemisphere in calculation. In particular, novel clinical studies show that right hemisphere acalculia encompasses a wide variety of symptoms, affecting even simple calculation, which cannot be easily attributed to spatial disorders or to a generic difficulty effect as previously believed. The studies reported here also show how the right hemisphere has its own specific role and that only a bilateral orchestration between the respective functions of each hemisphere guarantees, in fact, precise calculation. Vis-à-vis these data, the traditional wisdom that attributes to the right hemisphere a role mostly confined to spatial aspects of calculation needs to be significantly reshaped. The question for the future is whether it is possible to precisely define the specific contribution of the right hemisphere in several aspects of calculation while highlighting the nature of the cross-talk between the two hemispheres.This article is part of a discussion meeting issue 'The origins of numerical abilities'.

The Relationship between Cognitive Reserve and Math Abilities

Cognitive Reserve is the capital of knowledge and experiences that an individual acquires over their life-span. Cognitive Reserve is strictly related to Brain Reserve, which is the ability of the brain to cope with damage. These two concepts could explain many phenomena such as the modality of onset in dementia or the different degree of impairment in cognitive abilities in aging. The aim of this study is to verify the effect of Cognitive Reserve, as measured by a questionnaire, on a variety of numerical abilities (number comprehension, reading and writing numbers, rules and principles, mental calculations and written calculations), in a group of healthy older people (aged 65–98 years). Sixty older individuals were interviewed with the Cognitive Reserve Index questionnaire (CRIq), and assessed with the Numerical Activities of Daily Living battery (NADL), which included formal tasks on math abilities, an informal test on math, one interview with the participant, and one interview with a relative on the perceived math abilities. We also took into account the years of education, as another proxy for Cognitive Reserve. In the multiple regression analyses on all formal tests, CRIq scores did not significantly predict math performance. Other variables, i.e., years of education and Mini-Mental State Examination score, accounted better for math performance on NADL. Only a subsection of CRIq, CRIq-Working-activity, was found to predict performance on a NADL subtest assessing informal use of math in daily life. These results show that education might better explain abstract math functions in late life than other aspects related to Cognitive Reserve, such as lifestyle or occupational attainment.

Numerical activities of daily living in adults with neurofibromatosis type 1

BACKGROUND

This study aimed to identify the mathematical domains affected in adults with neurofibromatosis 1 (NF1) and the impact of the numerical difficulties on the patients' activities of daily living.

METHODS

We assessed 28 adult patients with NF1 and 28 healthy control participants. All participants completed the standardised battery of numerical activities of daily living along with clinical batteries of cognitive (Mini-Mental State Examination) and daily functioning (instrumental activities of daily living). The group comparisons of the performance on numerical activities of daily living were carried out using t-test correcting for multiple comparisons.

RESULTS

The results showed that the NF1 group performed worse than controls in written subtractions, written multiplication, multiplication principles and digit comprehension (dot counting) tasks. Importantly, no significant differences in numerical ecological tasks were found between patients and controls, suggesting a possible use of compensatory strategies in daily living abilities in spite of calculation deficits.

CONCLUSION

The findings indicate that NF1 affects calculation but not the basic comprehension or representation of numbers in adult patients. These data have important implications for designing cognitive interventions tailored to the cognitive profile of individuals with NF1.

Neural Dynamics of Multiple Object Processing in Mild Cognitive Impairment and Alzheimer's Disease: Future Early Diagnostic Biomarkers?

The aim of this study was to investigate the behavioral and electrophysiological dynamics of multiple object processing (MOP) in mild cognitive impairment (MCI) and Alzheimer's disease (AD), and to test whether its neural signatures may represent reliable diagnostic biomarkers. Behavioral performance and event-related potentials [N2pc and contralateral delay activity (CDA)] were measured in AD, MCI, and healthy controls during a MOP task, which consisted in enumerating a variable number of targets presented among distractors. AD patients showed an overall decline in accuracy for both small and large target quantities, whereas in MCI patients, only enumeration of large quantities was impaired. N2pc, a neural marker of attentive individuation, was spared in both AD and MCI patients. In contrast, CDA, which indexes visual short term memory abilities, was altered in both groups of patients, with a non-linear pattern of amplitude modulation along the continuum of the disease: a reduction in AD and an increase in MCI. These results indicate that AD pathology shows a progressive decline in MOP, which is associated to the decay of visual short-term memory mechanisms. Crucially, CDA may be considered as a useful neural signature both to distinguish between healthy and pathological aging and to characterize the different stages along the AD continuum, possibly becoming a reliable candidate for an early diagnostic biomarker of AD pathology.

Re-assessing acalculia: Distinguishing spatial and purely arithmetical deficits in right-hemisphere damaged patients

Arithmetical deficits in right-hemisphere damaged patients have been traditionally considered secondary to visuo-spatial impairments, although the exact relationship between the two deficits has rarely been assessed. The present study implemented a voxelwise lesion analysis among 30 right-hemisphere damaged patients and a controlled, matched-sample, cross-sectional analysis with 35 cognitively normal controls regressing three composite cognitive measures on standardized numerical measures. The results showed that patients and controls significantly differ in Number comprehension, Transcoding, and Written operations, particularly subtractions and multiplications. The percentage of patients performing below the cutoffs ranged between 27% and 47% across these tasks. Spatial errors were associated with extensive lesions in fronto-temporo-parietal regions -which frequently lead to neglect- whereas pure arithmetical errors appeared related to more confined lesions in the right angular gyrus and its proximity. Stepwise regression models consistently revealed that spatial errors were primarily predicted by composite measures of visuo-spatial attention/neglect and representational abilities. Conversely, specific errors of arithmetic nature linked to representational abilities only. Crucially, the proportion of arithmetical errors (ranging from 65% to 100% across tasks) was higher than that of spatial ones. These findings thus suggest that unilateral right hemisphere lesions can directly affect core numerical/arithmetical processes, and that right-hemisphere acalculia is not only ascribable to visuo-spatial deficits as traditionally thought.

Numerical Activities and Information Learned at Home Link to the Exact Numeracy Skills in 5-6 Years-Old Children

It is currently accepted that certain activities within the family environment contribute to develop early numerical skills before schooling. However, it is unknown whether this early experience influences both the exact and the approximate representation of numbers, and if so, which is more important for numerical tasks. In the present study the mathematical performance of 110 children (mean age 5 years 11 months) was evaluated using a battery that included tests of approximate and exact numerical abilities, as well as everyday numerical problems. Moreover, children were assessed on their knowledge of number information learned at home. The parents of the participants provided information regarding daily activities of the children and socio-demographic characteristics of the family. The results showed that the amount of numerical information learned at home was a significant predictor of participants' performance on everyday numerical problems and exact number representations, even after taking account of age, memory span and socio-economic and educational status of the family. We also found that particular activities, such as board games, correlate with the children's counting skills, which are foundational for arithmetic. Crucially, tests relying on approximate representations were not predicted by the numerical knowledge acquired at home. The present research supports claims about the importance and nature of home experiences in the child's acquisition of mathematics.