Cogstate Test Battery Research Articles

Maternal executive functioning is associated with infant sustained attention, but not executive functioning, in a sex-specific manner

Parental executive functioning (EF) is considered one key contributing source, via direct and indirect routes, of inter-individual variation in offspring EF. The current study investigated the unexplored associations between maternal EF and infant EF as well as its precursor, sustained attention. Ninety-seven mother-infant-dyads from the FinnBrain Birth Cohort Study participated. Maternal EF was assessed using selected measures from the Cogstate test battery. At 8 months, infants completed Lab-TAB Blocks and modified A-not-B tasks. A modest but robust link between maternal EF and infant attention was revealed in girls. There was no association between mother and infant EF in either sex at 8 months. Notable directions for future research, and potential underlying mechanisms of sex differences are discussed.

The impact of a history of child abuse on cognitive performance: a cross-sectional study in older patients with a depressive, anxiety, or somatic symptom disorder

BackgroundChild abuse is a major global burden with an enduring negative impact on mental and physical health. A history of child abuse is consistently associated with worse cognitive performance among adults; data in older age groups are inconclusive. Since affective symptoms and cognitive functioning are interrelated among older persons, a synergistic effect can be assumed in patients with affective symptoms who also have suffered from child abuse. This study examines the association between a history of child abuse and cognitive performance in such patients.MethodsCross-sectional data were collected from the ‘Routine Outcome Monitoring for Geriatric Psychiatry & Science’ project, including 179 older adults (age 60–88 years) with either a unipolar depressive, any anxiety, or somatic symptom disorder referred to specialized geriatric mental health care. A history of physical, sexual, and psychological abuse, and emotional neglect was assessed with a structured interview. Cognitive functioning was measured with three paper and pencils tests (10-words verbal memory test, Stroop Colour-Word test, Digit Span) and four tests from the computerized Cogstate Test Battery (Detection Test, Identification Test, One Card Learning Test, One Back Test). The association between a history of child abuse and cognitive performance was examined by multiple linear regression analyses adjusted for covariates.ResultsPrincipal component analyses of nine cognitive parameters revealed four cognitive domains, i.e., visual-verbal memory, psychomotor speed, working memory and interference control. A history of child abuse was not associated with any of these cognitive domains. However, when looking at the specific types of child abuse separately, a history of physical abuse and emotional neglect were associated with poorer interference control. A history of physical abuse was additionally associated with better visual-verbal memory.ConclusionsThe association between a history of child abuse and cognitive performance differs between the different types of abuse. A history of physical abuse might particularly be a key determinant of cognitive performance in older adults with a depressive, anxiety, or somatic symptom disorder. Future studies on the impact of these disorders on the onset of dementia should take child abuse into account.Trial registrationROM-GPS is registered at the Dutch Trial Register (NL6704 at www.trialregister.nl).

Utility of Cogstate Test Battery to Evaluate Early Cognitive Changes in Adults Receiving Radiotherapy (RT) for Primary Central Nervous System (CNS) Malignancies

Utility of Cogstate Test Battery to Evaluate Early Cognitive Changes in Adults Receiving Radiotherapy (RT) for Primary Central Nervous System (CNS) Malignancies

Study design of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) project; a cohort study of older patients with affective disorders referred for specialised geriatric mental health care

BackgroundAffective disorders, encompassing depressive-, anxiety-, and somatic symptom disorders, are the most prevalent mental disorders in later life. Treatment protocols and guidelines largely rely on evidence from RCTs conducted in younger age samples and ignore comorbidity between these disorders. Moreover, studies in geriatric psychiatry are often limited to the “younger old” and rarely include the most frail. Therefore, the effectiveness of treatment in routine clinical care for older patients and impact of ageing characteristics is largely unknown.ObjectiveThe primary aim of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) – project is to examine the impact of ageing characteristics on the effectiveness of treatment for affective disorders in specialised geriatric mental health care.MethodsROM-GPS is a two-stage, multicentre project. In stage one, all patients aged ≥60 years referred to participating outpatient clinics for specialised geriatric mental health care will be routinely screened with a semi-structured psychiatric interview, the Mini International Neuropsychiatric Interview and self-report symptom severity scales assessing depression, generalized anxiety, hypochondria, and alcohol use. Patients with a unipolar depressive, anxiety or somatic symptom disorder will be asked informed consent to participate in a second (research) stage to be extensively phenotyped at baseline and closely monitored during their first year of treatment with remission at one-year follow-up as the primary outcome parameter. In addition to a large test battery of potential confounders, specific attention is paid to cognitive functioning (including computerized tests with the Cogstate test battery as well as paper and pencil tests) and physical functioning (including multimorbidity, polypharmacy, and different frailty indicators). The study is designed as an ongoing project, enabling minor adaptations once a year (change of instruments).DiscussionAlthough effectiveness studies using observational data can easily be biased, potential selection bias can be quantified and potentially corrected (e.g. by propensity scoring). Knowledge of age-related determinants of treatment effectiveness, may stimulate the development of new interventions. Moreover, studying late-life depressive, anxiety and somatic symptom disorders jointly enables data-driven studies for more optimal classification of these disorders in later life.Trial registrationDutch Trial Register: NL6704 (www.trialregister.nl). Retrospectively registered on 2017-12-05.

Sensitivity of the Cogstate Test Battery for Detecting Prolonged Cognitive Alterations Stemming From Sport-Related Concussions.

To determine if the Cogstate test battery contains the requisite sensitivity to detect prolonged cognitive alterations. One hundred twenty collegiate athletes (71 with a history of concussion; 49 controls) completed the Cogstate test battery, to which we added a 2-back condition. In addition to the Cogstate clinical (transformed variables), we analyzed the raw data. The clinical variables failed to reveal any group differences. Further, although the raw data failed to reveal group differences for tasks measuring lower-level cognition, group differences were observed for accuracy on the 1- and 2-back tasks, which require multiple aspects of higher cognition. The overall classification accuracy was higher using the raw data than the clinical variables. The combined sensitivity of the 1- and 2-back task was moderate and specificity was high. These results suggest that using the raw scores over clinical variables increases the sensitivity of the test battery. Moreover, these results add another piece of evidence suggesting that concussive injuries are associated with subtle long-term alterations in aspects of higher cognition. Importantly, these deficits would have gone unobserved if we had relied solely on automated clinical variables. The current results further our scientific understanding of concussion and may be used to advance clinical practices.

Similar neurocognitive outcomes after 48 weeks in HIV-1-infected participants randomized to continue tenofovir/emtricitabine + atazanavir/ritonavir or simplify to abacavir/lamivudine + atazanavir

Human immunodeficiency virus (HIV)-associated neurocognitive disorders can persist in many patients despite achieving viral suppression while on antiretroviral therapy (ART). Neurocognitive function over 48 weeks was evaluated using a Cogstate test battery assessing psychomotor function, attention, learning, and working memory in 293 HIV-1-infected, ART-experienced, and virologically suppressed adults. The ASSURE study randomized participants 1:2 to remain on tenofovir/emtricitabine (TDF/FTC) and ritonavir-boosted atazanavir (ATV/r) or simplify to abacavir/lamivudine + atazanavir (ABC/3TC + ATV). Neurocognitive z-scores were computed using demographically adjusted normative data and were classified as “impaired” (defined as either a z-score ≤ − 2 or having 2 or more standardized individual test z-scores ≤ − 1); while higher scores (equaling better performance) were classified as “normal”. By z-scores, 54.7% of participants had impaired neurocognition at baseline and 50.2% at week 48. There were no significant differences (p < 0.05) in the baseline-adjusted performance between treatment groups for any individual test or by z-score. Specific demographic and medical risk factors were evaluated by univariate analysis for impact on neurocognitive performance. Factors with p < 0.10 were evaluated by backwards regression analysis to identify neurocognition-correlated factors after accounting for treatment, assessment, and baseline. Four risk factors at baseline for impaired neurocognition were initially identified: lower CD4 nadir lymphocyte counts, higher Framingham risk scores, and interleukin-6 levels, and a history of psychiatric disorder not otherwise specified, however none were found to moderate the effect of treatment on neurocognition. In this aviremic, treatment-experienced population, baseline-adjusted neurocognitive function remained stable and equivalent over 48 weeks with both TDF/FTC + ATV/r-treated and in the ART-simplified ABC/3TC + ATV treatment groups.

Time-Dependent Effects of Acute Exercise on University Students’ Cognitive Performance in Temperate and Cold Environments

Background: Few studies have examined the acute exercise-induced changes in cognitive performance in different thermal environments and the time course effects.Objective: Investigate the time-dependent effects of acute exercise on university students’ processing speed, working memory and cognitive flexibility in temperate and cold environments.Method: Twenty male university students (age 23.5 ± 2.0 years) with moderate physical activity level participated in a repeated-measures within-subjects design. Processing speed, working memory and cognitive flexibility were assessed using CogState test battery at baseline (BASE), followed by a 45-min rest (REST), immediately after (EX) and 30 min after (POST-EX) 30-min moderate-intensity treadmill running in both temperate (TEMP; 25°C) and cold (COLD; 10°C) environments. Mean skin temperature (MST) and thermal sensation (TS) were also recorded. Two-way repeated measures ANOVA was performed to analyze each variable. Spearman’s rho was used to identify the correlations between MST, TS and cognitive performance.Results: Reaction time (RT) of processing speed and working memory decreased immediately after exercise in both conditions (processing speed: p = 0.003; working memory: p = 0.007). The facilitating effects on processing speed disappeared within 30 min after exercise in TEMP (p = 0.163) and COLD (p = 0.667), while improvements on working memory remained 30 min after exercise in TEMP (p = 0.047), but not in COLD (p = 0.663). Though RT of cognitive flexibility reduced in both conditions (p = 0.003), no significance was found between EX and REST (p = 0.135). Increased MST and TS were significantly associated with reductions in processing speed RT (MST: r = -0.341, p < 0.001; TS: r = -0.262, p = 0.001) and working memory RT (MST: r = -0.282, p < 0.001; TS: r = -0.2229, p = 0.005), and improvements in working memory accuracy (MST: r = 0.249, p = 0.002; TS: r = 0.255, p = 0.001).Conclusion: The results demonstrate different time-dependent effects of acute exercise on cognition in TEMP and COLD. Our study reveals facilitating effects of exercise on university students’ processing speed and working memory in both environments. However, in contrast to TEMP, effects on working memory in COLD are transient.

Effects of two-week high-intensity interval training on cognition in adolescents – a randomized controlled pilot study

PurposeWe investigated the effects of a two-week high-intensity interval training (HIT) on cognition in adolescents.MethodsThe participants were recruited from local high schools with an electronic messaging system. The HIT group parti­cipated in 4 high-intensity interval running sessions and 2 circuit training sessions. The control group (CG) continued their usual habits. Reaction time, choose reaction time, working memory, visual memory, and learning were assessed by computerized CogState test battery. The intervention effect was investigated with repeated measures ANOVA and the effect size by Morris &lt;sub&gt;dppc2&lt;/sub&gt;.ResultsThe total of 25 participants aged 17–20 years participated in the baseline measurements and were randomized into the intervention (&lt;i&gt;n&lt;/i&gt; = 12) and control (&lt;i&gt;n&lt;/i&gt; = 13) groups; 9 people in the HIT group and 10 in the CG also participated in the follow-up assessments. Reaction time (mean change [SD] = 0.02 [0.03] vs. –0.05 [0.08], p for time*group interaction = 0.025, &lt;sub&gt;dppc2&lt;/sub&gt; = –0.297) and choice reaction time (0.03 [0.03] vs. –0.01 [0.04], p for time*group interaction = 0.017, &lt;sub&gt;dppc2&lt;/sub&gt; = –0.874) improved more in the CG than in the HIT group. While we found no other statistically significant time*group interactions, intervention turned out to have a small negative effect on working memory (&lt;sub&gt;dppc2&lt;/sub&gt; = –0.470) and a small positive effect on visual memory and learning (&lt;sub&gt;dppc2&lt;/sub&gt; = 0.419).ConclusionsThe study on HIT produced mixed effects on cognition in adolescents. Studies with a longer intervention period and larger sample sizes are warranted to further explore HIT effects on cognition.

The Role Of Sex As A Moderator Of Cognitive Outcome Following A Sport-related Concussion

Despite increasing research, results regarding sex as a moderator of outcome following a concussion are conflicting and management guidelines remain uncertain. PURPOSE: To determine if there is a gender difference in the long-term cognitive outcomes of athletes with a history of concussion (HOC). METHODS: 196 collegiate athletes (49 HOC women, HOC 49 men, 49 women matched controls, 49 men matched controls) completed a modified Cogstate test battery, to which a 2-back condition (N-back task) was added to increase our ability to detect persistent deficits in higher cognition. All participants were symptom-free at time of testing and those with a HOC were 6+ months from injury (24.0 ± 15.8 months, 1.44 ± 1.3 prior concussions). RESULTS: A significant interaction of error type × HOC × sex was observed. Specifically, HOC men exhibited a greater number of omission errors relative to HOC women (2.94 ± 2.5 vs. 0.31 ± 0.9, p<0.05). Moreover, irrespective of sex, HOC athletes exhibited a greater number of errors on the 1-back (2.30 ± 1.5 vs. 0.79 ± 0.9, p<0.01) and 2-back conditions (3.34 ± 2.6 vs. 1.46 ± 1.4, p<0.01), relative to controls. HOC athletes also exhibited decreased accuracy on the 1-back (95.45 ± 3.0% vs. 98.21± 2.2%, p<0.01) and 2-back conditions (93.98 ± 4.1% vs. 96.65 ± 3.3%, p<0.05). CONCLUSIONS: The current results suggest that beyond the acute phase of the injury, sex does not seem as a moderating variable of cognitive outcomes following concussion. Furthermore, the results reaffirm that concussive injuries can result in persistent deficits in aspects of higher cognition.

Neurocognitive effects of acute choline supplementation in low, medium and high performer healthy volunteers

Novel pharmacological treatments targeting alpha 7 nicotinic acetylcholine receptor (α7 nAChR) hypofunction in schizophrenia have shown mixed success in ameliorating cognitive impairments associated with this disorder. Choline, a selective agonist at α7 receptors is increased with oral administration of cytidine 5′-diphosphocholine (CDP-choline), the cognitive effects of which were assessed in healthy volunteers. Using the CogState test battery, behavioral performance in schizophrenia-relevant cognitive domains was assessed in 24 male participants following a single low (500mg) and moderate (1000mg) dose of CDP-choline. Relative to placebo, CDP-choline improved processing speed, working memory, verbal learning, verbal memory, and executive function in low baseline performers, while exerting no effects in medium baseline performers, and diminishing cognition in high baseline performers. Dose effects varied with cognitive domain but were evident with both the 500mg and 1000mg doses. These preliminary findings of cognitive enhancement in relatively impaired performers are consistent with the α7 receptor mechanism and support further trials with CDP-choline as a potential pro-cognitive strategy for cognitive impairment in schizophrenia.

Driving while drinking: performance impairments resulting from social drinking

Previous research has shown that the effects of alcohol on drivers’ performance can differ depending on whether blood alcohol concentrations are increasing or decreasing. The present research used a more ecologically representative alcohol consumption protocol in order to determine whether the same pattern of driver impairment would occur when drinking occurred in social groups over a longer period of time. Forty-four participants were assigned to one of two alcohol dose conditions or a placebo control group and consumed alcohol in groups of three (typically one participant from each condition) such that they gradually reached their target BAC (.05 or .08) and maintained it for 1h. The participants completed a series of cognitive tests (Cogstate test battery) and a simulated driving task (driver attention inhibition and reaction test) over the course of their intoxication curve (approximately 4h). The results showed strong placebo effects on ratings of subjective intoxication. Driving and cognitive performance both showed dose-dependent alcohol impairment, and some measures displayed acute protracted error. The findings provide strong evidence of expectancy effects in contributing to self-perceptions of intoxication.

High compliance to computerized tests for assessment of postoperative cognitive dysfunction

Background and Goal of Study: After cardiac surgery many patients experience postoperative cognitive dysfunction (POCD), usually comprising impaired concentration, attention, working memory and executive function. These sometimes subtle defects are usually assessed by neuropsychological examination, but this is time-consuming and associated with relatively high rates of non-compliance or completion caused by fatigue or impaired attention intrinsic to the disorder. We are studying POCD in patients undergoing cardiac surgery using a newer set of computerized tests (Cogstate, Australia) that may be more sensitive to detect cognitive decline than paper-and-pencil tests1. We present here an interim analysis of compliance with this test battery. Materials and Methods: In this ethical committee approved study, cognitive function before and after coronary artery revascularization was assessed in consenting patients using the CogState battery of tests. Assessments take the form of card games, which makes them culture-neutral and independent of educational level. The following 4 tasks were used: 1) detection task, 2) identification task, 3) one card learning task, and 4) one back task, assessing reaction time, psychomotor function, working memory, and attention respectively. POCD was defined as a composite score decrease of more than 2 Z-scores, or by a standardized change score decrease of ≥2 Z-scores in ≥2 tasks. Results and Discussion: We have included 32 patients so far. The incidence of POCD after 5.3 ± 2.1 days was 45%. All patients were able to perform detection and identification tasks after surgery. One did not complete the one card learning task and one back task. This patient fulfilled the criteria for POCDbased on the first 2 tasks. We estimate that the tests took on average 15 minutesin total to complete. In our experience so far, test compliance is 97-100%,similar to that reported by Padmanabhan (97-99%)2. Paper-and-pencil testshave a lower compliance record - Rasmussen reported a mean rate of 83.9% in a review of 13 studies3. Conclusion(s): We conclude that in addition to being a highly sensitive tool toestablish POCD, the CogState test battery is quick to perform, and associatedwith high compliance rates.

Early Cognitive Impairment After Sedation for Colonoscopy: The Effect of Adding Midazolam and/or Fentanyl to Propofol

The sedative drug combination that produces minimal cognitive impairment and optimal operating conditions during colonoscopy has not been determined. We sought to determine if the use of propofol alone results in less cognitive impairment at discharge than the use of propofol plus midazolam and/or fentanyl in patients presenting for elective outpatient colonoscopy. Two hundred adult patients presenting for elective outpatient colonoscopy were randomized to receive propofol alone or propofol plus midazolam, and/or fentanyl for IV sedation. Baseline cognitive function was measured using the computerized CogState test battery (Cogstate, Melbourne, Australia) before sedation. During the procedure, sedative drug doses, depth of sedation (via the bispectral index and observer's assessment of alertness/sedation score), complications, and treatability were recorded. Patients were interviewed about recall immediately after emerging from sedation, and cognitive testing was repeated at hospital discharge. Recovery times, quality of recovery, and satisfaction with care were also recorded. In the propofol plus adjuvants group, 84 patients received fentanyl 50 microg (25-100) (median [range]) and 57 patients received midazolam 2 mg (0.5-10). Patients' cognitive function at discharge was worse than their performance at baseline. However, the changes in cognitive function between discharge and baseline were not significantly different between the two groups. At discharge, 18.5% of patients were cognitively impaired to an extent equivalent to a blood-alcohol concentration of 0.05%. Sedation with propofol plus midazolam and/or fentanyl produced better operating conditions than sedation with propofol alone and was associated with shorter procedure times. Recovery times, recall, dreaming, quality of recovery, and patient satisfaction with care were similar between the groups. Administration of >2 mg of midazolam was a predictor of impaired cognitive function at discharge. Significant cognitive impairment was common at discharge from elective outpatient colonoscopy. However, the addition of midazolam and/or fentanyl to propofol sedation did not result in more cognitive impairment than the use of propofol alone. Furthermore, the use of adjuvants improved the ease of colonoscopy without increasing the rate of complications or prolonging early recovery times..

Fatigue‐related impairment in the speed, accuracy and variability of psychomotor performance: comparison with blood alcohol levels

Cognitive performance is impaired by fatigue arising from sustained wakefulness and alcohol. Three recent papers directly compared the effects of increasing fatigue and blood alcohol concentration (%BAC) to provide a framework for understanding fatigue-related cognitive impairment. While the expression of fatigue-related cognitive impairments in terms of %BAC equivalents is sound, the methodology in each study was flawed in that the statistics used to compare the effects of %BAC and fatigue on cognition did not account for variation between or within each condition. The point estimates of the difference between a baseline and any level of fatigue or %BAC provided no indication of the size of difference that could reasonably be expected by chance. Importantly, all studies showed that variation increased as cognitive performance declined because of both increasing fatigue and %BAC. The current study compared the effect of increasing levels of %BAC and fatigue on the simple reaction task from the CogState test battery on 40 healthy adults using statistical methods that account for intra-individual and within-group variability in performance. After 24 h of sustained wakefulness and with 0.08%BAC, individuals showed maximal cognitive impairment; however, the magnitude of impairment found for fatigue was equivalent only to that observed for 0.05%BAC. Re-analysis of the data using percentage change scores indicated that the magnitude of fatigue-related cognitive impairment was much greater than that detected for 0.08%BAC. This suggests that previous studies that have not accounted for variability in the performance data have overestimated the effect of fatigue on cognitive performance.

Subtle Memory Decline over 12 Months in Mild Cognitive Impairment

Objective: Screening of normal older persons for progressive memory decline is a worthwhile strategy in the pursuit of the earliest possible stages of pre-clinical Alzheimer’s disease (AD) or mild cognitive impairment (MCI). Reliable tests are needed to both detect MCI and measure the natural history of decline over months rather than years. We aimed to detect memory decline over 1 year in a group of older individuals with well-characterised amnestic MCI. Methods: The continuous learning task (CLT) from the CogState test battery was administered 8 times in 12 months to 15 individuals with MCI and 35 controls matched for age, education, IQ and gender. All subjects were recruited from an ongoing aging study. The rate of change in CLT performance over the year was compared between groups and also compared to that detected with a word list learning task and a computerised paired associate learning task. Results: At baseline, memory performance in the amnestic MCI group was significantly worse than controls on all memory tests. However, at 12 months the magnitude of the difference between the groups had increased significantly on the CLT due to decline in memory accuracy in the MCI group. No decline over 12 months was detectable on the routine memory tests. Conclusions: Subtle memory decline is detectable in amnestic MCI using reliable and sensitive tests of memory. Such measures may assist in the early identification of AD and also in trials of putative disease-modifying therapies to be conducted over as little as 12 months.