Cognitive Changes Research Articles

Plasma homocysteine and longitudinal change in cognitive function among urban adults

BackgroundCross-sectional and longitudinal studies have inconsistently linked cognitive performance and change over time to an elevated level of homocysteine (Hcy), with few conducted among urban adults. MethodsLongitudinal data [Visit 1 (2004–2009) and Visit 2 (2009–2013)] were analyzed from up to 1430 selected Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants. Baseline and follow-up blood Hcy was measured, while 11 cognitive function test scores were assessed at either of these two visits. Overall, sex- and race-stratified associations were evaluated using mixed-effects linear regression models, adjusting for key potential confounders. Interaction effects between Hcy and serum levels of folate and vitamin B-12 were also tested. ResultsWe found that greater LnHcyv1 was significantly associated with poorer baseline attention based on higher Loge (TRAILS A, in seconds) [β (SE): 0.101 (0.031), P = 0.001]. Heterogeneity was also found by sex and by race. Most notably, among men only, LnHcyv1 was associated with faster decline on the BVRT (# of errors), a measure of visuo-spatial memory (β (SE): 0.297(0.115), P = 0.010, reduced model); while among African American adults only, an elevated and increasing LnHcy over time was associated with faster rate of decline on Loge (TRAILS B, in seconds) [β (SE): +0.012 (0.005), p = 0.008], a measure of executive function. Interactions between Hcy, folate and vitamin B-12 blood exposures were also detected. ConclusionsIn summary, sex- and race-specific adverse association between elevated Hcy and cognitive performance over time were detected among middle-aged urban adults, in domains of attention, visuo-spatial memory and executive functioning.

Longitudinal Study of Cognitive Function in People with HIV and Toxoplasmic Encephalitis or Latent toxoplasma Infection.

Neurocognitive impairment (NCI) may occur during and persist even after recovery from HIV-related CNS co-infections such as toxoplasmic encephalitis (TE). The long-term cognitive effects of TE and latent toxoplomasmic infections (LTI) among persons with HIV (PWH) are unknown. We measured longitudinal effects on NC functioning in PWH with TE compared to LTI or no toxoplasmal infection. PWH (n = 345) followed in two longitudinal cohort studies underwent comprehensive neurocognitive assessments and an anti-Toxoplamic IgG assay. Participants were classified into one of three groups: TE+ (n = 39), LTI+ (n = 34), LTI- (n = 272). The primary outcome was change in neurocognitive function between baseline and 7-year visit. The mean age was 48 ± 11 years, mean educational level 13 ± 3 years, and 13% were female. TE+ patients were less likely to have undetectable viral loads (≤50 copies/mL) and had lower absolute CD4 counts. The TE+ group had the highest prevalence of NCI globally and in domains of verbal, executive function, learning, recall, working memory, processing speed and motor at baseline and at 7-year follow-up. Changes in longitudinal NC function over 7 years were small and did not differ significantly among all groups, except that speed of information processing improved more in TE+ compared with LTI- participants. PWH with a history of TE had cognitive impairment over a broad range of severity at both baseline and last follow-up. Changes in cognition from baseline to last examination in all groups were minimal and did not differ significantly among the groups with the exception of speed of information processing.

Cognitive and Salience Network Connectivity Changes following a Single Season of Repetitive Head Impact Exposure in High School Football.

During a season of high school football, adolescents with actively developing brains experience a considerable number of head impacts. Our aim was to determine whether repetitive head impacts in the absence of a clinically diagnosed concussion during a season of high school football produce changes in cognitive performance or functional connectivity of the salience network and its central hub, the dorsal anterior cingulate cortex. Football players were instrumented with the Head Impact Telemetry System during all practices and games, and the helmet sensor data were used to compute a risk-weighted exposure metric (RWEcp), accounting for the cumulative risk during the season. Participants underwent MRI and a cognitive battery (ImPACT) before and shortly after the football season. A control group of noncontact/limited-contact-sport athletes was formed from 2 cohorts: one from the same school and protocol and another from a separate, nearly identical study. Sixty-three football players and 34 control athletes were included in the cognitive performance analysis. Preseason, the control group scored significantly higher on the ImPACT Visual Motor (P = .04) and Reaction Time composites (P = .006). These differences increased postseason (P = .003, P < .001, respectively). Additionally, the control group had significantly higher postseason scores on the Visual Memory composite (P = .001). Compared with controls, football players showed significantly less improvement in the Verbal (P = .04) and Visual Memory composites (P = .01). A significantly greater percentage of contact athletes had lower-than-expected scores on the Verbal Memory (27% versus 6%), Visual Motor (21% versus 3%), and Reaction Time composites (24% versus 6%). Among football players, a higher RWEcp was significantly associated with greater increments in ImPACT Reaction Time (P = .03) and Total Symptom Scores postseason (P = .006). Fifty-seven football players and 13 control athletes were included in the imaging analyses. Postseason, football players showed significant decreases in interhemispheric connectivity of the dorsal anterior cingulate cortex (P = .026) and within-network connectivity of the salience network (P = .018). These decreases in dorsal anterior cingulate cortex interhemispheric connectivity and within-network connectivity of the salience network were significantly correlated with deteriorating ImPACT Total Symptom (P = .03) and Verbal Memory scores (P = .04). Head impact exposure during a single season of high school football is negatively associated with cognitive performance and brain network connectivity. Future studies should further characterize these short-term effects and examine their relationship with long-term sequelae.

Microglia: The Drunken Gardeners of Early Adversity.

Early life adversity (ELA) is a heterogeneous group of negative childhood experiences that can lead to abnormal brain development and more severe psychiatric, neurological, and medical conditions in adulthood. According to the immune hypothesis, ELA leads to an abnormal immune response characterized by high levels of inflammatory cytokines. This abnormal immune response contributes to more severe negative health outcomes and a refractory response to treatment in individuals with a history of ELA. Here, we examine this hypothesis in the context of recent rodent studies that focus on the impact of ELA on microglia, the resident immune cells in the brain. We review recent progress in our ability to mechanistically link molecular alterations in microglial function during a critical period of development with changes in synaptic connectivity, cognition, and stress reactivity later in life. We also examine recent research showing that ELA induces long-term alterations in microglial inflammatory response to "secondary hits" such as traumatic brain injury, substance use, and exposure to additional stress in adulthood. We conclude with a discussion on future directions and unresolved questions regarding the signals that modify microglial function and the clinical significance of rodent studies for humans.

COGNITIVE CHALLENGES AND PROFESSIONAL IMPLICATIONS OF PREGNANCY BRAIN IN ACADEMIA: A REVIEW OF PHYSIOLOGICAL AND PSYCHOLOGICAL BASES AND POTENTIAL INTERVENTIONS

Pregnancy brain, characterized by cognitive changes during pregnancy, has significant implications for women in academia, affecting professional performance and career progression. In this review, we focus on the physiological and psychological bases of pregnancy brain, its impacts on cognitive functions, and potential interventions for pregnant women. The objective of this review is to explore the phenomenon of pregnancy-induced cognitive decline, focusing on its physiological, psychological, and cognitive bases, and its potential impact on cognitive function. The impact of pregnancy on cognitive performance, career progression, and professional performance can be mitigated through increased awareness, research, and institutional support. By recognizing and addressing the cognitive challenges faced by pregnant women, academic institutions can foster a more inclusive and supportive environment, ultimately benefiting the professional and personal well-being of women in academic institutions. KEYWORDS: Pregnancy brain; Cognitive function; Women in academia; Professional performance; Institutional support

An exploration of intensive care unit patents’ experiences of the Addenbrooke’s Cognitive Examination (ACE-III) as a screening tool for cognitive functioning at different points in recovery from critical illness

Being critically ill can result in cognitive change. Cognitive functioning should be screened at different points in the care pathway, and it is important to understand patient’s experience of this process. A service evaluation examined fifteen in-patients’ and eleven outpatients’ experiences of completing the Addenbrookes Cognitive Examination-III (ACE-III) using thematic analysis. Four themes emerged: (1) willingness &amp; acceptability (2) strengths and weaknesses (3) factors affecting performance and (4) improving delivery. Generally, patients accepted the ACE-III and valued cognitive screening. Consideration is given to areas for development.

Enhancing Outcomes in Alzheimer's Disease: Exploring the Effects of a Diversified Rehabilitation Program Combined with Donepezil on Apathy, Cognitive Function, and Family Caregiver Burden.

Alzheimer's disease is a progressive neurodegenerative disorder characterized by cognitive decline, behavioral changes, and functional impairments. Apathy, a common symptom in Alzheimer's disease, refers to a lack of motivation, interest, and emotional responsiveness. It can significantly impact patients' quality of life and increase caregiver burden. This study aimed to determine the effects of a diversified rehabilitation program combined with donepezil on apathy, cognitive function, and family caregiver burden of Alzheimer's disease patients. A total of 105 Alzheimer's disease patients treated at our hospital between January 2020 and January 2023 were selected and analyzed retrospectively. They were assigned to the control group (n = 50) or the observation group (n = 55). The two groups did not differ in terms of general data such as age and sex. All patients were treated with donepezil orally. The control group was given routine nursing, whereas the observation group was given a diversified rehabilitation program intervention, including cognitive training and emotional support. The Hasegawa's dementia scale, mini-mental state examination, and Montreal cognitive assessment scale were adopted to evaluate the cognitive function of the two groups before and after treatment. A caregiver burden scale, the Zarit Burden Interview (ZBI) and the Apathy Evaluation Scale Informant version (AES-I) were used to evaluate the caregiver burden and apathy of the two groups. A significantly higher overall response rate to treatment was found in the observation group (94.55%) than in the control group (80.00%) (p = 0.024). After treatment, scores on the Hasegawa's dementia scale, mini-mental state examination, and Montreal cognitive assessment scale of the two groups increased to varying degrees, with greater increases in the observation group than in the control group (p < 0.05). The ZBI and AES-I scores of the two groups decreased to different degrees after treatment, with greater decreases in the observation group than in the control group (p < 0.05). A diversified rehabilitation program combined with donepezil can substantially alleviate the apathy of Alzheimer's disease patients, improve their cognitive function, and reduce the burden on their families.

Evaluating cognitive assessment tools for patients with major depressive disorder receiving electroconvulsive therapy: A systematic review and meta-analysis

BackgroundMajor Depressive Disorder (MDD) affects 350 million people worldwide. Electroconvulsive therapy (ECT) is effective, yet research on cognitive assessments post-treatment is lacking. This study systematically reviews and meta-analyzes the effectiveness of cognitive assessment tools post-ECT to optimize MDD treatment. MethodsFollowing PRISMA guidelines, this review was pre-registered on PROSPERO (CRD42023470318). Searches were conducted across nine databases up to November 12, 2023. Quality assessment for Randomized Controlled Trials (RCTs) and quasi-experimental studies was performed using the Cochrane risk of bias tool, JBI critical appraisal tools, and the Jadad scale. Meta-analyses for short-term and long-term cognitive function involved 24 and 18 tools, respectively. FindingsThirty studies (20 RCTs and 10 quasi-experimental) involving 2462 MDD patients were evaluated. Results indicated no significant differences in overall short-term and long-term cognitive functions post-ECT. Short-term analysis showed impairments in memory, learning, and verbal abilities but improvements in attention and processing speed. Long-term analysis revealed enhancements in memory, learning, verbal, and visuospatial abilities compared to baseline. Based on GRADE classification, we recommend 11 tools for assessing acute cognitive function and 10 tools for chronic cognitive impairment. These tools demonstrated high reliability and validity, supporting their clinical use. InterpretationThese findings provide critical evidence for future ECT clinical guidelines in managing MDD. The recommended tools can aid clinicians in adjusting ECT regimens, identifying early cognitive changes, and improving therapeutic outcomes in MDD treatment.

Short, frequent physical activity breaks improve working memory while preserving cerebral blood flow in adolescents during prolonged sitting - AbbaH teen, a randomized crossover trial

PurposePhysical activity (PA) breaks during school lessons have been suggested as a promising strategy to improve working memory performance in children and adolescents. There is a lack of studies investigating the underlying physiological mechanisms of PA on cognition, especially among adolescents. This study aimed to investigate the effects of different types of short frequent PA on adolescents’ cognitive task-related changes in cerebral blood flow in the prefrontal cortex (PFC) and working memory performance compared to prolonged sitting.MethodsIn this randomized crossover study, adolescents visited the laboratory on three different occasions for 80-minute sessions of prolonged sitting interrupted by four breaks for three minutes of simple resistance training (SRA), step-up at a pre-determined pace (STEP), or remaining seated (SOCIAL). Before and after each session, cognitive task-related changes in cerebral blood flow (oxygenated-hemoglobin, Oxy-Hb) during working memory tasks (1-, 2-, 3-back tests) were measured using functional near-infrared spectroscopy in the PFC. Accuracy and reaction time were derived from the working memory tasks. Linear mixed-effect models were used to analyze the data.ResultsA total of 17 students participated (mean age 13.6 years, 11 girls). Significant time x condition interactions were noted for Oxy-Hb in the most demanding working memory task (3-back), with a decrease following prolonged sitting in the SOCIAL condition compared to both the SRA (β 0.18, 95% CI 0.12, 0.24) and the STEP (β 0.11, 95% CI 0.05, 0.17). This was observed in parallel with improvements in reaction time following SRA (β -30.11, 95% CI -59.08, -1.13) and STEP (β -34.29, 95% CI -69.22, 0.63) although this was only significant for the SRA and no improvements in the SOCIAL condition.ConclusionWe found that short frequent PA breaks during prolonged sitting among adolescents can prevent the decrease in cognitive task-related changes in cerebral blood flow that occur following prolonged sitting. This was observed simultaneously with improvements in working memory, indicating that changes in cerebral blood flow could be one factor explaining the effects on working memory. Future studies should investigate the efficacy of implementing these PA breaks in schools.Trial registrationRetrospectively registered on 21/09/2020, ClinicalTrial (NCT04552626).

Detecting and Predicting Cognitive Decline in Individuals with Traumatic Brain Injury: A Longitudinal Telephone-Based Study.

Traumatic brain injuries (TBIs) can lead to long-lasting cognitive impairments, and some survivors experience cognitive decline post-recovery. Early detection of decline is important for care planning, and understanding risk factors for decline can elucidate targets for prevention. While neuropsychological testing is the gold standard approach to characterizing cognitive function, there is a need for brief, scalable tools that are capable of detecting clinically significant changes in post-TBI cognition. This study examines whether a clinically significant change can be detected using the Brief Test of Adult Cognition by Telephone (BTACT) in a sample of individuals with chronic TBI and investigates whether potentially modifiable factors are associated with cognitive decline. Ninety participants aged 40 or older with complicated mild-to-severe TBI participated in two telephone-based study visits ∼1 year apart. Demographic, head trauma exposure, comorbid medical conditions, physical, and psychosocial functioning data were collected via self-report. The BTACT, a brief measure of global cognitive function, was used to assess cognitive performance across six domains. A reliable change index for quantifying clinically significant changes in BTACT performance was calculated. Results revealed cognitive decline in 10-27% of participants across various cognitive domains. More specifically, only depressive symptoms, including depressed affect and anhedonia, were significantly associated with cognitive decline after correcting for multiple comparisons using false discovery rate (FDR). Other factors such as the number of blows to the head, male gender, dyspnea, increased anxiety symptoms, seizures, illicit drug use, and fewer cardiovascular comorbidities should be considered hypothesis generating. Importantly, age was not a significant predictor of cognitive decline, which challenges the assumption that cognitive decline is solely related to the natural aging process. It suggests that there are unique factors associated with TBI that impact cognitive function, and these factors can affect individuals across the lifespan. The BTACT is a brief and sensitive tool for identifying clinically meaningful changes in cognitive function over a relatively brief period (i.e., 1 year) in a sample of individuals in the chronic stages of TBI (i.e., x̄ = 6.7 years post-TBI). Thus, the BTACT may be useful in surveillance efforts aimed at understanding and detecting decline, particularly in situations where in-person cognitive screening is impractical or unfeasible. We also identified potentially modifiable targets for the prevention of post-TBI cognitive decline. These findings can offer insights into treatment goals and preventive strategies for individuals at risk for cognitive decline, as well as help to facilitate early identification efforts.

Exploring Cognitive Changes in High-Risk Cardiac Patients Receiving Dexmedetomidine and Evaluating the Correlation between Different Cognitive Tools: A Cohort Study.

Mini-mental State Examination (MMSE) is widely accepted clinically for postoperative cognitive dysfunction (POCD) assessment. This study aims to investigate the post-operative cognitive changes among high-risk cardiothoracic patients and establish a standardised approach to post-surgery cognitive assessment. This is a prospective cohort study, where cognitive assessments were done 1-day before surgery, at discharge, and during 6 weeks of follow-up. Sample size calculation, accounting for an estimated 20% dropout rate, determined a minimum of 170 subjects were required for the study. Reduction of MMSE score of more than 2.5 was considered as having POCD. Score differences between groups were analysed using T-test and analysis of variance (ANOVA), while consistency between tools was analysed using correlation and regression. A total of 188 patients completed the study, with a POCD prevalence of 20.2% and 6.9% at discharge and at the 6 week follow up, respectively. All cognitive tools show a significant difference between preoperative and postoperative scores. All tests show a significant moderate correlation with MMSE. In conclusion, it is imperative to employ a battery of cognitive assessments to evaluate cognitive changes comprehensively.

The Sensitivity of the Mini-Mental State Examination to Detect Objective Cognitive Side Effects Induced by Electroconvulsive Therapy: Results From the Dutch ECT Consortium

BackgroundMonitoring cognitive side effects following electroconvulsive therapy (ECT) is crucial for balancing side effects and clinical effectiveness. Yet, evidence-based guidelines on cognitive testing following ECT are lacking. A frequently used test in global ECT practice is the Mini-Mental State Examination (MMSE). We examined the change of the MMSE score and its performance in identifying a decline in predefined neuropsychological measures sensitive to ECT-induced cognitive changes: verbal recall and verbal fluency. MethodsMean MMSE scores before and 1 week after ECT were compared using a Wilcoxon signed rank test. The Reliable Change Index was calculated for all cognitive measures to indicate whether a participant’s change in score from before to after ECT was considered statistically significant. The sensitivity and specificity of the MMSE were calculated. ResultsA total of 426 patients with depression from 5 sites were included from the Dutch ECT Consortium. Mean (SD) MMSE score increased significantly from 26.2 (3.9) before ECT to 26.8 (3.8) after ECT (p = .002). After ECT, 36 patients (8.5%) showed a significant decline in MMSE score. The sensitivity of the MMSE in identifying patients who experienced a significant decline in verbal recall or verbal fluency ranged from 3.6% to 11.1%. The specificity of the MMSE in identifying patients who did not experience a significant decline in verbal recall or verbal fluency ranged from 95.6% to 96.6%. ConclusionsGiven the very low sensitivity of the MMSE, we propose reconsidering the prominence of the MMSE in ECT practice and cognitive monitoring guidelines, advocating for a more comprehensive approach to assess ECT-induced cognitive changes.

Cognitive outcome after stereo-electroencephalography-guided radiofrequency thermocoagulation in temporal lobe epilepsy.

Stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) is being used incrementally in the invasive diagnosis of epilepsy. There is currently a lack of information regarding the potential cognitive consequences of the extended use of this technique. This work describes, for the first time, the cognitive outcomes after RFTC in patients with temporal lobe epilepsy (TLE), evaluated longitudinally and using a control group. Forty-eight adult patients with drug-resistant unilateral TLE (30 RFTC-treated patients and 18 controls) were evaluated using a comprehensive neuropsychological protocol at baseline. In the RFTC group, two follow-up assessments were performed at 3 months and 1 year. The control group was reevaluated after 1 year. Two analyses were performed: 1) group-level analyses, in which linear mixed models were applied according to TLE lateralization (intragroup and intergroup [RFTC vs control] comparisons), and 2) individual-level analyses, in which the Reliable Change Index (RCI) algorithm was developed and a 90% CI (cutoff ± 1.64) was used to describe neuropsychological outcomes at 1 year post-RFTC. A memory subanalysis was performed in hippocampal RFTC patients (25/30). A Spearman coefficient study was conducted to determine the correlation between cognitive change and thermocoagulated contacts. Left- and right-sided TLE patients treated with RFTC showed cognitive preservation at baseline. At a group level, the short-term evaluation, including verbal and visual memory, language, and executive functions, showed preservation in these domains and no significant differences compared with baseline. In the long-term follow-up assessment (1 year after RFTC), no significant intragroup changes were found, nor were significant changes found in comparison with the control group. The RCI algorithm showed that significant individual cognitive losses and gains were infrequent. Three patients presented with naming deficits, only 1 (3.3%) of whom showed a clinically significant deficit. Significant gains were more prevalent in executive function tests with a speed component (4/20 left-sided RFTC patients). Twenty-five of the 30 (83%) patients were treated with hippocampal RFTC. No patients experienced significant loss in verbal delayed memory in the left-sided RFTC sample or in visual delayed memory in the right-sided RFTC sample. The correlations between cognitive change and RFTC contacts were mostly nonsignificant. In the group-level comparisons, discernible cognitive impairment following RFTC was not evidenced. The majority of patients did not exhibit significant individual declines during the 1-year follow-up period. Notably, the procedural intervention yielded no substantial repercussions on memory functioning following hippocampal RFTC. These findings underscore the evidence supporting the cognitive preservation associated with SEEG-guided RFTC.

Change in Depressive Symptoms and Longitudinal Regional Amyloid Accumulation in Unimpaired Older Adults

Depressive symptoms in older adults may be a harbinger of Alzheimer disease (AD), even in preclinical stages. It is unclear whether worsening depressive symptoms are manifestations of regional distributions of core AD pathology (amyloid) and whether cognitive changes affect this relationship. To evaluate whether increasing depressive symptoms are associated with amyloid accumulation in brain regions important for emotional regulation and whether those associations vary by cognitive performance. Participants from the Harvard Aging Brain Study, a longitudinal cohort study, underwent annual assessments of depressive symptoms and cognition alongside cortical amyloid positron emission tomography (PET) imaging at baseline and every 2 to 3 years thereafter (mean [SD] follow-up, 8.6 [2.2] years). Data collection was conducted from September 2010 to October 2022 in a convenience sample of community-dwelling older adults who were cognitively unimpaired with, at most, mild baseline depression. Data were analyzed from October 2022 to December 2023. Depression (Geriatric Depression Scale [GDS]-30-item), cognition (Preclinical Alzheimer Cognitive Composite-5 [PACC]), and a continuous measure of cerebral amyloid (Pittsburgh compound B [PiB] PET) examined in a priori-defined regions (medial orbitofrontal cortex [mOFC], lateral orbitofrontal cortex, middle frontal cortex [MFC], superior frontal cortex, anterior cingulate cortex, isthmus cingulate cortex [IC], posterior cingulate cortex, and amygdala). Associations between longitudinal GDS scores, regional amyloid slopes, and PACC slopes were assessed using linear mixed-effects models. In this sample of 154 individuals (94 [61%] female; mean [SD] age, 72.6 [6.4] years; mean (SD) education, 15.9 [3.1] years), increasing PiB slopes in the bilateral mOFC, IC, and MFC were associated with increasing GDS scores (mOFC: β = 11.07 [95% CI, 5.26-16.87]; t = 3.74 [SE, 2.96]; P = .004; IC: β = 12.83 [95% CI, 5.68-19.98]; t = 3.51 [SE, 3.65]; P = .004; MFC: β = 9.22 [95% CI, 2.25-16.20]; t = 2.59 [SE, 3.56]; P = .03). Even with PACC slope as an additional covariate, associations remained significant in these regions. In this cohort study of cognitively unimpaired older adults with, at most, mild baseline depressive symptoms, greater depressive symptoms over time were associated with amyloid accumulation in regions associated with emotional control. Furthermore, these associations persisted in most regions independent of cognitive changes. These results shed light on the neurobiology of depressive symptoms in older individuals and underscore the importance of monitoring for elevated mood symptoms early in AD.

Phishing vulnerability compounded by older age, apolipoprotein E e4 genotype, and lower cognition.

With technological advancements, financial exploitation tactics have expanded into the online realm. Older adults may be particularly susceptible to online scams due to age- and Alzheimer's disease-related changes in cognition. In this study, 182 adults ranging from 18 to 90 years underwent cognitive assessment, genotyping for apolipoprotein E e4 (APOE4), and completed the lab-based Short Phishing Email Suspicion Test (S-PEST) as well as the real-life PHishing Internet Task (PHIT). Across both paradigms, older age predicted heightened susceptibility to phishing, with this enhanced susceptibility pronounced among older APOE4 allele carriers with lower working memory. Additionally, performance in both phishing tasks was correlated in that reduced ability to discriminate between phishing and safe emails in S-PEST predicted greater phishing susceptibility in PHIT. The current study identifies older age, APOE4, and lower cognition as risk factors for phishing vulnerability and introduces S-PEST as an easy-to-administer, ecologically valid tool for assessing phishing susceptibility.

Caregivers' Perspective and Burden of the End-of-Life Phase of Patients with Glioblastoma: A Multicenter Retrospective Study

Glioblastoma represents the most common aggressive primary brain tumour in adults. Changes in cognition, personality and in behaviour of patient as well as side effects of treatments cause unique challenges for providing care and may impact caregiver burden in different ways.This retrospective study included 45 patients with diagnosis of glioblastoma treated between January 2022 and June 2023 in two Neurosurgical Departments. We investigated the quality of life and the experiences of glioblastoma patients caregivers on the end-of-life phase using a validated questionnaire consisting of 38 questions related to the caregiver's view of the patient's terminal phase and another 26 questions regarding caregiver's experiences and emotions during the last three months of the patient's life.Fatigue, reduced consciousness and sadness were the most common patient's symptoms reported by their caregivers. The reported quality of life of caregivers was low and superimposable to the quality of life that they attributed to the patients. The burnout symptoms and feelings of insufficient information emphasize the urgent need for psychological support and training dedicated to caregivers.The end-of-life phases of glioblastoma patient may represent a critical factor that significantly affects not only the patient but also caregiver burden, caregiving tasks, and caregiver time. A urgent multidisciplinary support program is needed to face and improve caregivers burden.

Altered gyrification in chemotherapy-treated older long-term breast cancer survivors.

The purpose of this prospective longitudinal study was to evaluate the changes in brain surface gyrification in older long-term breast cancer survivors 5-15 years after chemotherapy treatment. Older breast cancer survivors aged ≥ 65 years treated with chemotherapy (C+) or without chemotherapy (C-) 5-15 years prior and age- and sex-matched healthy controls (HC) were recruited (time point 1 (TP1)) and followed up for 2 years (time point 2 (TP2)). Study assessments for both time points included neuropsychological (NP) testing with the NIH Toolbox cognition battery and cortical gyrification analysis based on brain MRI. The study cohort with data for both TP1 and TP2 consisted of the following: 10 participants for the C+ group, 12 participants for the C- group, and 13 participants for the HC group. The C+ group had increased gyrification in six local gyral regions including the right fusiform, paracentral, precuneus, superior, middle temporal gyri and left pars opercularis gyrus, and it had decreased gyrification in two local gyral regions from TP1 to TP2 (p<.05, Bonferroni corrected). The C- and HC groups showed decreased gyrification only (p<.05, Bonferroni corrected). In the C+ group, changes in right paracentral gyrification and crystalized composite scores were negatively correlated (R=-0.76, p=.01). Altered gyrification could be the neural correlate of cognitive changes in older chemotherapy-treated long-term breast cancer survivors.

Youth Perspectives on the Flint Water Crisis and Its Health Effects.

While the youth of Flint are at risk from the effects of the water crisis, little is known about their perspective of the impact of the water on their health. To explore adolescents' perceptions of living in Flint during the water crisis, its impact on their health, and ways to address the crisis and rebuild trust. In summer 2018, four focus groups were conducted with adolescents in Flint (ages 13 to 17 years). Group sessions were conducted by trained facilitators who were Flint residents along with members of the community-academic research team. Group sessions were audio-recorded and transcribed. Transcripts were reviewed and themes identified by the research team and youth from the focus groups. Of the 53 participants, most identified as Black (66%) and male (64%). Participants expressed concern about the impact of the water on their health. They knew people who developed rashes, experienced cognitive changes, and who died, they believed, owing to the water. The crisis also led to psychological consequences for youth. They expressed ongoing mistrust of the water and of institutions that should protect them, as well as concern that exposure may have long-term effects on their health and their children's health. Despite these concerns, participants expressed resilience and a desire to share that they had the potential to live successful lives. Youth expressed concern about current and long-term health sequelae of the water crisis. Further work is needed to monitor the consequences of the crisis and to identify resident-informed approaches to mitigate its effects and rebuild trust.

Testing theories of the vocabulary spurt with monolingual and bilingual infants.

Sometime before their second birthday, many children have a period of rapid expressive vocabulary growth called the vocabulary spurt. Theories of the underlying mechanisms differ: Accumulator models emphasize the accumulation of experience with words over time to yield a spurtlike pattern, while cognitive models attribute the spurt to cognitive changes. To test these theories, English-French monolingual and bilingual children with different exposure to each language were studied. Dense, longitudinal data were analyzed from 45 infants aged 16-30 months, whose expressive vocabulary was measured on a total of 617 occasions in English and/or French. Single-language (English and/or French), concept (number of concepts lexicalized across both languages), and word (sum of both languages) vocabulary scores were computed. Infants' exposure to each language and their exposure balance were measured using a language exposure questionnaire. Logistic curves were fitted to each infant's data to estimate the timing (midpoint) and steepness (slope) of the vocabulary spurt in single-language, concept, and word vocabularies. Seventy-six percent of infants showed a spurt in at least one vocabulary type, and bilinguals were less likely to show one in their nondominant than their dominant language. For single-language vocabulary, infants with more exposure to a language had earlier spurts. For combined vocabularies (concept and word), monolinguals and unbalanced bilinguals had earlier and steeper spurts than balanced bilinguals. Results better support the predictions of accumulator models than cognitive theories and show that infants follow different vocabulary acquisition trajectories based on their language background. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the Cognitive Impact of Anxiolytics on Elderly Patients: A prospective observational study.

Background: The cognitive effects of anxiolytics in older adults are an important domain to research given the high rates of anxiety disorders and these medications commonly prescribed. Benzodiazepines, and some of the newer non-benzo" sedative anxiolytic agents have been associated with cognitive effects as a potential side effect. This study is going to be conducted in Lady Reading Hospital (LRH) Peshawar; thus the data will reflect upon population served by this particular hospital. Objectives: To assess the cognitive impact of anxiolytic medication in geriatric patients, specifically on short-term memory (STM), attention and executive functions. Design: A observational study. Place and Duration of Study: Department of Pharmacy, Lady Reading Hospital-Peshawar starting from January 05th 2021 to July 05th ,2022. Methods: This was an observational study conducted on 150 elderly patients at Lady Reading Hospital through non probability sampling, comparing cognitive domain of functioning between 75 users and rest controls. Cognitive function was evaluated by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment before and after the medication. Results - This section will describe the cognitive score changes in relation to anxiolytic use. One-way ANOVA will be utilized to examine the differences in cognitive outcomes according drug type, dosage and duration of use. Conclusions: The use of anxiolytics in elderly patients is associated with deterioration cognitive function, which was confirmed by a decrease MMSE and MoCA scores during the course of treatment. The potential cognitive side effects when prescribing anxiolytics to the elderly requires a nuanced approach by healthcare providers. Keywords: Anxiolytics; older adult patients; cognitive performance, MMSE/MoCA.