Cognitive Performance In Adolescents Research Articles

Correlation between perceived supportive parenting and adolescent cognitive performance: The mediating role of achievement attribution and depressive symptoms

BackgroundPrevious research has established a link between supportive parenting and cognitive performance in childhood. However, the relationship between perceived supportive parenting and cognitive performance in adolescents and the underlying processes involved have received limited attention in the literature. ObjectiveThis study aimed to investigate the relationship between adolescents’ perception of supportive parenting and their later cognitive performance, while examining the mediating roles of achievement attribution and depressive symptoms in this association. MethodsData from the China Family Panel Studies were used, following three waves of data collection. The study sample included 1,302 children and adolescents aged 8–15 years old, who completed measures of parenting, cognitive performance (assessed through mathematical and vocabulary tests), and depressive symptoms. Among them, 588 and 581 adolescents completed measures of internal and external attribution, respectively. ResultsThe findings revealed a significant positive association between perceived supportive parenting and later cognitive performance in adolescents. Structural equation modeling analysis demonstrated that internal attribution positively mediates the association between perceived supportive parenting and later cognitive performance, while external attribution and depressive symptoms serve as negative mediators. These results remained robust even after controlling for demographic variables. ConclusionsThese findings emphasize the importance of supportive parenting and internal attribution for adolescent cognitive performance, shedding light on the mechanisms through which supportive parenting influences cognition in adolescents. These results have important implications for parents and educators, offering insights into effective support and guidance strategies to promote adolescents’ cognitive performance.

A - 27 A Preliminary Investigation of the Relationship between Sleep Symptoms and Post-Concussion Cognitive Performance in Adolescents

Abstract Purpose To explore the relationship between self-reported sleep symptoms and post-concussion cognitive test performance in adolescents on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Method 54 adolescents (ages 12–16) referred to a specialized sports concussion private practice completed post-concussion ImPACT. Five symptom clusters were derived from the post-concussion symptom scale: sleep, physical, cognitive, affective, and headache. Two-factor cognitive composites from the ImPACT (memory and speed) were the outcome variables. Multivariate linear regression was conducted to examine the relationship between cognitive variables and sleep symptoms. Post-hoc forward stepwise linear regressions were used to explore the following potential additional predictors of cognitive outcomes: age, number of previous concussions, sex, hours slept the night before, and five symptom clusters. Results Sleep symptoms were significantly associated with cognitive performance, F(1,52) = 9.95, p < 0.001, ƞ2 = 0.28. Higher sleep symptom cluster scores were associated with worse memory, F(1,53) = 13.68, p < 0.001, ƞ2 = 0.21, and speed performance, F(1,53) = 17.84, p < 0.001, ƞ2 = 0.26. Results of post-hoc forward stepwise linear regressions revealed that a final model for speed performance included only the sleep symptom cluster, explaining 16.6% of the variance. The final model for memory performance included only the headache rating, explaining 20.1% of the variance. Conclusions Our results indicate that severity of self-reported sleep symptoms post-concussion are associated with cognitive performance in domains of memory and speed. After considering additional predictors, more severe sleep symptoms were significantly associated with worse speed performance and worse headache severity was significantly associated with memory performance.

Relationships between Iron Status and Selected Physical Fitness Components of South African Adolescents: The PAHL-Study.

Poor iron status is detrimental to physical and cognitive performance in adolescents. Due to the limited studies investigating the association between iron status and physical fitness components in adolescents from low- and middle-income countries, we aimed to determine the association of iron status with selected physical fitness components in South African adolescents. A cross-sectional study design, including 178 adolescents (102 girls and 76 boys) from the Physical Activity and Health Longitudinal Study (PAHLS), was followed. Height and weight were measured to calculate the body mass index (BMI). Subsequently, WHO BMI-for-age-specific categorised body fatness. Cardiorespiratory fitness was determined with a 20-m shuttle run test (V˙O2max), and lower-body explosive power by the standing broad jump (SBJ). Fasting haemoglobin (Hb) and ferritin were analysed from blood samples. Correlation analyses determine the association between iron status, explosive power and cardiorespiratory fitness. Of the 178 participants, 18.5% (n = 33) had low Hb, and 14% (n = 25) iron deficiency without anaemia. Significant positive correlations were found between the selected physical fitness components, ferritin, and Hb. In boys, a positive association was found between Hb and SBJ (r = 0.30, p = 0.006), whilst in girls, positive associations were found between ferritin (r = 0.25, p = 0.04) and SBJ, and Hb with both SBJ (r = 0.21, p = 0.03) and V˙O2max (r = 0.32, p = 0.001). Hb concentration remained associated with V˙O2max and SBJ in girls after adjustment for age, whilst in boys, Hb concentration was associated with SBJ. Higher iron status in South African adolescents is associated with higher lower-limb explosive power and cardiorespiratory fitness. We suggest monitoring of haematological parameters, and interventions to improve the iron status of South African adolescents.

215. A Preliminary Interim Analysis of Cognitive Performance in Adolescents With Depression and Neurotypical Peers Using the NIH Toolbox

215. A Preliminary Interim Analysis of Cognitive Performance in Adolescents With Depression and Neurotypical Peers Using the NIH Toolbox

0814 Light Regularity Associated with Cognitive Performance in Adolescents with ADHD

0814 Light Regularity Associated with Cognitive Performance in Adolescents with ADHD

Children's cognitive performance and suicide risk through middle adulthood.

Longitudinal studies show that lower cognitive performance in adolescence and early adulthood is associated with higher risk of suicide death throughout adulthood. However, it is unclear whether this cognitive vulnerability originates earlier in childhood since studies conducted in children are scarce and have inconsistent results. Vital status of 49,853 individuals born between 1959 and 1966 to participants in the Collaborative Perinatal Project cohort was determined by a probabilistic linkage to the National Death Index, covering all US deaths occurring from 1979 through 2016. Cox proportional hazard models were used to examine associations of general, verbal, and non-verbal intelligence at ages 4 and 7, and academic skills at age 7 with suicide death coded according to ICD-9/10 criteria, while accounting for sociodemographic and pregnancy factors previously associated with suicide in this sample. By the end of 2016, 288 cohort members had died by suicide. Cognitive performance at 7 years on tests with verbal components was associated with suicide risk (average vs. high verbal intelligence, HR = 1.97, 95% CI 1.05-3.71; low vs. high spelling skills, HR = 2.02, 95% CI 1.16-3.51; low vs. high reading skills, HR = 2.01, 95% CI 1.27-3.17). Associations were still evident, especially for verbal intelligence and reading skills, but hazard ratios were attenuated after adjusting for prenatal and sociodemographic factors at birth (verbal intelligence, HR = 1.97, 95% CI 1.03-3.78; spelling, HR = 1.61, 95% CI 0.90-2.88; reading, HR = 1.67, 95% CI 1.02-2.72). Childhood neurocognitive performance is associated with vulnerability to suicide mortality through middle-adulthood, suggesting that there might be a cognitive diathesis for suicide originating in early childhood. Future studies should examine how multiple domains of childhood cognitive performance contribute to vulnerability to suicide risk, including by increasing risk for social and environmental factors that are associated not only with suicide but also with many types of psychiatric disorders.

Body mass index, systemic inflammation and cognitive performance in adolescents: A cross-sectional study

BackgroundExcessive body weight has been related to lower cognitive performance. One of the mechanisms through which excess body weight may affect cognition is inflammation. HypothesisOur hypothesis is that both body mass index (BMI) and circulating levels of inflammatory biomarkers will be negatively related to cognitive performance. DesignCross-sectional study. SettingUsers of the public health centres of the Consorci Sanitari de Terrassa (Terrassa, Spain) between 2010 and 2017 aged 12–21 years. ParticipantsOne hundred and five adolescents (46 normoweight, 18 overweight, 41 obese). MeasurementsLevels of high sensitivity C-reactive protein, interleukin 6, tumour necrosis factor α (TNFα) and fibrinogen were determined from blood samples. Cognitive performance was evaluated and six cognitive composites were obtained: working memory, cognitive flexibility, inhibitory control, decision-making, verbal memory, and fine motor speed. A single multivariate general lineal model was used to assess the influence of the four inflammatory biomarkers, as well as participants’ BMI, sex, and age on the 6 cognitive indexes. ResultsAn inverse relationship between BMI and inhibitory control (F = 5.688, p = .019; β = −0.212, p = .031), verbal memory (F = 5.404, p = .022; β = −0.255, p = .009) and fine motor speed (F = 9.038, p = .003; β = −0.319, p = .001) was observed. Levels of TNFα and fibrinogen were inversely related to inhibitory control (F = 5.055, p = .027; β = −0.226, p = .021) and verbal memory (F = 4.732, p = .032; β = −0.274, p = .005), respectively. LimitationsThe cross-sectional nature of the study, the use of cognitive tests designed for clinical purposes, and the use of BMI as a proxy for adiposity are limitations of our study that must be taken into account when interpreting results. ConclusionsOur data indicate that some components of executive functions, together with verbal memory, are sensitive to specific obesity-related inflammatory agents at early ages.

The Efficacy of Creatine Supplementation in Improving Cognitive Performance in Adolescents: A Phase-II, Triple-Blind, Randomized Study Protocol

Background/Aims: Creatine supplementation has demonstrated cognitive benefits in neurodegenerative conditions, having a protective effect in the brain's function in stressful situations, with excellent safety (Watanabe et al., 2002). However, any beneficial effects on the cognitive performance of healthy adolescents underperforming in school is unknown. Our objective is to assess whether creatine supplementation improves cognitive performance in 15- to 17-year-old students with an average school grade below the 50th percentile. Methods: This will be a phase-II, triple-blinded, randomized, parallel-group, superiority, single-center trial. Students with grades below the 50th percentile in the prior semester will be enrolled and randomized to receive juice packages containing either creatine monohydrate supplementation (0.1 mg/kg/day), or placebo, for 12 weeks. The primary outcome will be the mean difference in change of Raven’s Standard Progressive Matrices (RSPM) scores from baseline to week 12 between groups. To achieve a 90% power for detecting a 3-point difference in change in the RSPM score, and accounting for drop-out, 116 participants will be included. Secondary outcomes will include the difference in processing speed (SpaceCode), working memory (SpaceMatrix), non-visual memory (backward digit span), percentage change in lean mass, and any safety events. Conclusion: To our knowledge, this will be the most comprehensive study assessing creatine supple-mentation in adolescents. This is a low-risk intervention that has been shown to improve cognitive function in other populations. This study will potentially support the widespread use of creatine supplementation in adolescents with low school performance, while having a positive impact on this population.

Associations between Sleep, Depression, and Cognitive Performance in Adolescence.

The relevance of cognitive performance during adolescence requires further studies that analyze potential associated factors. This study aimed to analyze inductive reasoning, reading comprehension, and mathematical thinking (problem-solving and number and calculation) in relation to sleep and depression in 244 students aged 12-17 years (47.6% boys and 52.4% girls). Daytime sleepiness, sleep quality, dysthymia, and euthymia (state and trait) were assessed by self-reported questionnaires. Moreover, correlations between these variables and cognitive performance, and differences depending on sociodemographic variables (sex, age, or academic year) were analyzed using non-parametric tests. Robust regression models were also conducted to evaluate the predictive role of significant variables on cognitive performance. The results showed significant bidirectional relationships between sleep- and depression-related variables, and between the latter ones and cognitive performance. Depression-trait was more related to cognitive performance than depression-state, and euthymia more than dysthymia, but neither daytime sleepiness nor sleep quality significantly correlated with it. As for sociodemographic variables, girls reported worse sleep and more depressive symptoms than boys did, and younger students reported better sleep but performed worse than the older ones. Although these findings should be further explored in forthcoming studies adding other promising variables, they highlight the importance of promoting euthymia to improve cognitive performance in adolescents.

Designed acute physical activity to benefit primary school children’s cognition: Effects of cognitive challenge, bout duration and positive affect

Designed acute physical activity to benefit primary school children’s cognition: Effects of cognitive challenge, bout duration and positive affect

The association of road traffic noise with cognition in adolescents: A cohort study in Switzerland

Environmental noise exposure has been shown to affect children's cognition, but the concept of cognition is multifaceted, and studies on associations with noise are still inconclusive and fragmented. We studied cognitive change within one year in 882 adolescents aged 10–17 years in response to road traffic noise exposure.Participants filled in a comprehensive questionnaire and underwent cognitive testing twice at an interval of one year. Figural and verbal memory was measured with the Intelligenz-Struktur-Test (IST), and concentration accuracy and constancy were measured with FAKT-II and d2 test. Exposure to noise and other environmental stressors were modelled for school and home location at baseline. Missing data was addressed with multiple imputation. Cross-sectional multilevel analyses and longitudinal change score analyses were performed.In cross-sectional analyses, figural memory was significantly reduced by −0.27 (95%CI -0.49,-0.04) units per 10 dB road traffic noise increase at home (Lden). Longitudinal analyses showed a significant reduction of concentration constancy Z-scores between baseline and follow-up by −0.13 (95%CI -0.25, 0.00) per 10 dB road traffic noise at home (Lden).Our study indicates that road traffic noise at home reduces cognitive performance in adolescents. Larger cohorts with longer follow-up time are needed to confirm these results.

Cognitive control training enhances the integration of intrinsic functional networks in adolescents.

We have demonstrated that intensive cognitive training can produce sustained improvements in cognitive performance in adolescents. Few studies, however, have investigated the neural basis of these training effects, leaving the underlying mechanism of cognitive plasticity during this period unexplained. In this study, we trained 51 typically developing adolescents on cognitive control tasks and examined how their intrinsic brain networks changed by applying graph theoretical analysis. We hypothesized that the training would accelerate the process of network integration, which is a key feature of network development throughout adolescence. We found that the cognitive control training enhanced the integration of functional networks, particularly the cross-network integration of the cingulo-opercular network. Moreover, the analysis of additional data from older adolescents revealed that the cingulo-opercular network was more integrated with other networks in older adolescents than in young adolescents. These findings are consistent with the hypothesis that cognitive control training may speed up network development, such that brain networks exhibit more mature patterns after training.

Effect of acute game-based exercises on steroid hormones and cognitive performance in adolescents

PurposeWhile exercise was found to affect cognitive performance in adolescents, the underlying mechanisms need to be considered. This study compared the effect of a 20 min game-based exercise with different intensities on hormonal responses and potential links to cognitive performance. Methods37 adolescents (24 girls and 13 boys; 15–16 years of age) were randomly assigned into light intensity (LIG; 58.64% HRmax), vigorous intensity (VIG; 89.51% HRmax), and control group (CON). The concentration of salivary Testosterone and Cortisol was measured before, immediately after, 20 min and 60 min after the intervention. ResultsRepeated-measure ANOVA revealed that neither light nor vigorous game-based exercise acutely affects Testosterone, while Cortisol was higher in the VIG, 20 min after the intervention compared to the LIG and CON. Furthermore, changes in Testosterone were negatively associated with changes in cognitive performance after the acute vigorous intensity exercise (r = −0.63, p = .039) and control condition (r = −0.78, p = .003), but positively associated with post-intervention cognitive performance after the acute light intensity exercise (r = 0.67, p = .012). ConclusionThe intensity of game-based exercise affected Cortisol concentration in adolescents, while Testosterone concentration did not change after the intervention. On the other hand, exercise intensity plays an important role in the association between Testosterone concentration and cognitive performance.

Investigating the role of age and maturation on the association between tennis experience and cognitive function in junior beginner to intermediate-level tennis players

Sport engagement, including tennis, and physical activity have been shown to have a positive influence on cognition in children. However, age has also been found to have a strong association with cognition in youth athletes. This study examines the threshold hypothesis by investigating the moderating role of age and maturation on the association between tennis experience and cognitive measures in Australian and German junior beginner to intermediate-level tennis players. The demographic information, which includes years of tennis experience, and anthropometrics (e.g. height and weight) was collected for 48 junior tennis players. A comprehensive cognitive testing battery was then completed to assess cognitive performance, with a principle component analysis used to determine an overall cognitive performance score. Multiple regression analyses were then performed to test the relationship between tennis experience and cognitive performance as well as the moderating effects of age and maturation. The results of this study indicate that the age and maturation rather than the exposure to tennis training are related to cognitive performance. Additionally, the positive relations of tennis experience to cognitive performance were stronger in younger participants, specifically those younger than 12 years old. Therefore, tennis may not provide a stimulus large enough for further cognitive improvement once players have developed a high level of cognitive performance. While age and biological maturity will largely dictate cognitive performance in adolescents, tennis experience may play some role in the cognitive performance of children (specifically <12 years of age).

Effect of Smartphone Distractions on Cognitive Performance in Adolescents: An Electroencephalography Approach

Introduction: The dependence on smartphones has become widespread among all age groups in every realm of daily life. There has been increased concern about the adverse effects of problematic smartphone use and media multitasking among adolescents. Recent studies used various performance measures like questionnaire surveys to examine the association between smartphone addiction and learning performance, and such studies have yielded mixed findings. The current study investigates the effects of media multitasking on cognitive performance using Electroencephalography (EEG) features and a self-report questionnaire survey. Methods: The patterns of smartphone use among adolescents in South India were investigated in this study, using a questionnaire survey. Further, the impact of smartphone usage on cognitive task performance was examined using EEG features. For this, EEGs of twenty-two healthy subjects were recorded during learning tasks before and after using a social networking site on smartphones. Subsequently, various EEG features were extracted, including ratios of wavelet decomposed EEG bands, attention index, and Sample entropy. Finally, these cognitive performance indices were evaluated and compared with a control group. Results: A total of 600 healthy individuals (341 males, 259 females) participated in the survey among whom, 310 (50.91%) belonged to the high-user group. Performance degradation (p=0.005), sleep problems (p=0.040) and mental stress (p=0.049) were more prevalent among the high-user group. A significant decline in EEG-based cognitive performance indices was also observed in the phone-use group compared to the control group. Conclusion: The findings of this study highlight the importance of controlling phone use when engaged in cognitive tasks. The study also offers an insight to develop neurofeedback techniques that enhance cognitive skills.

The Relationship Between Cognitive Performance and Cardiorespiratory Fitness in Adolescents

Background. Literature suggests cardiorespiratory fitness as a factor influencing cognitive improvement. The authors of the present study sought to investigate if cardiorespiratory fitness related to cognitive performance after an acute bout of game-based exercise of different intensities in adolescents.
 Methods. As many as 37 adolescents (24 girls and 13 boys, 15–16 years of age) were assigned to three groups: experimental group 1 (EX 1), experimental group 2 (EX 2), and control (CON) group. The experimental groups experienced different levels of exercise intensity (EX 1 – light intensity, EX 2 – vigorous intensity). The Shuttle Run Test was performed a week before the intervention and VO2peak was calculated. Symbol Digit Modalities Test (SDMT) was evaluated before and after the acute intervention. A 2 x 3 repeated-measures ANOVA was used to analyze the SDMT and Pearson’s correlation coefficient was used to estimate the relationship between the cognitive performance (SDMT) and cardiorespiratory fitness (VO2peak).
 Results. Comparing the SDMT scores before and after the intervention, there were no differences found between the three groups. Neither in any of the experimental groups nor in the control group was a relationship between the SDMT score and VO2peak observed.
 Conclusion. Acute game-based exercise intervention did not prove to improve cognitive performance effectively. The authors of the present paper did not confirm the relationship between cardiorespiratory fitness and cognitive performance in adolescents.
 Keywords: exercise, cognitive performance, cardiorespiratory fitness.

Breakfast and Exercise Improve Academic and Cognitive Performance in Adolescents.

This study examined the combined effects of breakfast and exercise on short-term academic and cognitive performance in adolescents. Eighty-two adolescents (64 female), aged 14–19 years, were randomized to four groups over a 4-hour morning: (i) a group who fasted and were sedentary (F-S); (ii) a group who ate breakfast but were sedentary (B-S); (iii) a group who fasted but completed a 30-min exercise bout (F-E); and (iv) a group who ate breakfast and completed a 30-min exercise bout (B-E). Individuals completed academic and cognitive tests over the morning. Adolescents in B-E significantly improved their mathematics score (B-E: 15.2% improvement on correct answers, vs. F-S: 6.7% improvement on correct answers; p = 0.014) and computation time for correct answers (B-E: 16.7% improvement, vs. F-S: 7.4% improvement; p = 0.004) over the morning compared with the F-S group. The B-E group had faster reaction times for congruent, incongruent and control trials of the Stroop Color-Word Task compared with F-S mid-morning (all p < 0.05). Morning breakfast and exercise combine to improve short-term mathematical task performance and speed in adolescents.

Memory and Executive Function in Adolescent and Young Adult Females with Moderate to Severe Obesity Before and After Weight Loss Surgery.

There is a global increase in the prevalence of severe obesity in females during adolescence, which is a critical period for neurocognitive development. An increasing number of adolescents and young adults are now undergoing weight loss surgery as a treatment strategy for obesity. In addition to metabolic complications, obesity has been linked to neurocognitive comorbidity, and studies exploring cognitive performance in adolescents with severe obesity and the impact of bariatric surgery on cognitive abilities are limited. Verbal memory and executive function were assessed cross-sectionally in 69 females with moderate to severe obesity and 24 females without obesity, 13-24 years old. In an exploratory analysis, cognitive changes were also assessed longitudinally over 12 months in a subset of 35 females with moderate to severe obesity following weight loss surgery (n = 21) or following usual care without surgery (n = 14). In cross-sectional analysis, females with moderate to severe obesity showed lower scores for short-term and long-term recall (verbal memory) and response inhibition and cognitive flexibility (executive function) than the comparison group, when adjusted for age and baseline intelligence. Females with moderate to severe obesity who underwent surgery showed significant weight loss but no improvement in verbal memory and executive function scores over 12 months compared with those who did not have surgery. Females with moderate to severe obesity demonstrate worse performance in tests of verbal memory and executive function than the comparison group without obesity. In addition, exploratory analyses provide no indication that weight loss surgery improves these observed cognitive decrements over a period of 12 months. Further studies are necessary to comprehensively evaluate changes in cognitive function following bariatric surgery.

A Short Bout of Exercise With and Without an Immersive Virtual Reality Game Can Reduce Stress and Anxiety in Adolescents: A Pilot Randomized Controlled Trial

Anxiety and stress are prominent issues for the adolescent population. Physical activity is known to reduce symptoms of anxiety and stress; however, many adolescents lack the time or motivation to exercise regularly, particularly during stressful exam weeks. Virtual Reality (VR) has the potential to make exercise more enjoyable and more engaging than exercise alone. We aimed to investigate the immediate effect of a 10-min dodgeball exercise session, with and without a VR headset, on self-reported stress, anxiety and cognitive performance in adolescents during times known to induce stress in high school, such as exam weeks. Participants were randomly assigned to a VR group (n = 16) where participants were immersed in a virtual dodgeball environment (exergame), or a dodgeball group (n = 14) which played a simple game of one-on-one dodgeball. Executive function was measured using the Trail Making Test (TMT) Parts A and B. Anxiety was self-reported on the Pediatric Anxiety Short Form 8a (PASF). Stress was self-reported on the Psychological Stress Experiences-Short Form 8a (PSES). Both groups significantly improved their TMT A and B performance and reduced stress and anxiety scores with effect size ranging from 0.59 to 1.2 (main effect of time p &amp;lt; 0.001 for all outcomes). There were no significant differences between groups and no time by group interaction for any outcome. A short bout of exercise, with or without VR, during stressful high school exam weeks was shown to be effective for immediate reduction of stress and anxiety and enhancement of cognitive function in a small sample of high school students. High schools looking to apply interventions to help their students manage anxiety and stress should consider encouraging them to take a “time-out” to exercise and play. The cost-effectiveness of exergames inside the school settings and implications for academic success should be investigated in future research.

Socioeconomic aspects are crucial to better intellectual outcome in early-treated adolescents with congenital hypothyroidism

ABSTRACT Congenital hypothyroidism (CH) is an important cause of preventable intellectual disability. Implementation of CH neonatal screening programs leading to early treatment has improved cognitive outcome. However, more subtle cognitive impairments are still reported, and there is lack of clarity regarding factors that impact long-term cognitive outcome. Research to better understand these factors can lead to further improvements in the cognitive prognosis for these patients. The current study aimed to evaluate the cognitive performance of adolescents who were early-treated for primary permanent CH and possible associated variables. Neurocognitive evaluation was carried out in 66 adolescents, 11 to 16 years old: 34 with CH and 29 paired controls. Intellectual quotient (IQ), verbal fluency, processing speed, executive functions, and memory were investigated. CH patients and control subjects were comparable regarding sex, age, schooling, family’s socioeconomic status and caregiver’s educational level. Both groups presented not only similar IQ scores but also equivalent performances regarding Perceptual Reasoning, Working Memory and Processing Speed index scores. Patients presenting different CH etiologies (dysgenesis and dyshormonogenesis) showed similar cognitive performance. Socioeconomic aspects along with the initial levothyroxine dose were the main variables to positively influence the cognitive performance, the family’s socioeconomic status having the strongest association with patients’ cognitive skills.