Cognitive Domains Research Articles

B - 121 Feasibility of a Remote Neuropsychological Protocol in a Cohort Based Epidemiological Study: the Framingham Heart Study

Abstract Objective Research demonstrates adequate consistency between in-person and tele-np assessments with the latter typically omitting visually based measures and limiting capture of process-oriented scores. This study presents a novel tele-np protocol designed at the Framingham Heart Study (FHS) allowing for capture of visual and Boston Process Approach (BPA) data. Methods Beginning in 2021, FHS participants completed a tele-np protocol via HIPAA-compliant Zoom that includes tests similar to those administered in-person assessing all cognitive domains including visual memory and visuospatial functioning. Records forms, digital pen for BPA capture, and a label for return of materials, were mailed to participants. Regression models were used to compare in-person and tele-np results. Results The tele-np protocol consisting of 15 tests was administered to 169 participants across 30 states and three countries. Participants were 71.8 years on average (SD = 9.98), well-educated (84.6% ≥ college-educated), Caucasian (86.4%), and 53% male. Mean completion time of the tele-np protocol is 77.7 minutes (SD = 13.2). 76% of participants were deemed to be cognitively intact and 24% cognitively impaired based on their tele-np and previous in-person data. With the exception of a test of processing speed (β = −5.24 [−7.58,-2.89], p < 0.001), raw scores across most tests did not significantly differ based on mode of administration (tele-np vs. in-person) after adjusting for age, sex, education, and years between in-person and tele-np evaluations. Conclusion Preliminary findings indicate that the current tele-np protocol yields reliable results. Tele-np offers a cost-effective approach to improve accessibility and retention of participants, especially those out of state who may have otherwise been excluded from data collection.

NEUROPSYCHOPEDAGOGICAL PERSPECTIVE: RELATIONSHIPS BETWEEN WORKING MEMORY AND MOTOR, INHIBITORY CONTROL, AND LINGUISTIC DEVELOPMENT IN ELEMENTARY SCHOOL

Working memory plays a pivotal role in cognitive functioning, serving as a dynamic interface for processing and integrating information across various domains. It is crucial for executing complex tasks such as reading comprehension, mathematical problem-solving, and logical reasoning. This study investigates the relationship between working memory and motor skills, inhibitory control, and language abilities in elementary school students, highlighting the role of specific assessment instruments in this analysis. The research involved 1107 students, aged 7 to 10 years, from public schools in Joinville, Brazil. Working memory was evaluated using the Neuropsychopedagogical Screening Scale for Working Memory (NSSWM), which comprises 23 items that assess the temporary storage and processing of information needed for tasks such as language comprehension, arithmetic, and problem-solving. Motor skills were assessed using the Neuropsychopedagogical Screening for Children's Motor Development, a 7-item scale focusing on motor coordination, fine motor control, and organizational skills during school activities. Inhibitory control was measured with the Child Inhibitory Control Screening Scale (CICS), which includes 18 scenarios that evaluate inhibitory responses, planning, and impulsivity. Phonological skills were assessed using the Screening Scale for Phonological Skills (SSPS), which measures the ability to recognize formal language characteristics through 17 items. Lastly, reading and writing skills were evaluated using the Children's Reading and Writing Screening Scale (CRWSS), a 16-item scale designed to identify potential difficulties in acquiring these skills in a school setting. The results revealed significant correlations between working memory and other cognitive domains, with motor skills exhibiting the strongest association (r=0.916, p=0.012). Additionally, inhibitory control (r=0.732, p=0.028) and phonological awareness (r=0.815, p=0.034) showed strong correlations with working memory, indicating that students with better-developed skills in these areas tend to perform better in working memory tasks, which, in turn, positively impacts their academic performance. The study underscores the importance of early neuropsychopedagogical interventions that address both cognitive and motor development. By employing specific, targeted assessment instruments, educators and mental health professionals can better identify students at risk of academic difficulties and implement effective strategies to enhance their cognitive and behavioral development, ultimately fostering a more supportive and inclusive learning environment.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0525/a.php" alt="Hit counter" /></p>

Creating and sharing linear algebra metaphors as an assessment for engaging students beyond the cognitive domain

In this research, we investigated how a summative assessment of creating and sharing metaphors for linear algebra concepts supported undergraduate students’ affective, behavioral, and cognitive engagement. All seven research participants were enrolled in an introductory linear algebra course designed to develop students’ geometric understanding of linear algebra concepts in R2 and R3. Using embodied cognition and an engagement framework, we analyzed students’ written responses and video-taped their focus group discussion. Our findings suggest that this summative assessment (a) privileged mathematical aesthetics and the affective domain of learning, (b) engaged students in binding formal aspects of linear algebra concepts with metaphors that they enacted via embodiment, and (c) was an opportunity to demonstrate learning and higher-order cognition. Thus, illustrating that assessments can focus on aesthetic and affective domains of mathematics while simultaneously integrating serious mathematical cognition. We conclude by offering adaptations of this assessment for other mathematics courses.

Impact of blood glucose on cognitive function in insulin resistance: novel insights from ambulatory assessment

Background/objectivesInsulin resistance (IR)-related disorders and cognitive impairment lead to reduced quality of life and cause a significant strain on individuals and the public health system. Thus, we investigated the effects of insulin resistance (IR), and blood glucose fluctuations on cognitive function under laboratory and free-living conditions, using ecological momentary assessment (EMA).Subjects/methodsBaseline assessments included neuropsychological tests and blood analysis. Individuals were classified as either insulin-sensitive (<2) or insulin-resistant (≥2), based on their Homeostatic Model Assessment (HOMA-IR) values. Continuous glucose monitoring (CGM) using a percutaneous sensor was performed for 1 week. Using multiple linear regression, we examined the effects of HOMA-IR and CGM metrics on cognitive domains. Working memory (WM) performance, which was assessed using EMA, 4 times a day for 3 consecutive days, was matched to short-term pre-task CGM metrics. Multilevel analysis was used to map the within-day associations of HOMA-IR, short-term CGM metrics, and WM.ResultsAnalyses included 110 individuals (mean age 48.7 ± 14.3 years, 59% female, n = 53 insulin-resistant). IR was associated with lower global cognitive function (b = −0.267, P = 0.027), and WM (b = −0.316; P = 0.029), but not with executive function (b = −0.216; P = 0.154) during baseline. EMA showed that higher HOMA-IR was associated with lower within-day WM performance (β = −0.20, 95% CI −0.40 to −0.00). CGM metrics were not associated with cognitive performance.ConclusionsThe results confirm the association between IR and decrements in global cognitive functioning and WM, while no effects of CGM metrics were observed, making IR a crucial time point for intervention. Targeting underlying mechanisms (e.g., inflammation) in addition to glycemia could be promising to minimize adverse cognitive effects. Registered under https://drks.de/register/de identifier no. DRKS00022774.

Psychometric validation of the Italian Self-Report Symptoms inventory (SRSI): Factor structure, construct validity, and diagnostic accuracy

The Self-Report Symptom Inventory (SRSI) is a novel tool designed to detect symptom overreporting and other forms of noncredible responding. Unlike existing scales, the SRSI includes genuine and pseudosymptoms scales covering cognitive, affective, motor, pain, and post-traumatic stress disorder domains. The present study aims to investigate the psychometric properties of the Italian Version of the SRSI (SRSI-It), in particular, its factor structure, reliability, convergent and discriminant validity, and diagnostic accuracy. Data from 1180 healthy participants showed a hierarchical structure with higher-order constructs for genuine symptoms and pseudosymptoms, each comprising five subscales. The SRSI-It showed a strong convergent validity with the Structured Inventory of Malingered Symptomatology and discriminant validity through low correlations with the Psychopathic Personality Inventory-Revised. Receiver operating characteristic analysis determined cut scores of 6 (95% specificity) and 9 (98% specificity) for pseudosymptoms, with a Ratio Index score of 0.289 (82% specificity). In summary, the SRSI-It appears to be a promising tool for identifying symptom exaggeration in clinical and forensic contexts, ultimately enhancing the quality and reliability of evaluations in these contexts.

Long-term brain structural and cognitive outcomes in a low-risk preterm-born sample

Prematurity has been related to altered brain structure and cognition, and so our aim was to describe them in the absence of major structural brain injury following low-risk preterm birth during adolescence and young adulthood. The sample consisted of 250 participants, 132 of whom were low-risk preterm (30–36 weeks’ gestational age) and 118 were full-term individuals (37–42 weeks’ gestational age), aged between 16 and 38 years old. All participants underwent an extensive neuropsychological assessment. T1- and diffusion-weighted MRI images of 33 low-risk preterm and 31 full-term young adults (20–32 years old) were analyzed. No differences were found in terms of general cognitive functioning score or current socioeconomic status; however, the low-risk preterm group obtained lower scores in phonetic and semantic fluencies, and theory of mind. Significant reductions were identified in the thalamus volume as well as thicker cortex in the inferior temporal gyrus in the low-risk preterm group. Low-risk preterm young adults evidenced greater regional AD and MD compared to the full-term sample; while low-risk preterm group showed lower mean NDI and ODI (FWE-corrected, p < 0.05). Being born preterm is associated with poorer performance in various cognitive domains (i.e., phonetic and semantic fluencies, and theory of mind) later in life, along with differences in normative structural brain development in inferior temporal gyrus and regional white matter microstructure.

Gender differences in the association between education and late-life cognitive function in the LifeAfter90 Study: A multiethnic cohort of the oldest-old.

Few studies have examined the relationship between education and cognition among the oldest-old. Cognitive assessments were conducted biannually for 803 participants (62.6% women) of LifeAfter90, a longitudinal study of individuals ≥90 years old. Gender differences in associations between education (<high school, high school, some college, and ≥ college) and cognition (verbal episodic memory, semantic memory, and executive function) were examined at baseline and longitudinally using linear mixed models. Higher education levels were associated with better cognitive performance at baseline for both men and women. College completion was more strongly associated with better baseline executive function among women. Education-cognition associations for baseline verbal episodic memory and baseline semantic memory did not differ by gender. Education was not associated with a decline in any domain-specific cognitive scores, regardless of gender. Education is associated with cognitive function among the oldest-old and varies by gender and cognitive domain at baseline but not over time. In the oldest-old, higher education was associated with better cognitive function. College completion was more strongly associated with executive function in women. Education was not associated with cognitive decline after age 90 regardless of gender. Improving education could decrease gaps in cognitive level among older individuals.

Cognitive Outcomes in Autosomal-Dominant Alzheimer's Disease: A Comprehensive Review from a Colombian Kindred with the Presenilin-1 E280A Mutation.

The largest identified kindred worldwide with a single mutation causing autosomal-dominant Alzheimer's disease (ADAD) is a family from Antioquia, Colombia, carrying the Presenilin-1 (PSEN1) E280A (Paisa) mutation. The majority of mutation carriers develop dementia, typically commencing in their late 30 s, with a median onset age of 49 years. Cognitive decline is a hallmark feature. This review synthesizes the existing literature on neuropsychological assessments in PSEN1 E280A mutation carriers throughout their lifespan. We provide a comprehensive overview of cognitive outcomes in this unique population. We reviewed and integrated the published research, analyzing studies on neuropsychological assessments in PSEN1 E280A carriers. Our focus was on measures of verbal, semantic, episodic, and spatial memory, and encompassed other cognitive domains such as language, attention, visuospatial memory, and executive functioning. Verbal, semantic, episodic, and spatial memory emerged as the most sensitive indicators of preclinical changes in PSEN1 E280A carriers. Inconsistencies were noted in findings from tests assessing language, attention, visuospatial memory, and executive functioning, suggesting potential limitations in detecting early cognitive changes in PSEN1 mutation carriers. Specific cognitive tasks developed for this population proved effective but underutilized. The review underscores the importance of continued test development tailored to detect early cognitive changes in PSEN1 E280A carriers, potentially enhancing ADAD screening. Furthermore, investigating ADAD mutations in children may identify early changes in AD and enhance our understanding of neuropsychological functioning across the lifespan. This synthesis provides valuable insights for researchers, clinicians, and policymakers engaged in the study and management of ADAD.

Feasibility of a Multidomain Resiliency Assessment in Patients with Advanced Heart Failure Requiring Surgery: A Pilot Study.

The resiliency of patients who have advanced heart failure (HF) and undergo a physical stressor such as heart transplantation or left ventricular assist device implantation has yet to be studied in the physical, cognitive, and psychosocial domains. The primary aim of this pilot study was to assess the feasibility of a multidomain resiliency assessment in patients who have advanced HF and require surgery. A battery of assessments in each of the domains was completed at baseline before surgical intervention, after intensive care discharge, and 3 and 6months after surgery. Feasibility was assessed through completion rates, time required to complete the assessments, and qualitative feedback from assessors. Although various completion rates were noted at different time points, high completion rates were seen for grip strength, the modified Fried frailty phenotype, and the Montreal Cognitive Assessment. Additionally, when controlled for patients who were medically restricted from physical function, the Short Physical Performance Battery, gait speed, and the 30-second chair stand test also had high completion rates. A trend toward return to baseline status or an improvement in baseline status was observed in all physical and cognitive assessments and most psychosocial assessments at 3 and 6months. Minimal change was noted in the Brief Resilience Scale questionnaire. This pilot study demonstrates that a multidomain assessment of resiliency is feasible in patients with advanced HF. Future studies are needed to help determine specific assessments or patient factors that would help predict positive postsurgical outcomes in this population. This study has implications for clinical practice on the most feasible assessments in multiple domains for patients who have advanced HF and are being evaluated for heart transplantation or left ventricular assist device.

Cognitive phenotypes: Unraveling the heterogeneity in cognitive dysfunction among patients with primary brain tumors receiving radiotherapy.

Patients with primary brain tumors demonstrate heterogeneous patterns of cognitive dysfunction, which we explore using latent profile analysis (LPA) to identify cognitive phenotypes and their trajectories in patients receiving radiotherapy (RT). Ninety-six patients completed neuropsychological testing before and post-RT (3, 6, 12-months) on a prospective longitudinal trial, including measures of processing speed, executive function, language, and verbal and visual memory. Models with 2-4 classes were examined. Demographic and clinical data were examined across phenotypes and post-RT cognitive change was evaluated. The optimal model identified three unique cognitive phenotypes including a group of patients with generalized impairments (11.5%), a group with isolated verbal memory impairments (21.9%), and a group with minimal impairments (66.7%). The Verbal Memory phenotype had fewer years of education (p=.007) and a greater proportion of males (p<.001); the Generalized group had a greater proportion of patients with IDH-wild type gliomas and showed greater symptoms of anxiety and poorer quality of life (p-values<.05); and the Minimal Impairment phenotype had higher rates of IDH-Mutant gliomas. Approximately 50% of patients declined on at least one cognitive domain with memory the most vulnerable. Patients that declined reported greater symptoms of depression (p=.007) and poorer quality of life (p=.025). We identified three distinct cognitive phenotypes in patients with primary brain tumors receiving RT, each associated with unique demographic and clinical (e.g., IDH mutational status) profiles, with mood symptoms associated with late cognitive decline. This patient-centered approach enhances our understanding of clinical profiles associated with cognitive dysfunction and treatment-related neurotoxicity.

Understanding the Contributions of the Hippocampus

The hippocampus plays an important role in human memory, with its anterior portion contributing to coarse-grained representations and its posterior portion contributing to fine-grained ones (Poppenk et al., 2013). My USRA project is focused on understanding the role of the hippocampus in a potential third type of memory representation; a general synthesis of stimuli. Beyond memory, the hippocampus has also been hypothesize to influence clinical disorders. For instance, preliminary research in our lab has found meta-cognitive memory abilities to be organized into factors resembling clinical disorders, when organized by variance in brain structure. My USRA project also aims to understand the contribution of the hippocampus to clinical disorders. My role in this project has been to develop administrative and experimental structure for the protocol, which involves extensive testing. Participants will complete approximately 27 hours of memory tasks, designed to evaluate the nature of their memory, and whether it is oriented towards detail, gist, or a synthesis of all stimuli. To do so, I have developed an extensive task of reading and evaluating reviews, as well as a recall task of lab-generated stories. Participants will also complete approximately 3-4 hours of online questionnaires, administered through Qualtrics. Over the summer, I conducted research to identify validated questionnaires that assess metacognitive abilities, in the domains of memory, attention, language, motor control, social cognition and perception. Results on these questionnaires will be used to validate preliminary findings on the relationship between metacognitive memory, brain variance and sub-threshold levels of clinical disorders, and to investigate whether these findings expand to other forms of metacognition. Finally, participants will complete a number of structural and functional MRI scans (including DTI). This work may help us understand the pure science of the function of human memory, as well as the nature of clinical disorders.

Trait-level predictors of human performance outcomes in personnel engaged in stressful laboratory and field tasks.

Personnel performance under stress hinges on various factors, including individual traits, training, context, mental and physiological states, and task demands. This study explored the link between the traits of military personnel and their performance outcomes in five domains: move, shoot, communicate, navigate, and sustain. A total of 387 U.S. Army soldiers participated in this study, undergoing trait assessments covering physical, cognitive, social-emotional, demographic/lifestyle, and health domains. Performance was measured through lab and field events assessing a broad range of individual and team-level skills under conditions demanding resilience to acute cognitive and physical stress exposure. Analysis used feature selection and elastic net regression. Analyses revealed complex associations between traits and performance, with physical, cognitive, health-related, social-emotional, and lifestyle traits playing roles in guiding and constraining performance. Measures of resilience, emotion regulation, grit, and mindfulness were identified as relevant predictors of several performance-related outcomes. Results carry implications for the selection, training, and operational effectiveness of personnel in high-stakes occupations including military and first response. Further research is necessary to explore the mechanisms underlying these associations and inform targeted interventions to boost personnel effectiveness.

Social decision making in binge drinking: An exploration through moral dilemmas.

The continuum hypothesis proposes that binge drinking and severe alcohol use disorder (SAUD) share qualitatively similar cognitive and emotional impairments. In SAUD, these deficits have a demonstrated impact on social decision making, resulting in a utilitarian bias. Namely, when confronted with moral dilemmas, patients with SAUD tend to focus on the consequences of their actions rather than on social norms. However, social decision-making abilities remain unexplored in binge drinking. We offered the first insights on the generalization of the continuum hypothesis to social decision making, through a multinomial processing tree model applied to moral dilemmas, the "CNI model" of moral decision making. We compared 35 binge drinkers (20 females) and 36 light drinkers (21 females) on a battery of 48 moral dilemmas involving interpersonal relations from the CNI model, through multinomial modeling analyses. In each dilemma, participants were asked if they would perform the described action, generating individual scores for sensitivity to consequences, sensitivity to norms, and inaction tendency. The statistical model related to the CNI approach fits the data well. Binge drinkers and controls did not differ regarding their sensitivity to consequences nor their sensitivity to moral norms, and both groups displayed an equal inaction tendency in response to moral dilemmas. We provided insights to better understand the specific (socio)cognitive domains impaired in subclinical populations with alcohol use disorder. We showed preserved social decision making in binge drinking, which suggests that the continuum hypothesis documented for classical neurocognitive functions does not extend to complex social abilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impaired or not impaired: The accuracy of the Montreal Cognitive Assessment in detecting cognitive impairment among patients with alcohol use disorder.

Cognitive impairments are common in alcohol use disorder (AUD), but only a few studies have investigated the accuracy of the Montreal Cognitive Assessment (MoCA) in this population. We examined the accuracy and precision of the MoCA in detecting cognitive impairment in a sample of patients with AUD. In addition, we investigated whether the MoCA predicts premature discontinuation from treatment. A sample of 126 persons with AUD undergoing treatment in specialist health services were administered the MoCA and a battery of 12 neuropsychological tests. Five cognitive domains were derived from the reference tests. A composite total score from these tests was used as a reference criterion for determining correct and incorrect classifications for the MoCA. We analyzed the optimal cut-off score for the MoCA and the accuracy and agreement of classification between the MoCA and the reference tests. Receiver operating characteristic (ROC) curve analyzes yielded an area under the curve (AUC) of 0.77 (95% CI [0.67, 0.87]). Applying 25 as the cut-off, MoCA sensitivity was 0.77 and specificity 0.62. The PPV was 0.53. The NPV was 0.84. Using a cut-off score of 24 yielded a lower sensitivity 0.60, but specificity was significantly better i.e., 0.79. PPV was 0.68. The NPV was 0.82. Kappa agreement between MoCA and the reference tests was fair to moderate, 0.38 for the cut-off of 25, and 0.44 for the cut-off of 24. MoCA did not predict discontinuation from treatment. Our findings indicate limitations in the classification accuracy of the MoCA in predicting cognitive impairment in AUD. Achieving the right balance between accurately identifying impaired cases without including too many false positives can be challenging. Further, MoCA does not predict discontinuation from treatment. Overall, the results do not support MoCA as a time-efficient screening instrument.

Modeling Cortical Versus Hippocampal Network Dysfunction in a Human Brain Assembloid Model of Epilepsy and Intellectual Disability.

Neurodevelopmental disorders often impair multiple cognitive domains. For instance, a genetic epilepsy syndrome might cause seizures due to cortical hyperexcitability and present with memory impairments arising from hippocampal dysfunction. This study examines how a single disorder differentially affects distinct brain regions by using human patient iPSC-derived cortical- and hippocampal-ganglionic eminence assembloids to model Developmental and Epileptic Encephalopathy 13 (DEE-13), a condition arising from gain-of-function mutations in the SCN8A gene. While cortical assembloids showed network hyperexcitability akin to epileptogenic tissue, hippocampal assembloids did not, and instead displayed network dysregulation patterns similar to in vivo hippocampal recordings from epilepsy patients. Predictive computational modeling, immunohistochemistry, and single-nucleus RNA sequencing revealed changes in excitatory and inhibitory neuron organization that were specific to hippocampal assembloids. These findings highlight the unique impacts of a single pathogenic variant across brain regions and establish hippocampal assembloids as a platform for studying neurodevelopmental disorders.

Tailoring Semantic Interventions for Older Adults: Task-Focused and Person-Centered Approaches.

In this narrative review, we explore the latest evidence on semantic interventions for older adults, including both prevention and rehabilitation/remediation efforts, discussing them particularly in the context of dementia. Cognitive interventions vary in their level of structure, encompassing standardized (task-focused tasks) and unstandardized tasks (person-centered tasks). These interventions also differ in their target: rehabilitation or prevention. Addressing semantic knowledge/semantic memory/semantics is important, primarily because its efficiency impacts other cognitive domains. Semantic tasks are commonly included in preventive and rehabilitation programs, typically as standardized tasks with pre-defined semantic referents. On the other hand, person-centered approaches introduce personally relevant semantics, allowing patients to share thoughts and experiences with expressive language. Although these approaches offer benefits beyond cognitive improvement, their lack of structure may pose challenges. Our question club (CQ) program blends structured activities with personally relevant semantics, aiming to harness the advantages of both methods. Additionally, in this narrative review, we discuss future challenges and directions in the field of semantic interventions.

Cerebrovascular hemodynamics association with brain structure and function in Multiple Sclerosis

BackgroundVascular risk factors seem to contribute to disease progression in Multiple Sclerosis (MS), but the mechanistic connection between vascular risk and MS is unknown. Understanding cerebrovascular hemodynamics (CVH) in MS may help advance our understanding of the link between vascular risk and MS. ObjectivesExamine the relationship between CVH [dynamic cerebral autoregulation (dCA) and vasoreactivity (VR)] and brain structure (MRI) and function (cognition, and gait) in individuals with MS. MethodsTranscranial Doppler ultrasound (TCD) was utilized to assess two key markers of CVH: dCA and VR. dCA (reported as phase and gain) is calculated from the spontaneous blood pressure and flow velocity oscillations. VR is calculated as the slope of change in cerebral blood flow velocity in response to end-tidal CO2. Global gray matter (GM), white matter (WM), WM hyperintensity (WMH) volumes and WM lesion counts were measured from brain MRI. All participants underwent detailed cognitive and gait assessments. ResultsEighty participants were included (age 44 ± 11, 26 % male); 75 had relapsing-remitting MS (94 %), with disease duration of 8 (11) years [median (IQR)] since MS diagnosis and an Expanded Disability Status Scale (EDSS) of 2.0 (4.0). Higher phase (better dCA) was associated with greater GM volume, lower WHM burden and higher cognitive scores in the memory and global cognitive domains (all P values <0.05). There was no relationship between CVH and gait speed in our study participants. There was no relationship between VR and any measures of brain structure and function. ConclusionsMore efficient cerebral autoregulation is associated with better brain structure (larger GM and lower WMH volumes) and function (cognition, but not gait) in patients with MS.

Evidence from aphasia suggests a bidirectional relationship between inner speech and executive function

Research over the past several decades has revealed that non-linguistic cognitive impairments can appear alongside language deficits in individuals with aphasia. One vulnerable cognitive domain is executive function, an umbrella term for the higher-level cognitive processes that allow us to direct our behavior towards a goal. Studies in healthy adults reveal that executive function abilities are supported by inner speech, the ability to use language silently in one's head. Therefore, inner speech may mediate the connection between language and executive function deficits in individuals with aphasia. Here, we investigated whether inner speech ability may link language and cognitive impairments in 59 adults with chronic, post-stroke aphasia. We used two approaches to measure inner speech: one based on internal retrieval of words and one based on internal retrieval plus silent manipulation of the retrieved phonological forms. Then, we examined relationships between these two approaches to measuring inner speech and five aspects of executive function ability: response inhibition, conflict monitoring/resolution, general task-switching ability, phonological control, and semantic control. We also looked for dissociations between inner speech ability and executive function ability. Our results show tentative relationships between inner speech (across multiple measurement approaches) and all aspects of executive function except for response inhibition. We also found evidence for a double dissociation: many participants show intact executive function despite poor inner speech, and vice versa, so neither process is strictly reliant on the other. We suggest that this work provides preliminary evidence of a bidirectional relationship between inner speech and executive function: inner speech supports some aspects of executive function via internal self-cueing and certain aspects of executive function support performance on complex inner speech tasks.

Prevalence and Prognostic Impact of Multiple Frailty Domain in Japanese Older Adults

ObjectivesIn this observational study, we aimed to evaluate the independent and overlapping effects of multiple frailty domains on long-term care insurance (LTCI) use. DesignPopulation-based cohort design. Setting and ParticipantsIn total, 9804 community-dwelling older adults were recruited from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. MethodsThe physical domain of frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria. The cognitive domain of frailty was identified as impairment of memory, attention, executive function, or processing speed using standardized thresholds established for each domain in population-based cohorts. The social domain was operationalized using the National Center for Geriatrics and Gerontology-Social Frailty Scale. The use of LTCI was prospectively determined over 60 months using data extracted from the Japanese long-term care insurance system. ResultsThe data from 7745 participants were analyzed, of whom 793 (10.2%) required LTCI certification within 60 months (interquartile range: 60–60 months). The Kaplan–Meier curve analysis demonstrated that a high number of frailty domains was associated with incident LTCI use. The proportions of incident LTCI use were 6.0%, 12.4%, 30.1%, and 43.9% for non-frail participants and those with impairments in 1, 2, and 3 frailty domains, respectively. In the multivariate Cox regression model, physical, cognitive, and social domain impairments independently increased the risk of incident LTCI use [physical domain impairment, hazard ratio (HR), 1.67; 95% CI, 1.39–2.01; cognitive domain impairment, HR, 1.59; 95% CI, 1.37–1.84; social domain impairment, HR, 1.26; 95% CI, 1.05–1.50]. Conclusions and ImplicationsOverlapping frailty domains were strongly associated with incident LTCI use among community-dwelling older adults. These findings emphasize the importance of assessing multiple frailty domains and tailoring interventions according to the unique circumstances of older adults to prevent functional disabilities.

What clinicians could consider in providing group interventions for people with cognitive impairments: a scoping review.

This study identified evidence and considerations for allied health clinicians in providing group interventions for people with cognitive impairment. A scoping review was conducted by searching the MEDLINE (Ovid), CINHAL (EBSCOhost), Scopus (Elsevier), Embase (Ovid) and TROVE databases from 2016. Articles of any study design in which group interventions were performed by an allied health professional with participants with cognitive impairment were included. Data on physical, cognitive, psychological, and quality of life measures were extracted from the selected articles. Standardised mean changes (SMC) were calculated. Ten articles were included in the study. No article directly compared group interventions versus one-to-one interventions. The results of the meta-analysis showed significant improvements after the intervention in the physical (SMC = 0.42, P = 0.013), cognitive (SMC = 0.43, P = 0.005), psychological (SMC = 0.14, P = 0.005), and quality of life domains (SMC = 0.28, P = 0.002). This review identified considerations for clinicians when developing group interventions for people with cognitive impairments, including specific participant criteria, increasing support, modifications to intervention difficulty, and environmental considerations. Group intervention for people with cognitive impairments demonstrated moderate effectiveness in improving physical and cognitive domains and a small effect in improving psychological and quality of life domains. Specific considerations are recommended when clinicians provide group interventions for people with cognitive impairments.