The effects of interpreting training on executive functions: A longitudinal study

Background: Determinants of changes in cognitive function during aging are not well-understood. We aimed to estimate the effects of depression-, anxiety- and anger symptoms on cognition and on cognition changes, especially on changes in episodic memory (EM) and executive functioning (EF).Methods: We analyze data from the Mid-Life in the Midlife in the United States Biomarker study at two time points including n = 710 women, and n = 542 men (1996/1997) at the first assessment and n = 669 women, and n = 514 men at the second assessment (2013/2014). To assess cognition we used the Brief Test of Adult Cognition (BTACT). To measure depression-, anxiety- and anger symptoms we used the Mood and Anxiety Symptom Questionnaire (MASQ), the Center for Epidemiologic Studies Depression Scale (CES-D) and the State-Trait Anger Expression Inventory (STAXI). We used repeated models analyses to explore changes in cognition, and repeated measures linear mixed-effects models to investigate depression, anxiety and anger effects on cognition. All analyses were adjusted for potential confounders (cognition at baseline, age, education, income).Results: At the first assessment, women had significantly better episodic memory functioning than men; men in the oldest age group had significant better executive functioning. At the second assessment, more education, and white ethnicity were associated with less negative changes on episodic memory and executive functioning. Depression- and anger symptoms were associated with declines in episodic memory among women; anxiety symptoms were associated with declines in episodic memory and executive functioning in both gender in men (EF: β: −0.02, (95% CI: −0.03, −0.01; EM: β −0.02 (−0.02, 95% CI: −0.03, −0.01) and in women (EF: β −0.01, 95% CI: −0.02, −0.0004; EM: β −0.013, 95% CI: −0.03, −0.001).Conclusions: Depression-, anxiety- and anger symptoms were associated with changes in episodic memory and executive functioning. Further longitudinal studies are critical in populations in more countries to better understand the impact of depression, anxiety and anger symptoms on cognition changes.

Data in many experiments arise as curves and therefore it is natural to use a curve as a basic unit in the analysis, which is termed functional data analysis (FDA). In longitudinal studies, recent developments in FDA have extended classical linear models and linear mixed effects models to functional linear models (also termed varying-coefficient models) and functional mixed effects models. In this paper we focus our review on the functional mixed effects models using smoothing splines, because functional linear models are special cases of this more general framework. Due to the connection between smoothing splines and linear mixed effects models, functional mixed effects models can be fitted using existing software such as SAS Proc Mixed. A case study is presented as an illustration.

Aim. To determine the characteristics of memory changes in associative and spatial memory in the dynamics of repeated blast-induced neurotrauma (rBINT) in rats. Materials and methods. The study was conducted on 36 sexually mature male rats, in accordance with the current legislation on the humane treatment of animals. The selected rats were randomly divided into 2 groups for assessment using the conditioned passive avoidance response (CPAR) test (I) and the Barnes maze (II). In each of these groups, three subgroups were formed: Experimental – subjected to 3-fold exposure to a blast wave with an excess pressure of 31.6 ± 4.8 kPa; Control – exposed only to halothane and fixation; Intact. The study was conducted on the 1st, 3rd, 7th, 14th, 21st and 28th days after the blast wave exposure. Results. Experimental reproduction of rBINT on the 1st, 3rd, 7th, 14th, 21st day showed a significant decrease in the time spent by rats in the light compartment in the CPAR test as compared to the control and intact groups, indicating a deterioration in associative memory. The study using the Barnes maze demonstrated significantly increased latency to find the target hole and the number of errors in experimental animals throughout the observation period as compared to the control and intact groups, indicating a deterioration in spatial memory. Conclusions. Experimental modeling of repeated blast-induced neurotrauma in rats has revealed a significant decrease in associative memory within the first 14 days after the exposure with partial recovery from day 21 to 28. Spatial memory remained impaired throughout the observation period, as evidenced by increased time to locate the hidden platform and the number of errors in the Barnes maze. The detected impairments suggest the impact of the blast wave on cognitive functions, and could be associated with hippocampal pathologies, neuroinflammation, and prefrontal cortex dysfunction.

Longitudinal data, comprising repeated measurements of the same individuals over time, arise frequently in cardiology and the biomedical sciences in general. For example, Frison and Pocock1 used repeated measurements of the liver enzyme creatine kinase in serum of cardiac patients to study changes in liver function over a 12-month study period. The main goal, indeed the raison d’etre , of a longitudinal study is characterization of changes in the response of interest over time. Ordinarily, changes in the response are also related to selected covariates. For example, Frison and Pocock1 compared changes in creatine kinase between patients randomized to active drug and placebo. The past 25 years have witnessed remarkable developments in statistical methods for the analysis of longitudinal data. Despite these important advances, researchers in the biomedical sciences have been somewhat slow to adopt these methods and often rely on statistical techniques that fail to adequately account for longitudinal study designs. The goal of the present report is to provide an overview of some recently developed methods for longitudinal analyses that are more appropriate, with a focus on 2 methods for continuous responses: the analysis of response profiles and linear mixed-effects models. The analysis of response profiles is better suited to settings with a relatively small number of repeated measurements, obtained on a common set of occasions, whereas linear mixed-effects models are suitable in more general settings. Before describing these methods, we review some of the defining features of longitudinal studies and highlight the main aspects of longitudinal data that complicate their analysis. ### Covariance Structure A common feature of repeated measurements on an individual is correlation; that is, knowledge of the value of the response on one occasion provides information about the likely value of the response on a future occasion. Another common feature of longitudinal data is heterogeneous …

Visual memory in children with high-functioning autism (HFA) is an area of debate. According to the few studies that have examined visual memory in children with autism, the memory profile appears to vary according to the memory process and type of stimuli, and contrasting results may be found. This study aims to analyze the visual memory profile of children with HFA. Fifteen children with HFA (mean age 9.6) and 15 typically developing children (TD; mean age 9.2) matched by chronological age and Leiter-R Brief IQ score took part in the study. Associative and recognition memory as well as visuospatial working memory were assessed. Impairments in face recognition and forward memory were found, whereas associative memory and shape recognition were preserved. The memory profile in children with Autism Spectrum Disorder (ASD) showed relatively stronger abilities in associative memory than in the other visual memory domains. The results support the hypothesis that the level of stimulus processing may influence memory performance by having a large impact on tasks and stimuli that require access to a semantic or global level of processing. In contrast to the TD population, children with ASD may have difficulty extracting underlying regularities from experiences and generalizing that information. Highlights Children with high-functioning autism (HFA) show preserved ability in associative memory and shape recognition. Face recognition appears to be a specific deficit in children with HFA. Associative memory appeared to be the strongest ability in the memory profile of children with autism spectrum disorder (ASD) and typically developing (TD) children.

Introduction: Apart from stroke, cognitive change after incident myocardial infarction (MI) is unclear. We aim to determine associations between incident MI and acute and long-term changes in cognitive function, controlling for risk factors and pre-MI cognitive trajectories, censoring for stroke. Methods: We performed a pooled analysis of 31,377 participants, ≥18 years, free of MI and dementia, from 6 longitudinal cohort studies (1971-2017): Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Outcomes were changes in global cognition (primary), memory, and executive function. Linear mixed-effects models were used to estimate the association between incident MI and acute cognitive decline at the time of MI (Model A), and decline in cognition over the years after MI (Model B). Results: Median study follow up was 6.4 years (IQR 4.9-19.7 years) and 1,047 participants had incident MI. Incident MI was associated with significant acute decline in global cognition and executive function, but not memory, after the MI event (Models A, Table 1). After including change in cognitive function (slope) after incident MI in the model, the effect estimates indicating acute declines in global cognition and executive function were not significant (Models B, Table 1). However, participants with incident MI demonstrated significantly faster declines in global cognition (-0.15 points/year faster [95% CI, -0.21 to -0.10]), memory (-0.13 points/year faster [95% CI, -0.23 to -0.04]), and executive function (-0.14 points/year faster [95% CI, -0.20 to -0.08]) compared to those without MI (Models B, Table 1). Conclusions: Incident MI is associated with faster declines in global cognition, memory, and executive function over years following the MI event.

The magnitude of cognitive changes after incident heart failure (HF) is unclear. We assessed whether incident HF is associated with changes in cognition after accounting for pre-HF cognitive trajectories and known determinants of cognition. This pooled cohort study included adults without HF, stroke, or dementia from 6 US population-based studies from 1971 to 2019. Linear mixed-effects models estimated cognitive change with incident HF diagnosis and the rate of cognitive change over the years after HF, controlling for pre-HF cognitive trajectories and participant factors. Outcomes included change in global cognition (primary outcome), executive function, and memory (secondary outcomes). Cognitive outcomes were standardized to a t score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. We included 29 614 adults (mean [SD] age was 61 [10] years, 55% female, 70% White). During a median follow-up of 6.6 (Q1-Q3, 5.0-19.8) years, 1407 (5%) adults received an incident diagnosis of HF. Incident HF diagnosis was associated with initial decreases in global cognition (-1.1 points [95% CI, -1.4 to -0.8]) and executive function (-0.6 points [95% CI, -1.0 to -0.3]). Larger decreases in global cognition after HF were seen with older age, female sex, and White race. Participants with incident HF diagnosis demonstrated faster and long-term declines in global cognition (-0.1 points per year [95% CI, -0.2 to -0.1]) and executive function (-0.2 points per year [95% CI, -0.2 to -0.1]). The change in memory with incident HF diagnosis was not statistically significant but showed a similar trend with an initial decline of -0.5 points (95% CI, -1.4 to +0.3) and a slope of -0.1 points per year (95% CI, -0.3 to 0.0). In this pooled cohort study, incident HF diagnosis was associated with initial decreases in global cognition and executive function and faster, persistent declines in these domains at follow-up.

Short-term PM2.5 exposure and cognitive function: Association and neurophysiological mechanisms

HomeCirculationVol. 120, No. 4Letter by Patel Regarding Article, “A Primer in Longitudinal Data Analysis” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Patel Regarding Article, “A Primer in Longitudinal Data Analysis” Chirag B. Patel, MSE Chirag B. PatelChirag B. Patel Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex Search for more papers by this author Originally published28 Jul 2009https://doi.org/10.1161/CIRCULATIONAHA.108.836767Circulation. 2009;120:e25To the Editor:I read with great interest the article titled “A Primer in Longitudinal Data Analysis” by Fitzmaurice and Ravichandran.1 Focusing on longitudinal data, the authors highlighted the important chasm between advancements in statistical methods and the analysis of current biomedical studies. Furthermore, the pros and cons of 2 particular approaches (analysis of response profiles and linear mixed-effects models) were well explained through case examples of previous studies. However, with the exception of a passing mention of cited sources for further reading (references 7 and 9 in the original article), the authors did not explain another important approach for analyzing longitudinal data: generalized estimating equations (GEEs).2GEEs can be used to model correlated data from repeated measures over the course of a longitudinal study. With respect to the defining features of longitudinal studies explained by Fitzmaurice and Ravichandran (eg, covariance structure and balanced versus unbalanced designs), GEEs have been shown to be more robust when missing data, imputation techniques, and other factors are considered.3 Of particular interest to longitudinal clinical studies is the use of GEEs to identify the best correlation structure and subset of covariates for a given model. Seemingly conflicting reports on the inefficiency of GEEs compared with independence estimating equations4,5 can be explained by differences in the type of data and covariate and correlation structures under study. The use of more recent models, such as the conditional second-order GEE estimator,6 has yielded improved efficiency. Furthermore, GEE models can be implemented in the software packages discussed by Fitzmaurice and Ravichandran.Clinician investigators and article reviewers would benefit greatly from knowing which model for the analysis of longitudinal data (eg, analysis of response profiles, linear mixed-effects models, GEE, independence estimating equation, or conditional second-order GEE) is most apt given a study’s design, data structure, and other relevant factors. Moreover, and in line with Fitzmaurice and Ravichandran’s intent, such an understanding will lead to an improved interpretation of longitudinal study results. This would get us “closer to reality” in terms of understanding the true impact of devices, pharmaceuticals, and other interventions for improved care of patients with cardiovascular risk factors and disease.DisclosuresNone. References 1 Fitzmaurice GM, Ravichandran C. A primer in longitudinal data analysis. Circulation. 2008; 118: 2005–2010.LinkGoogle Scholar2 Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988; 44: 1049–1060.CrossrefMedlineGoogle Scholar3 Twisk J, de Vente W. Attrition in longitudinal studies: how to deal with missing data. J Clin Epidemiol. 2002; 55: 329–337.CrossrefMedlineGoogle Scholar4 Sutradhar BC, Das K. On the efficiency of regression estimators in generalised linear models for longitudinal data. Biometrika. 1999; 86: 459–465.CrossrefGoogle Scholar5 Fitzmaurice GM. A caveat concerning independence estimating equations with multivariate binary data. Biometrics. 1995; 51: 309–317.CrossrefMedlineGoogle Scholar6 Vonesh EF, Wang H, Nie LDM. Conditional second-order generalized estimating equations for generalized linear and nonlinear mixed-effects models. J Amer Statistical Assoc. 2002; 97: 271–283.CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rahman S, Sullivan J, Barger L, St. Hilaire M, O’Brien C, Stone K, Phillips A, Klerman E, Qadri S, Wright K, Halbower A, Segar J, McGuire J, Vitiello M, de la Iglesia H, Poynter S, Yu P, Sanderson A, Zee P, Landrigan C, Czeisler C and Lockley S (2021) Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians, Pediatrics, 10.1542/peds.2020-009936, 147:3, Online publication date: 1-Mar-2021. July 28, 2009Vol 120, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.836767PMID: 19635976 Originally publishedJuly 28, 2009 PDF download Advertisement SubjectsEpidemiology

Memory Concerns and Cognitive Change in a Diverse Cohort of Oldest Old Individuals: LifeAfter90 Study

Elevated tau phosphorylation has been linked to the Apolipoprotein E (APOE) ɛ4 allele, which is considered one of the most significant genes related to Alzheimer's disease (AD). However, it is uncertain whether the impact of increased plasma tau phosphorylated at threonine 181 (p-tau181) on memory and executive function decline would be greater among APOEɛ4 carriers. To investigate the effects of plasma p-tau181 and APOEɛ4 on memory and executive function. The longitudinal analysis included 608 older adults without dementia (aged 72±7 years; 47% female; follow-up period of 1.59±1.47 years) from the ADNI dataset, including 180 individuals with normal cognition and 429 individuals with mild cognitive impairment. Linear mixed-effects models were utilized to assess the contributions of APOEɛ4 status and plasma p-tau181 to longitudinal changes in memory composite score and executive function composite score. At baseline, the APOEɛ4+/Tau+ group exhibited poorer performance in memory composite score and executive function composite score, and an elevated load of cerebrospinal fluid Aβ and tau pathologies. To further understand longitudinal changes, we compared groups directly based on plasma p-tau181 and APOEɛ4 status (four groups: APOEɛ4-/Tau-, APOEɛ4-/Tau+, APOEɛ4+/Tau-, APOEɛ4+/Tau+). Both the memory composite score and executive function composite score showed a significantly greater decline in the APOEɛ4+/Tau+ group than in all other groups. Our findings indicate that there is an interaction between plasma p-tau181 levels and APOEɛ4 status, which contributes to the longitudinal changes of memory and executive function in older adults without dementia.

Impaired everyday function is a diagnostic criterion for dementia, and a determinant of healthcare utilization and caregiver burden. Although many previous studies have demonstrated a cross-sectional relationship between cognition (particularly executive functions and memory) and everyday function in older adults, very little is known about longitudinal relationships between these domains. This study examined the association between longitudinal change in episodic memory (MEM) and executive functioning (EXEC) and change in everyday function. Participants were a cognitively heterogeneous group of 100 elderly persons including those with normal cognition, as well as those with mild cognitive impairment and dementia. They were followed for an average of 5 years. Random effects modeling showed that change in both MEM and EXEC were independently associated with rate of change in informant-rated instrumental activities of daily living (IADLs), even after controlling for age, education, and gender. Findings indicate that declines in MEM and EXEC over time make unique and independent contributions to declines in older adults’ ability to function in daily life.

Trajectory of associative memory impairment during electroconvulsive therapy in depression

Patterns of time spent in sedentary behavior, physical activity, and sleep are associated with cognitive decline among CLSA participants: A latent class analysis.

Physical literacy & early childhood executive function and language development: Active Early Learning randomised controlled trial