Cognitive Vulnerability Research Articles

THE GEROPSYCHIATRIC NURSING COLLABORATIVE: ADDRESSING BEHAVIORAL NEEDS OF PERSONS WITH DEMENTIA

Abstract Over the last decade, the Geropsychiatric Nursing Collaborative (GPNC) has sought to improve care of older adults with mental health needs such as those with dementia. Geropsychiatric nurses are well-poised to deliver person-centered care to address the psychosocial needs of persons with dementia, which may include behavioral expressions. In this interdisciplinary symposium, we will highlight approaches members of the GPNC are taking to address mood and behavior in persons with dementia. The first session will describe how persons with mild-cognitive impairment draw upon their inner strength after they receive a diagnosis. The second session will discuss how common behavioral expressions such as anxiety, depression and apathy contribute to difficulty with everyday functional activities in persons with Alzheimer’s disease. The third session will describe an interprofessional communication tool to improve communication of behavioral expression in the nursing home setting. The last session will share findings from a nurse practitioner-led team care management model to address cognitive vulnerability in older adults with dementia, depression, and/or delirium. Together, these presentations describe how geropsychiatric nurses are investigating mood and behavioral symptoms in persons with dementia and addressing their mental health needs with innovative person-centered interventions.

The interactive effects of family violence and peer support on adolescent depressive symptoms: The mediating role of cognitive vulnerabilities

BackgroundFamily violence as an inducing factor of depressive symptoms has been confirmed in previous studies. However, the mechanisms underlying this association are not well understood, particularly in Chinese adolescents. Guided by the social-ecological diathesis-stress model, this three-wave longitudinal study aimed to examine the effects of an individual's cognitive vulnerabilities (rejection-sensitivity anxiety and negative cognitive error) and positive societal contexts (peer support) on the link between family violence and depressive symptoms in Chinese society. MethodsA total of 859 Chinese adolescents (44.35 % female; Mage = 12.73, SD = 0.43 at baseline) completed self-reporting surveys that assessed variables associated with study and peer-nominated peer support. ResultsThe results showed that family violence increased the incidence of depressive symptoms in adolescents after two years, resulting in rejection-sensitivity anxiety and negative cognitive error. Surprisingly, higher self-reported peer support, although not peer-nominated support, exacerbated rather than mitigated this indirect effect, supporting the reverse stress-buffering model and extending the healthy context paradox. LimitationsMost of the measures were based on participants' self-reports. ConclusionsThese results emphasize the importance of individual cognition and societal contexts in adolescents with traumatic experiences and provide empirical evidence for the intervention and clinical treatment of depressive symptoms.

Do Proximal Risk Factors Mediate the Impact of Affect on Symptoms of Generalized Anxiety Disorder and Major Depressive Disorder? An Extension of the Hierarchical Model of Cognitive Vulnerability

Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are among the most prevalent forms of psychopathology. The hierarchical model of cognitive vulnerability proposes that higher order risk factors explain co-occurrence among internalizing disorders, whereas lower order risk factors explain discordance. Methods: Participants (N = 646; mean age = 38.50, SD = 10.00; 49.2% female) were recruited from Amazon MTurk to complete self-report questionnaires related to psychopathology in the summer of 2020. Structural equation modeling was used to examine the relations that negative affect (NA) and positive affect (PA) share with MDD and GAD, through rumination and intolerance of uncertainty (IU), cross-sectionally. Results: When modeling both IU and depressive rumination together as explaining the indirect effects from affect to psychopathology, the association between NA and symptoms of MDD was explained by depressive rumination. There were no indirect effects from PA to MDD or GAD symptoms. When modeled separately, both risk factors explained the associations NA shared with MDD and GAD symptoms. Conclusions: The present study extends the hierarchical model of cognitive vulnerability by finding that depressive rumination explains the association between NA and symptoms of MDD, even when controlling for IU.

Pathways from developmental vulnerabilities in early childhood to schizotypy in middle childhood.

Childhood disturbances in social, emotional, language, motor and cognitive functioning, and schizotypy have each been implicated as precursors of schizophrenia-spectrum disorders. We investigated whether relationships between early childhood developmental vulnerabilities and childhood schizotypy are mediated by educational underachievement in middle childhood. Participants were members of a large Australian (n=19,216) population cohort followed longitudinally. Path analyses were used to model relationships between developmental vulnerabilities at age ~5 years, educational underachievement from ages ~8 to 10 years and three distinct profiles of schizotypy at age ~11 years (true, introverted and affective schizotypy). Early childhood developmental vulnerabilities on five broad domains (related to physical, emotional, social, cognitive and communication development) were associated with schizotypy profiles in middle childhood. Educational underachievement in middle childhood was associated with all schizotypy profiles, but most strongly with the true schizotypy profile (OR=3.92, 95% CI=3.12, 4.91). The relationships between schizotypy profiles and early childhood developmental vulnerabilities in 'language and cognitive skills (school-based)' and 'communication skills and general knowledge' domains were fully mediated by educational underachievement in middle childhood, and the relationships with early childhood 'physical health and well-being' and 'emotional maturity' domains were partially mediated. Developmental continuity from early childhood developmental vulnerabilities to schizotypy in middle childhood is mediated by educational underachievement in middle childhood. While some domains of early developmental functioning showed differential relationships with distinct schizotypy profiles, these findings support a developmental pathway to schizotypy in which cognitive vulnerability operates from early childhood through to middle childhood.

Long-Term Outcomes of Adolescent THC Exposure on Translational Cognitive Measures in Adulthood in an Animal Model and Computational Assessment of Human Data

Although perceived as relatively harmless and nonaddictive, adolescent cannabis use significantly increases the likelihood of developing cannabis use disorder in adulthood, especially for high-potency cannabis. Risky decision-making is associated with chronic cannabis use, but given confounds of human studies, it remains unclear whether adolescent cannabis exposure and Δ9-tetrahydrocannabinol (THC) potency specifically predicts risky decision-making or influences cognitive response to the drug later in life. To leverage a human data set of cannabis users and a rat model to evaluate the long-term outcomes of adolescent THC exposure on adult decision-making and impulse control. This translational rat study tested the link between adolescent THC exposure and adulthood decision-making. A reanalysis of a previously published dataset of human chronic cannabis users was conducted to evaluate decision-making phenotypes. Computational modeling assessed the human and animal results in a single framework. Data were collected from 2017 to 2020 and analyzed from 2020 to 2022. Decision-making was measured by the Iowa Gambling Task (IGT) and Rat Gambling Task (rGT). Impulse control was assessed in the rat model. Computational modeling was used to determine reward and punishment learning rates and learning strategy used by cannabis users and THC-exposed rats. Cell-specific molecular measures were conducted in the prefrontal cortex and amygdala. Of 37 participants, 24 (65%) were male, and the mean (SD) age was 33.0 (8.3) years. Chronic cannabis users (n = 22; mean [SE] IGT score, -5.182 [1.262]) showed disadvantageous decision-making compared with controls (n = 15; mean [SE] IGT score, 7.133 [2.687]; Cohen d = 1.436). Risky choice was associated with increased reward learning (mean [SE] IGT score: cannabis user, 0.170 [0.018]; control, 0.046 [0.008]; Cohen d = 1.895) and a strategy favoring exploration vs long-term gains (mean [SE] IGT score: cannabis user, 0.088 [0.012]; control, 0.020 [0.002]; Cohen d = 2.218). Rats exposed to high-dose THC but not low-dose THC during adolescence also showed increased risky decision-making (mean [SE] rGT score: vehicle, 46.17 [7.02]; low-dose THC, 69.45 [6.01]; high-dose THC, 21.97 [11.98]; Cohen d = 0.433) and elevated reward learning rates (mean [SE] rGT score: vehicle, 0.17 [0.01]; low-dose THC, 0.10 [0.01]; high-dose THC, 0.24 [0.06]; Cohen d = 1.541) during task acquisition. These animals were also uniquely susceptible to increased cognitive impairments after reexposure to THC in adulthood, which was correlated with even greater reward learning (r = -0.525; P < .001) and a shift in strategy (r = 0.502; P < .001), similar to results seen in human cannabis users. Molecular studies revealed that adolescent THC dose differentially affected cannabinoid-1 receptor messenger RNA expression in the prelimbic cortex and basolateral amygdala in a layer- and cell-specific manner. Further, astrocyte glial fibrillary acidic protein messenger RNA expression associated with cognitive deficits apparent with adult THC reexposure. In this translational study, high-dose adolescent THC exposure was associated with cognitive vulnerability in adulthood, especially with THC re-exposure. These data also suggest a link between astrocytes and cognition that altogether provides important insights regarding the neurobiological genesis of risky cannabis use that may help promote prevention and treatment efforts.

Differences in Cognitive Triad, Biased Information Processing, and Metacognitive Beliefs Between Women with Depression and Premenstrual Syndrome

The timing of premenstrual syndrome (PMS) suggests that hormonal fluctuations are a key component in its pathogenesis. Unfortunately, women with PMS cannot be distinguished from asymptomatic women regarding biological markers. Research suggests that increased susceptibility to hormonal changes among women with PMS may be explained by the theory of cognitive vulnerability to affective disorders. The study group comprised 127 women (aged 19–35). The participants were divided into four groups: asymptomatic, nondepressed with PMS, depressed without PMS, and both depressed and with PMS. PMS was diagnosed by prospective daily reports, and depression by SCID-IV. All participants completed the Cognitive triad inventory (CTI), Metacognitive belief questionnaire (MCQ-30), and the self-referent information processing task (SRET) randomly either in the follicular or luteal phase. Findings indicated that only the asymptomatic women differed in cognitive processing from the depressed women. Those with PMS, despite demonstrating a slightly greater intensity of distorted cognitive processing, did not differ significantly from the asymptomatic participants; however, they differed from those with depression regarding in the cognitive triad. The phase of the cycle was not a significant factor in differentiating distorted cognitive processing. Depressed women have more distorted cognitive processes than non-depressed women. Women with PMS appear to be a group that lies between asymptomatic women and those who suffer from depression. Moreover, among women with depression, those with PMS have even more severe distorted cognitive processing than those without PMS.

Educational approaches to enable marketplace metacognition and social intelligence in subsistence consumers

PurposeSubsistence marketplace can be characterized as a marketplace with widespread cognitive and social vulnerabilities, due to low income and low literacy levels. This may result in retailers exploiting the consumers. The purpose of this research paper is to develop a holistic learning program to impart marketplace intelligence to overcome these vulnerabilities of subsistence consumers.Design/methodology/approachUsing vicious cycle approach, the authors illustrate the self-perpetuating nature of consumer vulnerabilities. The authors argue that retailers behave in an opportunistic manner and exploit the consumers. This further reinforces the vulnerabilities of subsistence consumers resulting in a vicious cycle. The authors draw insights from Sen’s capability approach and propose marketplace intelligence as a potential solution to eradicate consumers’ vulnerabilities. The authors apply Biggs’s 3Ps model to design a learning program to impart two types of marketplace intelligence – marketplace metacognition and marketplace social intelligence.FindingsBased on a review of literature on subsistence marketplace initiatives, persuasive knowledge management and education research, the authors have devised a holistic learning program comprising an integrated learning environment (presage), problem-based approach (process) and assessment strategies for learning outcomes (product).Originality/valueThis study marks a pioneering effort toward liberating subsistence consumers from the vicious cycle of retailers’ exploitation by empowering them with marketplace intelligence. This study’s novelty lies in conceptualizing consumer vulnerabilities in the subsistence marketplace as a self-perpetuating phenomenon and subsequently designing a holistic learning program to impart intelligence toward alleviating these vulnerabilities.

Practice effects in cognitive assessments three years later in non-carriers but not in symptom-free mutation carriers of autosomal-dominant Alzheimer's disease: Exemplifying procedural learning and memory?

Practice effects (PEs) defined as an improvement of performance in cognition due to repeated assessments between sessions are well known in unimpaired individuals, while less is known about impaired cognition and particularly in latent brain disease as autosomal-dominant Alzheimer's disease. The purpose was to evaluate the general (across tests/domains) and domain-specific PE calculated as the annual rate of change (ARC) in relation to years to the estimated disease onset (YECO) and in four groups of AD: asymptomatic mutation carriers (aAD, n = 19), prodromal, i.e., symptomatic mutation carriers, criteria for AD diagnosis not fulfilled (pAD, n = 4) and mutation carriers diagnosed with AD (dAD, n = 6) as well as mutation non-carriers from the AD families serving as a healthy comparison group (HC, n = 35). Cognition was assessed at baseline and follow-up about 3 years later by 12 tests covering six domains. The aAD and HC groups were comparable at baseline in demographic characteristics (age, gender, and education), when they were in their early forties, while the pAD and dAD groups were older and cognitively impaired. The results on mean ARC for the four groups were significantly different, small, positive, and age-insensitive in the HC group, while ARC was negative and declined with time/disease advancement in AD. The differences between HC and aAD groups in mean ARC and domain-specific ARC were not significant, indicating a subtle PE in aAD in the early preclinical stage of AD. In the symptomatic stages of AD, there was no PE probably due to cognitive disease-related progression. PEs were the largest in the verbal domain in both the HC and aAD groups, indicating a relationship with cognitive vulnerability. The group-related difference in mean ARC was predominant in timekeeping tests. To conclude, the practice effect in over 3 years was suggested to be linked to procedural learning and memory.

Biolaw, Digital Hyperconsuption and Cognitive Vulnerability: Towards a Biojuridical Resignification of Bioethical Principles for the Protection of Cognitive Health

Cognitive health is necessary for human development. However, the hyperconsumption of biotechnologies (smartphones, internet, video games, social networks, virtual reality) can cause damage to cognitive health and, therefore, to human health and development. Consequently, such research focuses on limiting the consumption of specific technologies in minors in order to protect their health. This research is divided in five parts: the contextualization on the colonization of biotechnological consumption; a diagnosis of neuronal violence and consequences for human development; a review of the cognition sequelae due to the abuse of biotechnologies, based on selected medical research; an exposition on the necessary relationships between the moral order and the legal one, from philosophical realism and natural law approaches; proposal of minimum fundamental rules, based, in turn, on a biojuridical specification of principles to protect cognitive health, which serve as preliminary support to elaborate a future Universal Declaration for the Protection of Cognitive Health, as an essential biological basis for human development.

Key demographics and psychological skills associated with adjustment to progressive Multiple Sclerosis early in the diagnosis.

Background/purposeBeing diagnosed with a progressive type of multiple sclerosis (MS) has been associated with worse psychological outcomes compared to relapsing-remitting type. Previous studies of adjustment to MS have primarily focused on relapsing-remitting type MS. The present study aims to examine psychological adjustment for people newly diagnosed with progressive multiple sclerosis.MethodsThis was a multicenter cross-sectional survey of 189 people newly diagnosed with progressive MS. A composite measure of psychological adjustment was created from questionnaires measuring psychological distress, positive affect, perceived-stress, life satisfaction and self-concept. Predictor variables included coping strategies, social support, relationship with partner, psychological vulnerability, MS-related beliefs, and responses to symptoms. Data were analysed using a regularised regression model to indicate which group of all variables are associated with adjustment.ResultsPeople who were older (b = 0.17(0.07), p = 0.02), in employment (b = 0.40 (0.17), p = 0.01), and with lower illness severity (b = −0.24 (0.08), p = 0.001) showed better adjustment. Based on a Lasso regression, the most important psychological and demographic variables associated with lower adjustment (out-of-sample cross-validation R2 = 62.6%) were lower MS self-efficacy and higher avoidance, cognitive vulnerability, embarrassment avoidance, conflict, helplessness, and secondary progressive MS type.Conclusions and implicationsHelping newly diagnosed people to find ways to tolerate anxiety-causing situations by encouraging acceptance may help people adjust to progressive MS by lowering their avoidance. Further, building confidence in managing the illness and addressing relationship issues are key focus areas in psychological interventions for people with progressive multiple sclerosis.

A Gambling Just-In-Time Adaptive Intervention (GamblingLess: In-The-Moment): Protocol for a Microrandomized Trial.

BackgroundThe presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available.ObjectiveThis study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode.MethodsGamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand.ResultsThe project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024.ConclusionsGamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=FalseInternational Registered Report Identifier (IRRID)PRR1-10.2196/38958

EEG-responses to mood induction interact with seasonality and age.

The EEG is suggested as a potential diagnostic and prognostic biomarker for seasonal affective disorder (SAD). As a pre-clinical form of SAD, seasonality is operationalized as seasonal variation in mood, appetite, weight, sleep, energy, and socializing. Importantly, both EEG biomarkers and seasonality interact with age. Inducing sad mood to assess cognitive vulnerability was suggested to improve the predictive value of summer assessments for winter depression. However, no EEG studies have been conducted on induced sad mood in relation to seasonality, and no studies so far have controlled for age. We recorded EEG and calculated bandpower in 114 participants during rest and during induced sad mood in summer. Participants were grouped by age and based on a seasonality score as obtained with the seasonal pattern assessment questionnaire (SPAQ). Participants with high seasonality scores showed significantly larger changes in EEG power from rest to sad mood induction, specifically in the alpha frequency range (p = 0.027), compared to participants with low seasonality scores. Furthermore, seasonality interacted significantly with age (p < 0.001), with lower activity in individuals with high seasonality scores that were older than 50 years but the opposite pattern in individuals up to 50 years. Effects of sad mood induction on brain activity are related to seasonality and can therefore be consider as potential predicting biomarkers for SAD. Future studies should control for age as a confounding factor, and more studies are needed to elaborate on the characteristics of EEG biomarkers in participants above 50 years.

The antidepressant effect of cognitive reappraisal training on individuals cognitively vulnerable to depression: Could cognitive bias be modified through the prefrontal-amygdala circuits?

Cognitive reappraisal (CR) is one of the core treatment components of cognitive behavioral therapy (CBT) and is the gold standard treatment for major depressive disorders. Accumulating evidence indicates that cognitive reappraisal could function as a protective factor of cognitive vulnerability to depression. However, the neural mechanism by which CR training reduces cognitive vulnerability to depression is unclear. There is ample evidence that the prefrontal–amygdala circuit is involved in CR. This study proposes a novel cognitive bias model of CR training which hypothesizes that CR training may improve the generation ability of CR with altered prefrontal–amygdala functional activation/connectivity, thus reducing negative cognitive bias (negative attention bias, negative memory bias, negative interpretation bias, and/or negative rumination bias) and alleviating depressive symptoms. This study aims to (1) explore whether there is abnormal CR strategy generation ability in individuals who are cognitively vulnerable to depression; (2) test the hypothesis that CR training alleviates depressive symptoms through the mediators of cognitive bias (interpretation bias and/or rumination bias); (3) explore the neural mechanism by which CR training may enhance the ability of CR strategy generation; and (4) examine the short- and long-term effects of CR training on the reduction in depressive symptoms in individuals who are cognitively vulnerable to depression following intervention and 6 months later. The study is promising, providing theoretical and practical evidence for the early intervention of depression-vulnerable individuals.

Decoding of Processing Preferences from Language Paradigms by Means of EEG-ERP Methodology: Risk Markers of Cognitive Vulnerability for Depression and Protective Indicators of Well-Being? Cerebral Correlates and Mechanisms

Depression is a frequent mental affective disorder. Cognitive vulnerability models propose two major cognitive risk factors that favor the onset and severity of depressive symptoms. These include a pronounced self-focus, as well as a negative emotional processing bias. According to two-process models of cognitive vulnerability, these two risk factors are not independent from each other, but affect information processing already at an early perceptual processing level. Simultaneously, a processing advantage for self-related positive information including better memory for positive than negative information has been associated with mental health and well-being. This perspective paper introduces a research framework that discusses how EEG-ERP methodology can serve as a standardized tool for the decoding of negative and positive processing biases and their potential use as risk markers of cognitive vulnerability for depression, on the one hand, and as protective indicators of well-being, on the other hand. Previous results from EEG-ERP studies investigating the time-course of self-referential emotional processing are introduced, summarized, and discussed with respect to the specificity of depression-related processing and the importance of EEG-ERP-based experimental testing for well-being and the prevention and treatment of depressive disorders.

A distinct astrocyte subtype in the aging mouse brain characterized by impaired protein homeostasis.

The aging brain exhibits a region-specific reduction in synapse number and plasticity. Although astrocytes play central roles in regulating synapses, it is unclear how changes in astrocytes contribute to age-dependent cognitive decline and vulnerability to neurodegenerative diseases. Here, we identified a unique astrocyte subtype that exhibits dysregulated autophagy and morphology in aging hippocampus. In these autophagy-dysregulated astrocytes (APDAs), autophagosomes abnormally accumulate in swollen processes, impairing protein trafficking and secretion. We found that reduced mammalian target of rapamycin (mTOR) and proteasome activities with lysosomal dysfunction generate APDAs in an age-dependent manner. Secretion of synaptogenic molecules and astrocytic synapse elimination were significantly impaired in APDAs, suggesting that APDAs have lost their ability to control synapse number and homeostasis. Indeed, excitatory synapses and dendritic spines associated with APDAs were significantly reduced. Finally, we found that mouse brains with Alzheimer's disease showed a significantly accelerated increase in APDAs, suggesting potential roles for APDAs in age- and Alzheimer's disease-related cognitive decline and synaptic pathology.

Understanding shark-related cognitive vulnerability and its role in shark diving: implications for conservation

ABSTRACT Negative perceptions and vulnerable feelings about sharks have been one of the greatest barriers to effective shark conservation efforts. This study used a self-report survey of young adults in a coastal state (N = 616) to examine how shark-related risk perceptions (severity and susceptibility) and sensation-seeking tendency influence cognitive vulnerability to sharks and its affective, cognitive, and behavioral outcomes. Results of a path analysis showed that perceived susceptibility was positively associated with cognitive vulnerability to sharks, which in turn was negatively related to behavioral intention to shark dive. Perceived severity was associated with higher levels of fear, less favorable attitudes toward shark diving, and had a negative indirect effect on behavioral intention through attitude. Sensation-seeking had both a direct and an indirect effect through attitude on behavioral intention to shark diving. Theoretical and practical implications of findings in human-wildlife interactions are described.

Relating psychiatric symptoms and self-regulation during the COVID-19 crisis

Disruptions of self-regulation are a hallmark of numerous psychiatric disorders. Here, we examine the relationship between transdiagnostic dimensions of psychopathology and changes in self-regulation in the early phase of the COVID-19 pandemic. We used a data-driven approach on a large number of cognitive tasks and self-reported surveys in training datasets. Then, we derived measures of self-regulation and psychiatric functioning in an independent population sample (N = 102) tested both before and after the onset of the COVID-19 pandemic, when the restrictions in place represented a threat to mental health and forced people to flexibly adjust to modifications of daily routines. We found independent relationships between transdiagnostic dimensions of psychopathology and longitudinal alterations in specific domains of self-regulation defined using a diffusion decision model. Compared to the period preceding the onset of the pandemic, a symptom dimension related to anxiety and depression was characterized by a more cautious behavior, indexed by the need to accumulate more evidence before making a decision. Instead, social withdrawal related to faster non-decision processes. Self-reported measures of self-regulation predicted variance in psychiatric symptoms both concurrently and prospectively, revealing the psychological dimensions relevant for separate transdiagnostic dimensions of psychiatry, but tasks did not. Taken together, our results are suggestive of potential cognitive vulnerabilities in the domain of self-regulation in people with underlying psychiatric difficulties in face of real-life stressors. More generally, they also suggest that the study of cognition needs to take into account the dynamic nature of real-world events as well as within-subject variability over time.

Illuminating the need for a specific clinical care pathway for patients living with heart failure and identified as clinically frail.

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Against a background of increasing global population aging, frailty affects 8-10% of those over 65 years and 25-50% in those over 85 years. Frailty has a 4-6 times greater prevalence in heart failure patients and is increasingly recognised as a predictor of increasing hospitalisation and mortality in cardiovascular disease. The Rockwood Clinical Frailty Scale estimates an individual’s degree of frailty on a scale of 1(very fit) to 9 (terminally ill) with a score of 5 or greater indicating frailty. Purpose To estimate the 30-day prevalence of frailty in patients attending an ANP-led Heart Failure Clinic as a precursor to developing a clinical care pathway that systematically identifies frailty and triggers a comprehensive geriatric assessment. Methods A multi-centre audit was conducted in three hospitals in Ireland. We retrospectively audited consecutive patients attending three ANP-led HF clinics in November 2021 to assess the prevalence of frailty. Demographic data, NYHA classification, number of hospital admissions in the previous year, clinical Frailty Score (CFS) and the number of patients under the care of a geriatrician was obtained from the medical notes of 170 heart failure patients consecutively reviewed. CFS was calculated in those patients over 65 years. Results Of 376 HF reviews in November 2021, 170 individual patients were identified, 65% were male, 86% were aged 65ys or older of which 34% were over 80 years and a mean age of 73.4 years. 52% of the cohort were admitted at least once in the previous year of which 12% were admitted twice and 5% were admitted 3-4 times. 37% were classified as NYHA III and 0.6% were NYHA IV. The majority (68%) were newly diagnosed with HF within the previous year. 14% of patients were aged under 65yrs and did not have a CFS, 19% were deemed vulnerable (CFS 4), 41% were CFS 5 or greater and only 5% were under the care of a geriatrician. Conclusion(s) The prevalence of frailty (41%) was high in comparison with the national average of 24% and global average of 17%. Despite a strong association between age, frailty and heart failure, few patients were managed by a geriatrician. This audit emphasises the importance of developing a regional clinical care pathway that promptly recognises frailty in a high-risk population and triggers a comprehensive geriatric assessment. Furthermore, this audit highlights the limitations of the CFS in demonstrating cognitive and social vulnerability provoking further discourse in how patients are assessed and managed in the future.

Scores on the suicide cognitions scale-revised (SCS-R) predict future suicide attempts among primary care patients denying suicide ideation and prior attempts

BackgroundApproximately half of patients who attempt or die by suicide screened negative for suicidal ideation during their most recent medical visit. Maladaptive beliefs and schemas can increase cognitive vulnerability to suicidal behavior, even among patients without recent or past suicidal thoughts and behaviors. Assessing these beliefs could improve the detection of patients who will engage in suicidal behavior after screening negative for elevated suicide risk. MethodsPrimary care patients who completed the Patient Health Questionnaire-9 and the Suicide Cognitions Scale-Revised (SCS-R) during routine clinic visits and denied suicidal ideation at baseline (N = 2417) were included in the study sample. Suicidal behaviors during the 12 months after baseline were assessed. Logistic regression analyses examined the association of baseline SCS-R scores with later suicidal behavior. ResultsIn both univariate and multivariate analyses, SCS-R total scores were associated with significantly increased risk of suicidal behavior within 90, 180, and 365 days post-baseline. Results were unchanged when patients who reported prior suicidal behavior were excluded (N = 2178). In item-level analyses, all 16 SCS-R items significantly differentiated patients with and without follow-up suicidal behavior. LimitationsStudy limitations included missing follow-up data, restriction of sample to U.S. military medical beneficiaries, and inability to assess representativeness of the sample relative to the full primary care population. ConclusionsSCS-R scores are elevated among patients who attempt suicide after denying both suicidal ideation and prior suicide attempts, suggesting the scale may reflect enduring suicide risk. The SCS-R could enhance suicide risk screening and assessment.

Gait Speed as a Biomarker of Cognitive Vulnerability: A Population-Based Study with Cognitively Normal Older Adults

We aimed to examine associations between cognitive vulnerability and gait speed (GS) in a large older sample. A cross-sectional study analyzed data from the “Health, Lifestyle and Fitness in Adults and Seniors in Amazonas” (SEVAAI) project. In total, 697 participants were included (mean age 70.35 ± 6.86 years). Usual and fast GS were evaluated, and cognitive performance was examined by the COGTEL test battery. There was a positive and large correlation between cognition (COGTEL score) and usual GS (r = 0.510; p &lt; 0.001) and fast GS (r = 0.503; p &lt; 0.001). The usual GS, as a continuous variable, indicated a chance of improved cognitive performance by up to 55%, and fast GS by up to 82%. After controlling for potential confounders (i.e., sex, age, MMSE and years of education), usual and fast GS indicated a chance of improving cognition, respectively, in 57% and 85%. Analysis of GS in quartiles (Q) showed high and significant associations between usual and fast GS and cognitive vulnerability. GS classified as Q1 (slower), Q2 and Q3 represented a greater chance of presenting cognitive deficits, respectively, than in participants with both GS classified as Q4 (highest). Cognitive vulnerability was associated with low GS. Usual and fast GS can be used as complementary measures for the evaluation of cognitively normal Brazilian older adults.