Digit Span Backward Test Research Articles

Evidence for modulation of planning and working memory capacities by transcranial direct current stimulation in a sample of adults with attention deficit hyperactivity disorder

Background and ObjectiveAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects up to 2.8% of the adult population. Albeit pharmacological and behavioral therapies alleviate some core symptoms of ADHD, they do not avail cognitive dysfunction adequately. Executive dysfunction has been considered to have a principal role in ADHD and has previously been linked to activity alterations in the prefrontal cortex. Transcranial Direct Current Stimulation (tDCS) is a noninvasive brain stimulation technique that may modulate prefrontal cortex activity and induce neuroplasticity, with preliminary results in ADHD. The aim of the present study is to assess the effect of repeated tDCS on measures of executive functions in adults with ADHD. MethodIn this randomized double-blind sham-controlled study, 22 adults with ADHD were allocated into two groups and were administered five consecutive sessions of 2 mA active/sham tDCS over the dorsolateral prefrontal cortex (right anodal/left cathodal). A neuropsychological test battery was administered before the first session and immediately after the last session. ResultsThe maximum number of digits and the total number of correct trials in the Digit Span Backward test increased in the active group (p = 0.017). The total move score in the Tower of London test decreased (p = 0.033), suggesting better planning ability. However, no significant differences were observed on Stroop Test and Trail Making Test after tDCS. DiscussionThe present study corroborates the modulating effects of tDCS on planning and working memory in a small group of adults with ADHD. Our results highlighted that cognitive functions are modulable using tDCS in adults with ADHD.

Correlation of muscle strength with cognitive function and medial temporal lobe atrophy in patients with mild to moderate Alzheimer's disease

Objective: To analyze the correlation of muscle strength with cognitive function and medial temporal lobe atrophy (MTA) in patients with mild to moderate Alzheimer's disease (AD). Methods: General information, sarcopenia-related indicators, neuropsychological tests and MTA score were collected in 80 confirmed AD patients (41 mild and 39 moderate patients) and 43 normal controls (NC) from the Memory Disorders Clinic of Department Of Neurology in the Second Affiliated Hospital of Soochow University between January and December 2021. Appendicular skeletal muscle mass index (ASMI), grip strength and 5-times sit-to-stand time and 6-m gait speed were used for assessing muscle mass, muscle strength and physical function, respectively. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment scale (MoCA), Memory and Executive Screening Scale (MES), Digit Symbol Substitution Test (DSST), Digital Span Test (DST) and Verbal Fluency Task (VFT), respectively. DST included Forward Digit Span Test (FDST) and Backward Digit Span Test (BDST). All the subjects underwent 3.0T coronal three-dimensional gradient echo sequence MRI. MTA scale was performed to evaluate the degree of medial temporal lobe atrophy. The differences in the sarcopenia-related indicators, cognitive score and MTA score were analyzed among the three groups, and the partial correlation analysis was performed between the inter-groups. Results: Eighty AD patients (24 males and 56 females) were included, aged (72±7) years old, with 41 mild and 39 moderate patients. Meanwhile, 43 NC included 19 males and 24 females, with a mean age of (70±6) years old. The disease duration in moderate AD patients was longer than that of mild AD patients [34.0 (25.0, 43.5) months vs 24.0 (11.0, 34.0) months, P<0.001]. The differences of sarcopenia-related indicators and MTA score among the three groups were statistically significant (all P<0.001), including 5-times sit-to-stand time [(13.6±1.8) s vs (11.5±1.7) s vs (10.3±1.9) s, P<0.001] and MTA score [2.0 (2.0, 3.0) vs 1.0 (1.0, 2.0) vs 0 (0, 0), P<0.001]. In neuropsychological tests, compared to the NC group, MMSE, MoCA, MES and VFT scores in mild and moderate AD groups were lower (all P<0.001); meanwhile, compared to the mild AD group, the moderate group had lower MMSE, MoCA, MES, DSST and VFT scores (all P<0.001). In sarcopenia-related indicators, muscle strength in particular was correlated with widespread cognitive functioning domains and MTA score in AD patients. Grip strength was positively correlated with MMSE, MoCA , MES, FDST (r=0.387, 0.418, 0.522 and 0.484, respectively, all P<0.001), DSST (r=0.327, P=0.006) and VFT score (r=0.354, P=0.003), and negatively correlated with MTA score (r=-0.631, P<0.001). 5-times sit-to-stand time was negatively correlated with MMSE, MoCA, MES, DSST, FDST, VFT score (r=-0.583, -0.587, -0.814, -0.591, -0.552 and -0.485, respectively, all P<0.001), and BDST (r=-0.355, P=0.003) strongly positively correlated with MTA score (r=0.836, P<0.001). ASMI was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.257, 0.238, 0.428, 0.282 and 0.364, respectively, all P<0.05), and negatively correlated with MTA score (r=-0.377, P=0.001). 6-m gait speed was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.419, 0.486, 0.699, 0.559 and 0.500, respectively, all P<0.001), BDST and VFT score (r=0.384、0.377, respectively, both P=0.001), and strongly negatively correlated with MTA score (r=-0.803, P<0.001). Conclusions: Patients with mild to moderate AD have widespread cognitive impairment. Muscle mass, muscle strength and physical function are all significantly impaired. Compared to muscle mass and physical function, decreased muscle strength is significantly associated with widespread cognitive decline and increased degree of medial temporal lobe atrophy.

Arterial spin labeling magnetic resonance evaluates changes of cerebral blood flow in patients with mild traumatic brain injury.

The patients with mild traumatic brain injury (mTBI) accounts for more than 80% of the patients with brain injury. Most patients with mTBI have no abnormalities in CT examination. Therefore, most patients choose to self-care and recover rather than seeking medical treatment. In fact, mTBI may result in persistent cognitive decline and neurobehavioral dysfunction. In addition, changes occurred in neurochemistry, metabolism, and cells after injury may cause changes in cerebral blood flow (CBF), which is one of the causes of secondary injury and slow brain repair. This study aims to evaluate the changes of CBF with the progression of the disease in patients with mTBI based on arterial spin labeling (ASL) magnetic resonance imaging technology. In the outpatient or emergency department of the Second Affiliated Hospital of Wenzhou Medical University, 43 mTBI patients were collected as an mTBI group, and 43 normal subjects with age, gender, and education level matching served as a control group. They all received clinical neuropsychology and cognitive function evaluation and magnetic resonance imaging. In the mTBI group, 22 subjects were followed up at acute phase, 1 month, 3 months, and 12 months. Based on the control group, the abnormal regions of CBF in the whole brain of mTBI patients were analyzed. The abnormal regions were taken as the regions of interest (ROI). The correlation of the values of the CBF in ROIs with clinical indications, cognitive function, and the changes of CBF in ROI at each time point during the follow-up were analyzed. Compared with the control group, the CBF in the bilateral dorsolateral superior frontal gyrus and auxiliary motor areas in the cortical region, as well as the right putamen, caudate nucleus, globus pallidus, and parahippocampus in the subcutaneous regions in the acute phase of the mTBI group were significantly increased (all P<0.01, TFCE-FWE correction). The analysis results of correlation of CBF with neuropsychology and cognitive domain showed that in the mTBI group, whole brain (r=0.528, P<0.001), right caudate nucleus (r=0.512, P<0.001), putamen (r=0.486, P<0.001), and globus pallidus (r=0.426, P=0.006) values of the were positively correlated with Backward Digit Span Test (BDST) score (reflectting working memory ability), and the right globus pallidus CBF was negatively correlated with the Post-Traumatic Stress Disorder Cheeklist-CivilianVersion (PCL-C) score (r=-0.402, P=0.010). Moreover, the follow-up study showed that abnormal CBF in these areas had not been restored. The correlation of CBF was negatively correlated with PCL-C and BDST at 1 months, 3 months, and 12 months (all P>0.05). The elevated CBF value is one of the stress characteristics of brain injury in the mTBI patients at the acute phase. There is abnormal elevation of CBF values in multiple cortex or subcortical areas. Multi-time point studies show that there is no obvious change of CBF in abnormal areas, suggesting that potential clinical treatment is urgently needed for the mTBI patients.

Effects of computerized cognitive training on cognitive function, activity, and participation in individuals with stroke: A randomized controlled trial.

Computerized cognitive training (CCT) is an emerging alternative intervention for stroke survivors. This study investigated the effects of CCT on the cognition, activity, and participation of stroke survivors and compared the findings with those of match-dosed conventional cognitive training. This randomized controlled trial included 39 patients with stroke who were divided into the intervention group (n = 19; receiving CCT with Lumosity software) and the control group (n = 20; receiving conventional cognitive training). Both the groups were trained for 20 min, twice a week, for 12 weeks. Participants were evaluated at pretest, posttest, and 4-week follow-up. Outcome measures included various cognitive function tests and the Stroke Impact Scale scores. The CCT group exhibited significant improvement in global cognitive function (evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment) and specific cognitive domains: verbal working memory (backward digit span test), processing speed (Symbol Digit Modalities Test), and three MoCA subtests (attention, naming, and delayed recall). CCT exerted no significant effect on activities and participation. No significant between-group differences in changes in cognitive function were noted. However, CCT significantly improved cognitive function domains immediately after training, and these effects were sustained at the 4-week follow-up. Cognitive function of individuals with chronic stroke could improve after administration of CCT. However, future studies with a more rigorous design and higher training dose are warranted to validate our findings.

The Boston Process Approach and Digital Neuropsychological Assessment: Past Research and Future Directions.

Neuropsychological assessment using the Boston Process Approach (BPA) suggests that an analysis of the strategy or the process by which tasks and neuropsychological tests are completed, and the errors made during test completion convey much information regarding underlying brain and cognition and are as important as overall summary scores. Research over the last several decades employing an analysis of process and errors has been able to dissociate between dementia patients diagnosed with Alzheimer's disease, vascular dementia associated with MRI-determined white matter alterations, and Parkinson's disease; and between mild cognitive impairment subtypes. Nonetheless, BPA methods can be labor intensive to deploy. However, the recent availability of digital platforms for neuropsychological test administration and scoring now enables reliable, rapid, and objective data collection. Further, digital technology can quantify highly nuanced data previously unobtainable to define neurocognitive constructs with high accuracy. In this paper, a brief review of the BPA is provided. Studies that demonstrate how digital technology translates BPA into specific neurocognitive constructs using the Clock Drawing Test, Backward Digit Span Test, and a Digital Pointing Span Test are described. Implications for using data driven artificial intelligence-supported analytic approaches enabling the creation of more sensitive and specific detection/diagnostic algorithms for putative neurodegenerative illness are also discussed.

Mango (Mangifera indica L.) Polyphenols Enhanced by Supplemental Probiotics Improve Biomarkers for Inflammation and Cognitive Function in Lean and Obese Individuals

ObjectivesThis study was designed to investigate the effects of daily mango supplementation with probiotics for 8 weeks on inflammation and cognitive function in lean and obese individuals. It was hypothesized that mango supplementation with probiotic consumption has a synergistic benefit by enhancing the bioavailability of their metabolites and their beneficial activities. MethodsThis double-blind, randomized, placebo-controlled pilot study was conducted in 50 healthy lean (BMI 18–23 kg/m2) and 44 obese (BMI 27–35 kg/m2) participants aged 18–55. Participants consumed 400 g of mango pulp with one placebo/probiotics capsule over 8 weeks. On days 1 and 54, participants underwent cognitive function tests and blood-collections. In addition, participants took 10 sessions of visual cognitive function testing on days 43–54.< ResultsMango intake with probiotics for 8 weeks reduced plasma levels of TNF-a and IL-10 (p = 0.037 and 0.049, respectively) compared to mango placebo group in obese participants but had no significant effect in lean participants. Visual cognitive performance was greater in lean participants (p = 0.050) but training responses were similar to obese. Probiotic resulted in lower visual cognitive performance (p = 0.018) but similar training responses as compared to placebo. In the trail making test (Attention) and digit span test (Memory), mango intake significantly improved overall cognitive performance in the lean participants, but only on the digit span backward test in obese participants. Simultaneous intake of mango and probiotics was not significantly different compared to mango with placebo in the trail making test but showed a synergistic effect in the digit span test. The amount of plasma metabolites was directly correlated with BMI (p = 0.0176, r = –0.1753, Spearman correlation) and IFN-g (p = 0.0336, r = 0.1572, Spearman correlation). ConclusionsMango consumption improved cognitive performance in lean individuals, whereas simultaneous intake of mango and probiotics had a synergistic effect in attenuating inflammation and improving cognitive functioning in obese individuals, at least in part due to increased bioavailability of mango polyphenols. Funding SourcesUSDA-AMS-National Mango Board.

The Effect of Lifetime Noise Exposure and Aging on Speech-Perception-in-Noise Ability and Self-Reported Hearing Symptoms: An Online Study.

Animal research shows that aging and excessive noise exposure damage cochlear outer hair cells, inner hair cells, and the synapses connecting inner hair cells with the auditory nerve. This may translate into auditory symptoms such as difficulty understanding speech in noise, tinnitus, and hyperacusis. The current study, using a novel online approach, assessed and quantified the effects of lifetime noise exposure and aging on (i) speech-perception-in-noise (SPiN) thresholds, (ii) self-reported hearing ability, and (iii) the presence of tinnitus. Secondary aims involved documenting the effects of lifetime noise exposure and aging on tinnitus handicap and the severity of hyperacusis. Two hundred and ninety-four adults with no past diagnosis of hearing or memory impairments were recruited online. Participants were assigned into two groups: 217 “young” (age range: 18–35 years, females: 151) and 77 “older” (age range: 50–70 years, females: 50). Participants completed a set of online instruments including an otologic health and demographic questionnaire, a dementia screening tool, forward and backward digit span tests, a noise exposure questionnaire, the Khalfa hyperacusis questionnaire, the short-form of the Speech, Spatial, and Qualities of Hearing scale, the Tinnitus Handicap Inventory, a digits-in-noise test, and a Coordinate Response Measure speech-perception test. Analyses controlled for sex and cognitive function as reflected by the digit span. A detailed protocol was pre-registered, to guard against “p-hacking” of this extensive dataset. Lifetime noise exposure did not predict SPiN thresholds, self-reported hearing ability, or the presence of tinnitus in either age group. Exploratory analyses showed that worse hyperacusis scores, and a greater prevalence of tinnitus, were associated significantly with high lifetime noise exposure in the young, but not in the older group. Age was a significant predictor of SPiN thresholds and the presence of tinnitus, but not of self-reported hearing ability, tinnitus handicap, or severity of hyperacusis. Consistent with several lab studies, our online-derived data suggest that older adults with no diagnosis of hearing impairment have a poorer SPiN ability and a higher risk of tinnitus than their younger counterparts. Moreover, lifetime noise exposure may increase the risk of tinnitus and the severity of hyperacusis in young adults with no diagnosis of hearing impairment.

Effectiveness of Computerized Working Memory Training on Sustained Attention and Working Memory of Male School Students

Background and Aims Sustained attention and working memory are the intertwined executive functions of the brain. Studies have shown that working memory training induce no far transfer effect to executive functions. Considering the importance of sustained attention in academic and occupational performance, this study aims to evaluate the effectiveness of computerized working memory (WM) training on sustained attention and WM of male students. Methods Participants were 32 male middle-school students in the eighth grade, who were selected by a cluster random sampling method and assigned randomly to two groups of the training (n=16) and control (n=16). The computerized dual n-back task was used for WM training for 4 weeks at 12 sessions, each for 40 minutes. The computerized continuous performance test and the digit span test (forward and backward) were used for evaluating sustained attention and WM, respectively. The pre-test evaluation was performed one week before and the post-test evaluation was executed one week after the training course. Results After the WM training, the sustained attention (P=0.043) and the backward digit span test score (P=0.033) in the training group were improved significantly compared to the control group, but no significant change was reported in the forward digit span test score (P=0.236). Conclusion Improved sustained attention following WM training indicates the far transfer of the training effect to the sustained attention, and confirms the involvement of sustained attention in the central executive part of WM. On the other hand, no change in short-term verbal memory after training indicates that the mechanism of WM training effect is through strengthening the central executive, not through improving the phonological loop of WM.

Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism rather than homocysteine increase the risk of ischemic stroke-associated executive dysfunction

Background: An executive dysfunction is a form of cognitive impairment commonly found in ischemic stroke patients with a significant impact on the patients' quality of life. The methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and homocysteine ​​are considered important risk factors for stroke and various forms of cognitive dysfunction. This study aimed to investigate the association between the MTHFR C677T polymorphism and serum homocysteine levels and the risk of ischemic stroke-associated executive dysfunction. Method: 87 ischemic stroke patients within the first three months of stroke onset in West Nusa Tenggara General Hospital, Siti Hajar Hospital, and Mataram General Hospital were recruited. Serum homocysteine levels were assessed using ELISA. The MTHFR C677T polymorphism was analyzed using the PCR-RFLP procedure. The executive function of the patients was evaluated using Trail Making Test Part-B, verbal fluency, and backward digit span tests. Results: The mean age of the subjects was 54.1 years. CT scan data revealed that 78.2% of subjects had a small infarct size. The MTHFR C677T polymorphism frequency was 25.3%, consisting of 2.3% homozygous and 23.0% heterozygous mutants. Multivariate logistic regression analysis showed that patients with MTHFR C677T polymorphism were more likely to have executive dysfunction than those with the wild-type genotype of the MTHFR gene (OR 4.53, 95% CI 1.06–19.27, p = 0.041). However, patients with hyperhomocysteinemia (≥13 μmol/l) were not associated with an increased risk of executive dysfunction. Conclusion: The MTHFR C677T polymorphism was the risk factor for ischemic stroke executive dysfunction.

Topological Alterations of the Brain Functional Network in Type 2 Diabetes Mellitus Patients With and Without Mild Cognitive Impairment.

The aim of this study was to explore the topological alterations of the brain functional network in type 2 diabetes mellitus (T2DM) patients with and without mild cognitive impairment (MCI) using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory approaches. In total, 27 T2DM patients with MCI, 27 T2DM patients without MCI, and 27 healthy controls (HCs) underwent rs-fMRI scanning. The whole-brain functional network was constructed by thresholding the Pearson’s correlation matrices of 90 brain regions. The topological organization of the constructed networks was analyzed by using graph theory approaches. The global and nodal properties of the participants in the three groups were compared by using one-way ANOVA as well as post hoc Tukey’s t-tests. The relationships between the altered topological properties and clinical features or scores of neuropsychological tests were analyzed in T2DM patients with MCI. At the global level, the global and local efficiency of the patients in the T2DM with MCI group were significantly higher than that of participants in the HCs group, and the length of the characteristic path was significantly lower than that of the participants in the HCs group (p < 0.05). No significant difference was found among the other groups. At the nodal level, when compared with T2DM patients without MCI, T2DM patients with MCI showed significantly increased nodal centrality in four brain regions, which were mainly located in the orbitofrontal lobe and anterior cingulate gyrus (ACG) (p < 0.05). No significant difference was found between the T2DM patients without MCI and HCs. Moreover, nodal degree related coefficient (r = −0381, p = 0.050) and nodal efficiency (r = −0.405, P = 0.036) of the ACG showed a significant closed correlation with the scores of the digit span backward test in the T2DM patients with MCI. Our results suggested that the increased nodal properties in brain regions of the orbitofrontal lobe and ACG were biomarkers of cognitive impairment in T2DM patients and could be used for its early diagnosis. The global topological alterations may be related to the combination of MCI and T2DM, rather than any of them.

Environmental satisfaction, mood and cognitive performance in semi-outdoor space in the tropics

The use of semi-outdoor space for the well-being of occupants is promoted in the tropics. Although a semi-outdoor space is often used for break space, environmental satisfaction and work performance are unclear in a semi-outdoor space as work activity space compared with air-conditioned (AC) room. This study focuses on the use of semi-outdoor space for short-term work activities such as office work and meetings. Experiments were carried out to evaluate environmental satisfaction, mood and cognitive performance in the cool and warm seasons in an AC room and a semi-outdoor space in Singapore. Eighty-nine participants answered questionnaires and conducted cognitive performance tests of Stroop test, visual backward digit span test, typing test and mind map test for 70 min per case in the AC room and semi-outdoor space with or without the operation of a ceiling fan. We analyzed the relationships among environmental satisfaction, mood, work performance by Structural Equation Modeling. The conditions which 80% of participants accepted in the semi-outdoor space were thermal environment ranged from 23.3 °C to 30.1 °C SET*, lighting levels of more than 260 lx and noise levels of less than 48 dBA. No differences in cognitive performance were found between the AC room and semi-outdoor space (p > 0.05). Mood influenced work performance (p < 0.001) while environmental satisfaction did not (p = 0.28). Self-reported performance, especially stress, influenced creativity (p = 0.047). These findings lead to the possibility of short-term work activities in the semi-outdoor space without a decrease in work performance.

Difficulties Experienced by Older Listeners in Utilizing Voice Cues for Speaker Discrimination.

Human listeners are assumed to apply different strategies to improve speech recognition in background noise. Young listeners with normal hearing (NH), e.g., have been shown to follow the voice of a particular speaker based on the fundamental (F0) and formant frequencies, which are both influenced by the gender, age, and size of the speaker. However, the auditory and cognitive processes that underlie the extraction and discrimination of these voice cues across speakers may be subject to age-related decline. The present study aimed to examine the utilization of F0 and formant cues for voice discrimination (VD) in older adults with hearing expected for their age. Difference limens (DLs) for VD were estimated in 15 healthy older adults (65–78 years old) and 35 young adults (18–35 years old) using only F0 cues, only formant frequency cues, and a combination of F0 + formant frequencies. A three-alternative forced-choice paradigm with an adaptive-tracking threshold-seeking procedure was used. Wechsler backward digit span test was used as a measure of auditory working memory. Trail Making Test (TMT) was used to provide cognitive information reflecting a combined effect of processing speed, mental flexibility, and executive control abilities. The results showed that (a) the mean VD thresholds of the older adults were poorer than those of the young adults for all voice cues, although larger variability was observed among the older listeners; (b) both age groups found the formant cues more beneficial for VD, compared to the F0 cues, and the combined (F0 + formant) cues resulted in better thresholds, compared to each cue separately; (c) significant associations were found for the older adults in the combined F0 + formant condition between VD and TMT scores, and between VD and hearing sensitivity, supporting the notion that a decline with age in both top-down and bottom-up mechanisms may hamper the ability of older adults to discriminate between voices. The present findings suggest that older listeners may have difficulty following the voice of a specific speaker and thus implementing doing so as a strategy for listening amid noise. This may contribute to understanding their reported difficulty listening in adverse conditions.

Animacy-induced conflict in sentence production and comprehension from late childhood to adolescence

Some animacy configurations elicit parallel semantic interference in adult production and comprehension; for example, phrases with similar animate nouns like the man that the girl is hugging are more difficult than phrases like the doll that the girl is hugging. Yet little is known about how this interference manifests in development, particularly, beyond early childhood. Because frontal brain maturation and cognitive control improvements are known to occur across late childhood and adolescence, we investigated (a) how animacy-induced difficulty in production and comprehension vary with age throughout this period and (b) whether control processes reflected in the backward digit span (BDS) test uniquely explained these differences besides other language measures. In separate tasks, participants (8- to 15-year-old children; N = 91) heard auditory descriptions of depicted characters, produced characters’ descriptions, and completed BDS, vocabulary, and reading experience tests. Results indicated that, as in adults, animacy modulated performance in production and comprehension across all ages. The animacy modulation interacted with age in production but not in comprehension, suggesting age-related animacy differences in production but relatively stable differences in comprehension despite processing speed improvements. Importantly, these age-related production differences were also modulated by the BDS scores; only participants with higher BDS scores displayed age-related animacy differences. Together, these results indicate that comprehension and production develop at different rates and that the development of BDS performance interacts with age-dependent changes in sentence planning from late childhood to adolescence. More generally, the study highlights tasks’ disparities to be explained by cognitive and developmental models of language.

Cognitive impairment in recipients of liver transplantation and relation to hepatic encephalopathy

BackgroundLiver transplantation (LT) helped to save the life of end stage liver disease (ESLD) patients; however, there is a debate on the persistence of cognitive impairment. The study aimed to evaluate cognitive functions in patients with ESLD before and after liver transplantation and to assess its relation to hepatic encephalopathy (HE). Thirty recipients 47.6 ± 11 years undergone living donor liver transplantation at the transplantation center of both Ain Shams Center for Organ Transplant and Egypt air organ transplant unit were prospectively assessed by Trail Making Test, Wechsler Memory Scale–Revised, Benton Visual Retention—for the evaluation of cognitive functions before and 3 months after transplantation.ResultsThe mean age of the patients was 47.6 ± 11 years, 17 males and 13 females. Eight out of 30 (26.7%) had past history of hepatic encephalopathy. The study reported significant improvement in the post-operative 3 months scores of Trail Making Test part (A), the digit span forward test, digit span backward test and the correct score difference of the Benton Visual Retention, as p value was (0.02), (0.01) (0.02), and (0.01) respectively, compared to the pre-operative scores. However, there was no difference in the scores of part (B), verbal association I, II, information subtest of WMS. Cognitive performance showed no significant difference between patients with or without history of HE.ConclusionsPatients with ESLD have significant cognitive impairment that showed improvement after LT; HE did not correlate with cognitive function. Hence, transplantation has a favorable outcome on the cognitive impairment.

Evaluation of cognitive deficits in patients infected with COVID-19.

COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected with COVID-19. The demographic and infection-related characteristics of patients who had been infected with COVID-19 were determined. Their cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) findings were recorded. The Mini-Mental State Evaluation (MMSE), clock drawing test, forward and backward digit span tests, visual memory test, and Frontal Assessment Battery were applied to the patients. Finger agnosia and ideomotor apraxia were also determined. The study included 176 patients [100 female (56.8%), 76 male (43.2%), mean age 66.09±13.96 years]. About half of the patients were hospitalized for symptoms of COVID-19 infection (n=82, 46.6%). One third of these patients required intensive care (n=26, 14.8%). While 50 (45.9%) of the 109 patients diagnosed with dementia before infection were hospitalized, 32 (47.8%) of the 67 patients without a diagnosis of dementia required hospitalization (p=0.46). The most common neurological finding during COVID-19 infection was insomnia (n=36, 20.5%). The MMSE and visual memory test scores of the patients who were hospitalized for severe respiratory distress were lower than those whose treatment at home was completed (respectively 17.92±7.69/20.59±7.01, p=0.02; 2.53 ±1.73/3.69±2.80, p=0.01). The patients with moderate to severe cognitive impairment had significantly higher CRP levels at admission than the others (37.52±43.09/20.93±31.74, p=0.01, respectively). Cognitive damage in COVID-19 infection may be caused by ACE receptor density in the pial, hippocampal, and amygdala areas. In addition, the reason why people with severe dementia have a milder infection might be explained by the atrophy in these areas.

Self-Reported Sleep and Executive Function in Early Primary School Children

The study investigated the associations between children’s self-reported habitual sleep disturbance and multidimensional executive function (EF). Two hundred and four 7–9-year-old typically developing children completed the Sleep Self-Report and finished the Red-Blue Test, Wisconsin Card Sorting Test, and Backward Digit Span Test, indexing different EF components including inhibitory control, cognitive flexibility, and working memory. Results revealed that all the three EF components were significantly correlated with sleep. However, cognitive flexibility was no longer significantly related to sleep when the other EF components – inhibitory control and working memory – were controlled for. Meanwhile, inhibitory control, as well as working memory, was still significantly related to sleep after controlling for the other EF components. Results suggest that children’s self-reported sleep might be associated directly with inhibitory control and working memory, but indirectly with cognitive flexibility.

Mediterranean, DASH, and MIND Dietary Patterns and Cognitive Function: The 2-Year Longitudinal Changes in an Older Spanish Cohort.

Background and Aims: Plant-forward dietary patterns have been associated with cardiometabolic health benefits, which, in turn, have been related to cognitive performance with inconsistent findings. The objective of this study was to examine the relationship between baseline adherence to three a priori dietary patterns (Mediterranean, DASH, and MIND diets) with 2-year changes in cognitive performance in older adults with overweight or obesity and high cardiovascular disease risk.Methods: A prospective cohort analysis was conducted within the PREDIMED-Plus trial, involving 6,647 men and women aged 55–75 years with overweight or obesity and metabolic syndrome. Using a validated, semiquantitative 143-item food frequency questionnaire completed at baseline, the dietary pattern adherence scores were calculated. An extensive neuropsychological test battery was administered at baseline and 2-year follow-up. Multivariable-adjusted linear regression models were used to assess associations between 2-year changes in cognitive function z-scores across tertiles of baseline adherence to the a priori dietary patterns.Results: Adherence to the Mediterranean diet at baseline was associated with 2-year changes in the general cognitive screening Mini-Mental State Examination (MMSE, β: 0.070; 95% CI: 0.014, 0.175, P-trend = 0.011), and two executive function-related assessments: the Trail Making Tests Part A (TMT-A, β: −0.054; 95% CI: −0.110, − 0.002, P-trend = 0.047) and Part B (TMT-B, β: −0.079; 95% CI: −0.134, −0.024, P-trend = 0.004). Adherence to the MIND diet was associated with the backward recall Digit Span Test assessment of working memory (DST-B, β: 0.058; 95% CI: 0.002, 0.114, P-trend = 0.045). However, higher adherence to the DASH dietary pattern was not associated with better cognitive function over a period of 2 years.Conclusion: In older Spanish individuals with overweight or obesity and at high cardiovascular disease risk, higher baseline adherence to the Mediterranean dietary pattern may be associated with better cognitive performance than lower adherence over a period of 2 years.

Cardiovascular risk moderates aerobic exercise efficacy on executive function in subcortical ischemic vascular cognitive impairment

AbstractBackgroundAerobic exercise can promote cognitive function in adults with Subcortical Ischemic Vascular Cognitive Impairment (SIVCI) by modifying cardiovascular risk factors. However, one’s cardiovascular health may attenuate the benefits of aerobic exercise on cognitive outcomes in SIVCI. We examined whether baseline Framingham Cardiovascular Risk Profile Score (FCRP) moderates the effect of a 6‐month progressive aerobic exercise program on executive function in adults with SIVCI.MethodA secondary analysis of a proof‐of‐concept randomized controlled trial in 71 adults, who were randomized to either: 1) 3x/week progressive aerobic exercise program (AT); or 2) education program (CON). Three executive processes were measured: 1) response inhibition by Stroop Colour Word Test; 2) working memory by digits backward test, and 3) set shifting by the Trail Making Test (B‐A). Baseline cardiovascular risk was calculated using the FCRP, and participants were classified as either low risk (&lt;20% FCRP score; LCVR) or high risk (&gt;20% FCRP score; HCVR). A complete case analysis (n=57) was conducted using an analysis of covariance (ANCOVA) to evaluate between‐group differences in the three executive processes. Age, baseline Montreal Cognitive Assessment score, education, and baseline score for the outcome variable were entered as covariates in all models.ResultA significant interaction was found between FCRP and group (AT or CON) for the digit span backward (F(1,49)=4.67, p=0.03) and the Trail Making Test (F(1,50)=4.09, p=0.04). On the digit span backward test, AT improved performance compared to CON (3.74±.33 vs. 2.75±.46) in those with LCVR, while in those with HCVR, AT did not improve performance compared to CON (2.97±.45 vs. 3.76±.41). Similarly, for the Trail Making Test (B‐A), AT improved performance compared to CON (52.66±13.27 vs. 80.12±17.82) in those with LCVR, while AT was not beneficial compared to CON in those with HCVR (98.80±18.06 vs. 59.92±17.09).ConclusionBaseline cardiovascular risk significantly moderates the efficacy of aerobic exercise on working memory and set shifting in adults with SIVCI. Our findings highlight the importance of intervening early in the disease course of SIVCI, when cardiovascular risk may be lower, to reap maximum benefits of aerobic exercise.

Heterogeneous associations of air quality improvement with domain‐specific cognitive function in older women

AbstractBackgroundAir pollution is associated with increased risk of cognitive decline and dementia. However, whether and how air quality (AQ) improvement is associated with better cognitive performance across multiple domains is unknown.MethodParticipants included 2,114 women (aged 74‐92 at the enrollment) from the US‐based Women’s Health Initiative Memory Study‐Epidemiology of Cognitive Health Outcomes. Cognitive domains evaluated annually included episodic memory (EM; sum of scores by immediate and delayed recalls of East Boston Memory Test and the word list of modified Telephone Interview for Cognitive Status), language (Verbal Fluency‐Animals), working memory (WM, sum of scores from forward and backward Digit Span Tests), and attention/executive function (AEF, log‐transformed ratio of the time spent in Part A over Part B for Oral Trails Making Test), all standardized using corresponding baseline measure. Annual PM2.5 (fine particulate matter) and NO2 were estimated using regionalized universal kriging models and aggregated to 3‐year average at 10 years (remote) and immediately (recent) before enrollment. AQ improvement was defined as reduction from remote to recent exposures. We examined associations between AQ improvement and domain‐specific cognitive trajectories using linear mixed effect models, adjusting for sociodemographic, lifestyle, clinical covariates, and time‐varying propensity scores to account for selective attrition.ResultsAQ improved significantly over 10 years for both PM2.5 (13.3±2.7µg/m3 to 10.6±2.0µg/m3) and NO2 (15.7±7.1ppb to 10.4±4.9ppb). Over a median of 6.2 (inter‐quartile‐range [IQR]=5.1) years of follow‐up, cognitive performance declined significantly in all domains. Women residing in locations with greater PM2.5 improvement (per IQR=1.77µg/m3) had better performance in EM (βPM2.5=0.069, p=0.002), WM (βPM2.5=0.050, p=0.01), and AEF (βPM2.5=0.044, p=0.01), but not in language (βPM2.5=0.013, p=0.57). Similar findings with stronger associations were observed with improved NO2 (βNO2=0.065∼0.073 per IQR=3.89ppb for EM, WM and AEF, all p≤0.002). Slower declines in cognitive trajectories across EM, Language and AEF were found with improved AQ, but only the association between improved NO2 and slower EM decline was statistically significant (βNO2=0.010/year, p&lt;0.001).ConclusionsImproved AQ of PM2.5 and NO2 was associated with better performance of EM, WM and AEF, but not language. In addition, improved NO2 was associated with slower decline of EM over time in older women.

Sex Differences in the Relationship Between Arterial Stiffness and Cognitive Function in Older Adults

ObjectiveTo examine potential sex differences in the relationship between arterial stiffness and global cognitive function and executive functions. MethodsBaseline data from 80 older adults were included from two randomized controlled trials (NCT02669394 and NCT02737878). Arterial stiffness was measured by carotid-femoral pulse wave velocity (cf-PWV). Cognitive function assessment included global cognition (Mini-Mental State Examination [MMSE]) and executive functions (set shifting [Trail Making Test Part B minus A], inhibition [Stroop Test], and working memory [Verbal Digit Span Backwards Test]). Separate statistical models were constructed to assess the effect of cf-PWV on each cognitive outcome for females and males. Each statistical model controlled for Framingham cardiovascular disease risk score and education. ResultsHigher cf-PWV was associated with impaired MMSE performance in males (β = -0.48; p = 0.018), but not females (p ≥ 0.389). For executive processes, higher cf-PWV was associated with impaired Trail Making Test Part B minus A (β = 0.56; p = 0.005) and Stroop Test (β = 0.59; p = 0.004) in males, but not in females (ps ≥ 0.108). cf-PWV was not significantly associated with Verbal Digit Span Forward minus Backward Test in males or females (ps ≥ 0.108). ConclusionsArterial stiffness is more strongly associated with cognitive impairment in males than females. These results further elucidate the interplay between vascular health and cognitive function by providing support for sex-specific mechanisms.