What You Don't Know Can Hurt You: Uncertainty Impairs Executive Function.

Cognitive Predictors of Response to Treatment for Depression in Multiple Sclerosis

Depression is associated with more rapid cognitive decline in Parkinson's disease (PD).The goal of this study was to examine the impact of the acute (8-week) and longer-term (24-week) antidepressant treatment on cognition in PD and to detail cognitive predictors of treatment response.Fifty-two depressed PD patients were enrolled in an NIH funded randomized-controlled trial of nortriptyline, paroxetine, and placebo.Neuropsychological testing was performed at baseline, and weeks eight and twenty-four.Higher baseline scores on measures of executive functioning, speed of processing, and verbal memory were associated with antidepressant response.Treatment responders did not exhibit larger gains in cognition than non-responders.Findings warrant replication.

Attentional processes involved in the development of set shifting and restricted and repetitive behaviours in young typically developing children and children with autism

ABSTRACTObjectives: Unusually high engagement in expressive suppression (i.e., purposeful regulation of overt affect) has been associated with poorer performance on executive functioning (EF) and motor-sequence learning tasks. As such, expressive suppression represents one possible source of fluctuations in executive test performance. However, the relationship between expressive suppression and EF and motor performance has not yet been examined in older adults, who are more prone to EF and motor fluctuations than are younger adults. The purpose of this study was to test whether greater self-reported, naturally occurring expressive suppression is related to poorer EF performance and motor-sequence learning in older adults.Method: One hundred and ten community-dwelling older adults completed a self-report measure of expressive suppression, a battery of EF tests, and a computer-based measure of motor-sequence learning.Results: As expected, higher self-reported burden of expressive suppression in the 24 hours prior to testing was related to poorer performance on EF tests and on multiple aspects of motor-sequence learning (action planning latencies and sequencing errors) even after accounting for age, depressive symptoms, and component processes (e.g., processing speed).Conclusions: The current results suggest that naturally occurring expressive suppression depletes EF, which builds on previous findings from experimental studies that show that expressive suppression leads to reduced EF performance. Furthermore, this effect can be captured using self-report methods. These findings highlight expressive suppression as one source of intraindividual fluctuations in executive and motor functioning, which likely place older adults at risk for both functional and motor lapses (e.g., medication mistakes, falls).

Cognitive Impairment in Dialysis Patients: Focus on the Blood Vessels?

In everyday communication, word retrieval is semantically driven. A similar processing mechanism can be assumed for category fluency tasks. In contrast, in phonemic fluency tasks or rhyme production, the retrieval process must be based on the word form. In phonemic fluency, executive and language functions have been discussed as influencing this specific retrieval mechanism. In addition, studies of adults with developmental dyslexia and non-literate individuals have shown that deficits in written language processing are associated with poorer performance in phonemic fluency; a relationship that is not evident for category fluency. In people with aphasia (PWA), there is a lack of research on the possible relationship between written language skills and word form based word retrieval performance, although PWA often have acquired dyslexia/dysgraphia. There is also a paucity of data on possible effects on rhyme production. The aim of the present study was to investigate the effects of written language skills, word retrieval performance, aphasia severity and executive function on phonemic fluency, rhyme production and category fluency. It is hypothesised that phonemic fluency and rhyme production are associated with written language skills, while this is not assumed for category fluency. Word retrieval performance, aphasia severity and executive functions could have an impact on all three tasks. The study was conducted with 19 PWA (13f, 6m), showing predominantly post-semantic word retrieval disorders. The assessment included the following tasks: phonemic fluency, rhyme production, category fluency, reading and writing of nonwords (sub-lexical written language), reading and writing of unregular words (lexical written language), oral naming in the Boston Naming Test (word retrieval), Token Test (aphasia severity) and two visual-spatial tasks, spatial 2-back (executive function: updating) and antisaccade (executive function: inhibition). Descriptive analyses included correct responses and errors. In a second step, data were analysed by using hierarchical regression analyses. For both phonemic fluency and rhyme production, reading/writing of nonwords showed the strongest explanatory power. In contrast, for category fluency, the strongest predictor was oral naming performance in the Boston Naming Test. The results of the current study indicate that sub-lexical written language abilities are associated with phonemic fluency and rhyme production performance. In light of these results, it must be critically discussed whether phonemic fluency and rhyme production are appropriate tasks in the diagnosis and therapy of post-semantic word retrieval disorders, particularly in PWA with acquired dyslexia/dysgraphia. What is already known on this subject So far, it has been discussed that language functions, e.g., confrontation naming performance or vocabulary size, and executive functions have an impact on phonemic fluency in people with aphasia (PWA). In addition, studies with people with developmental dyslexia and non-literate people have shown that phonemic fluency performance is strongly influenced by segmental written language skills. What this paper adds to the existing knowledge The present study has shown that in PWA with post-semantic word retrieval disorders, segmental written language skills, i.e., reading/writing of nonwords, are associated with their performance in phonemic fluency and rhyme production. In contrast, performance in category fluency showed a relationship with spoken word retrieval abilities as measured by confrontation naming. What are the potential or actual clinical implications for this work? At least for PWA with dyslexia/dysgraphia, word form-based tasks such as phonemic fluency and rhyme production may not be appropriate for assessing or treating word retrieval disorders, as performance on these tasks, which rely on phonological strategies, appears to be related to deficits in segmental written language skills. Alternatively, tasks that also require semantic references may be more appropriate.

Personality Disorder Symptomatology and Neuropsychological Functioning in Closed Head Injury

Neurocognitive deficits in chronic alcoholic men are well documented. Impairments include memory, visual-spatial processing, problem solving and executive function. The cause of impairment could include direct effects of alcohol toxicity, pre-existing cognitive deficits that predispose towards substance abuse, comorbid psychiatric disorders and abuse of substances other than alcohol. Cigarette smoking occurs at higher rates in alcoholism and has been linked to poor cognitive performance, yet the effects of smoking on cognitive function in alcoholism are often ignored. We examined whether chronic alcoholism and chronic smoking have effects on executive function. Alcoholism and smoking were examined in a community-recruited sample of alcoholic and non-alcoholic men (n = 240) using standard neuropsychological and reaction-time measures of executive function. Alcoholism was measured as the average level of alcoholism diagnoses across the study duration (12 years). Smoking was measured in pack-years. Both alcoholism and smoking were correlated negatively with a composite executive function score. For component measures, alcoholism was correlated negatively with a broad range of measures, whereas smoking was correlated negatively with measures that emphasize response speed. In regression analyses, both smoking and alcoholism were significant predictors of executive function composite. However, when IQ is included in the regression analyses, alcoholism severity is no longer significant. Both smoking and alcoholism were related to executive function. However, the effect of alcoholism was not independent of IQ, suggesting a generalized effect, perhaps affecting a wide range of cognitive abilities of which executive function is a component. On the other hand, the effect of smoking on measures relying on response speed were independent of IQ, suggesting a more specific processing speed deficit associated with chronic smoking.

Patients with schizophrenia exhibit impairments in working memory that often appear in attenuated form in persons at high risk for the illness. The authors hypothesized that deviations in task-related brain activation and deactivation would occur in persons with an at-risk mental state performing a working memory task that entailed the maintenance and manipulation of letters. Participants at ultra high risk for developing psychosis (N=60), identified using the Comprehensive Assessment of At-Risk Mental States, and healthy comparison subjects (N=38) 14 to 29 years of age underwent functional MRI while performing a verbal working memory task. Group differences in brain activation were identified using analysis of covariance. The two groups did not show significant differences in speed or accuracy of performance, even after accounting for differences in education. Irrespective of task condition, at-risk participants exhibited significantly less activation than healthy comparison subjects in the left anterior insula. During letter manipulation, at-risk persons exhibited greater task-related deactivation within the default-mode network than comparison subjects. Region-of-interest analysis in the at-risk group revealed significantly greater right dorsolateral prefrontal cortex activation during manipulation of letters. Despite comparable behavioral performance, at-risk participants performing a verbal working memory task exhibited altered brain activation compared with healthy subjects. These findings demonstrate an altered pattern of brain activation in at-risk persons that contains elements of reduced function as well as compensation.

We investigated whether, and the extent to which, vascular and degenerative lesions in the brain mediate the association of diabetes with poor cognitive performance. This cross-sectional study included 4,206 participants (age > 65 years; 57.8% women) of the Age, Gene/Environment Susceptibility-Reykjavik Study. Data were collected through interview, clinical examination, psychological testing, and laboratory tests. The composite scores on memory, information-processing speed, and executive function were derived from a cognitive test battery. Markers of cerebral macrovascular (cortical infarcts), microvascular (subcortical infarcts, cerebral microbleeds, and higher white matter lesion volume), and neurodegenerative (lower gray matter, normal white matter, and total brain tissue volumes) processes were assessed on magnetic resonance images. Mediation models were employed to test the mediating effect of brain lesions on the association of diabetes with cognitive performance controlling for potential confounders. There were 462 (11.0%) persons with diabetes. Diabetes was significantly associated with lower scores on processing speed and executive function, but not with memory function. Diabetes was significantly associated with all markers of brain pathology. All of these markers were significantly associated with lower scores on memory, processing speed, and executive function. Formal mediation tests suggested that markers of cerebrovascular and degenerative pathology significantly mediated the associations of diabetes with processing speed and executive function. Diabetes is associated with poor performance on cognitive tests of information-processing speed and executive function. The association is largely mediated by markers of both neurodegeneration and cerebrovascular disease. Older people with diabetes should be monitored for cognitive problems and brain lesions.

: Recent population studies have suggested that children with multiple exposures to anesthesia and surgery at an early age are at an increased risk of cognitive impairment. The authors therefore have established an animal model with single versus multiple exposures of anesthetic(s) in young versus adult mice, aiming to distinguish the role of different types of anesthesia in cognitive impairment. : Six- and 60-day-old mice were exposed to various anesthesia regimens. The authors then determined the effects of the anesthesia on learning and memory function, levels of proinflammatory cytokine interleukin-6 and tumor necrosis factor-α in brain tissues, and the amount of ionized calcium-binding adaptor molecule 1-positive cells, the marker of microglia activation, in the hippocampus. : In this article, the authors show that anesthesia with 3% sevoflurane for 2 h daily for 3 days induced cognitive impairment and neuroinflammation (e.g., increased interleukin-6 levels, 151 ± 2.3% [mean ± SD] vs. 100 ± 9.0%, P = 0.035, n = 6) in young but not in adult mice. Anesthesia with 3% sevoflurane for 2 h daily for 1 day and 9% desflurane for 2 h daily for 3 days induced neither cognitive impairment nor neuroinflammation. Finally, an enriched environment and antiinflammatory treatment (ketorolac) ameliorated the sevoflurane-induced cognitive impairment. : Anesthesia-induced cognitive impairment may depend on developmental stage, anesthetic agent, and number of exposures. These findings also suggest the cellular basis and the potential prevention and treatment strategies for anesthesia-induced cognitive impairment, which may ultimately lead to safer anesthesia care and better postoperative outcomes for children.

Autistic individuals generally exhibit real-world executive function (EF) difficulties and perform poorly on EF tasks. However, while autistic traits are distributed continuously throughout the general population, the relationships between autistic traits and EF among nonclinical individuals remain unclear. Here, we conducted complementary meta-analyses to clarify the relationships between autistic traits and various aspects of EF in the general population. A literature search was conducted using PubMed, PsycINFO, and Web of Science on July 11, 2025. After screening by two independent reviewers, 39 articles that reported 40 studies were included. These studies either compared EF between groups with high and low autistic traits, based on a cutoff, or investigated the relationships between continuous measures of autistic traits and EF. We found significant negative associations between autistic traits and EF among nonclinical individuals across EF processes. Notably, these relationships were observed only when EFs were measured using questionnaires rather than behavioral tasks. Specifically, random-effects and robust Bayesian meta-analyses revealed significant, strong correlations between higher autistic traits and poorer ratings on EF questionnaires, with primarily substantial evidence supporting the presence than absence of relationships. In contrast, the meta-analyses indicated nonsignificant, very weak correlations between higher autistic traits and poorer performances on EF tasks, with primarily substantial evidence supporting the absence than presence of relationships. These findings were mainly based on self-reported measures of autistic traits in adults and derived from single studies without follow up or replication. Autistic traits are associated with lower perceived real-world EF behavior rather than poorer EF task performance in the general population. These findings underscore the importance of paying closer attention to addressing the concerns of individuals with high autistic traits and their parents regarding their own and their children's EF behavior. Based on the available evidence, we construct a picture of the relationships between autistic traits and EF across the trait's continuum. This study was preregistered at https://osf.io/zncv3 .

To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.

To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD). Children in second and fourth grade with a diagnosis of ADHD (n = 104) were randomly assigned to neurofeedback (NF) (n = 34), cognitive training (CT) (n = 34), or control (n = 36) conditions. A 2-point growth model assessed change from pre-post intervention on parent reports (Conners 3-Parent [Conners 3-P]; Behavior Rating Inventory of Executive Function [BRIEF] rating scale), teacher reports (Swanson, Kotkin, Agler, M-Flynn and Pelham scale [SKAMP]; Conners 3-Teacher [Conners 3-T]), and systematic classroom observations (Behavioral Observation of Students in Schools [BOSS]). Paired t tests and an analysis of covariance assessed change in medication. Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention, Executive Functioning and Global Index, on all BRIEF summary indices, and on BOSS motor/verbal off-task behavior. Children who received CT showed no improvement compared to the control condition. Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning, all BRIEF summary indices, SKAMP Attention, and Conners 3-T Inattention subscales. Stimulant medication dosage in methylphenidate equivalencies significantly increased for children in the CT (8.54 mg) and control (7.05 mg) conditions but not for those in the NF condition (0.29 mg). Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions. Thus, NF is a promising attention training treatment intervention for children with ADHD.

Background It is reported that executive functions are impaired in a variety of neuropsychiatric syndromes, including depressive disorders. Studies on executive functions in depressive disorders are inconclusive. Methods A total of 50 drug naive patients with major depressive disorder were included in the study. The severity of depression was measured using the Hamilton Depression Rating Scale (HAM-D), and executive functions were assessed using the Digit Symbol Substitution Test, Digit Vigilance Test, Controlled Oral Word Association Test, Animal naming test, Verbal N back (1&2) test, Trail making test A & B and Stroop test as per the NIMHANS Neuropsychology Battery 2004 manual. Results The mean age of the sample was 31.9 years. Females constituted 60% of the sample. A majority were Hindus, nearly 75% were from semi-urban areas, 66% were married, and 58% had a college education. Depression was associated with poor performance on executive functions except for working memory and set shifting. Older age, greater severity of depression, a longer duration of illness and the duration of the present episode were associated with poor performance on executive functions. A higher level of education was associated with better performance on executive functions. Conclusions This cross-sectional assessment suggests that some aspects of executive functions are impaired in patients with major depressive disorder. Further studies in remitted patients, controlled for age, and education level are suggested.