Delis-Kaplan Executive Function System Tests Research Articles

Cognitive flexibility is associated with sickness resilience.

Psychological constructs related to health outcomes and well-being, such as metacognitive beliefs, have been linked to executive functions in general, and cognitive flexibility more specifically. However, such effects have previously only been discussed on a theoretical level and behavioral flexibility has most often been measured through self-report, only approximating information processing capacities. Objectively measured executive functions may be a more potent predictor of health outcomes. We set out to test whether cognitive flexibility capacity was associated with sick leave in a medium sized company. We included 111 subjects of widely different occupations and assessed their executive functions using Delis-Kaplan Executive Function System test battery (D-KEFS). To assess cognitive flexibility capacity, we included Design Fluency (DF) and Verbal Fluency (VF) and computed these into an index of cognitive flexibility (DFVF). Detailed information on sick leave for the last 5 years was gathered from the company. Our results showed that there was a significant negative correlation between DFVF and sick leave [rs(109) = -0.23, p = 0.015] in the full group as well as in the group that had at least 1 day of sick leave [rs(72) = -0.25, p = 0.03]. The results withstood adjustment for sex, age, occupation, and several core executive functions as well as autistic and ADHD-traits. The results remained for separate analyses using DF or VF. Our main findings were conceptually replicated in a group of bipolar disorder patients. This study shows that objectively measured capacity of cognitive flexibility is associated with key health outcomes such as sick leave.

Domain-Specific Stimulation of Executive Functioning in Low-Performing Students with a Roma Background: Cognitive Potential of Mathematics

The current study investigated whether a domain-specific intervention of ExeFun-Mat targeting math and executive functions in primary school children with a Roma background would be effective in improving their scholastic performance and executive functioning. ExeFun-Mat is based on the principles of the reciprocal teaching approach, scaffolding and self-questioning. The domain-specific content was divided into modules. Each module consisted of a set of graded tasks. The criteria for the grading and hierarchical organization of the tasks were based on the level of cognitive difficulty and the type of representation. In total, 122 students attending grade four of elementary school took part in the project. The study concerned a pretest-intervention-posttest experimental design with three conditions: the experimental condition, an active, and a passive control group. To assess the children’s level of EF, the Delis–Kaplan executive function system test battery was used; to assess children’s mathematical achievement, the cognitive abilities test (the numeracy battery), and ZAREKI—a neuropsychological test battery for numerical processing and calculation—were used. The results suggested that both math performance and executive functions improved over time, with no significant differences between the three conditions. An additional correlational analysis indicated that pretest performance was not related to posttest performance for the children in the experimental and active control group.

Cognitive impairment and psychopathology in out-of-hospital cardiac arrest survivors in Denmark: The REVIVAL cohort study protocol

IntroductionCognitive impairment and psychopathology caused by brain hypoxia and the traumatic impact of critical illness are common in cardiac arrest survivors and can lead to negative consequences of everyday life...

The Effect of Perceptual-Motor Training on Executive Functions in Children with Non-Verbal Learning Disorder.

PurposeResearch shows an atypical cognitive process in children with nonverbal learning disorder (NLD) compared to typically developing children, but a wealth of information indicates that physical activity can influence cognitive processes. However, little is known about the effects of perceptual-motor training and its impact on the cognitive process of children with NLD. Thus, the major goals of this study are to compare the executive functions (EFs) in children with NLD with typically developing children and then to investigate the effect of perceptual-motor training on EFs of children with NLD.MethodsTo achieve the first goal, 400 typically developing (IQ >80) and NLD children (7–13 years old) were randomly selected in the city of Mashhad, Iran, during the period 2017–2018. As for the second goal, 50 children with NLD were randomly assigned to an experimental or control group. To evaluate executive functions, Delis–Kaplan executive function system test was used at the pretest, posttest, and 3-month follow-up. The experimental group received the Werner and Reini’s perceptual-motor training program in sixteen 45-min sessions (three sessions per week), but the control group did not receive any intervention.ResultsThe results showed that children with NLD were significantly weaker than typically developing children in London Tower Test (t (38) = −4.662, p <0.01), Trail Making Test (t (33.926) = −3.11, p <0.01), Card Sorting Test (t (38) = −3.427, p <0.01), and Stroop Color Test (t (30.035) = −5.876, p <0.01). The Pilates training had an obvious effect on enhancing the performance of participants in the experimental group (p<0.001), but similar results were not observed in the control group.ConclusionChildren with NLD have problems in EFs, but perceptual-motor training can be used as an effective intervention for these children.

Multivariate base rates for the assessment of executive functioning among children and adolescents

ABSTRACTThis study provides observed base rates of low executive functioning test scores among healthy children and adolescents, stratifies those base rates by narrow intellectual functioning and age groupings, and provides normative classification ranges to aid the interpretation of performances on the Delis-Kaplan Executive Function System (D-KEFS) in clinical practice and research. Participants included 875 children and adolescents between 8 and 19 years old from the D-KEFS normative sample (48% male; 52% female). Among these participants, 838 had complete data and were included in the current study. The racial/ethnic composition of the sample was: White (73.7%), African American (12.4%), Hispanic (11.1%), and other racial/ethnic backgrounds (2.7%). The Overall Test Battery Mean (OTBM) and the prevalence of low scores at various clinical cut-offs were calculated for the 13 primary scores from the D-KEFS Trail Making Test, Verbal Fluency Test, and Color-Word Interference Test. The OTBM and base rates were also calculated separately for those scores reflecting executive functioning (n = 7) and processing speed (n = 6). Healthy children and adolescents commonly obtained low scores on the D-KEFS tests considered here. Younger age, lower estimated full-scale intelligence quotient, and more test scores interpreted were associated with a greater frequency of low scores. Clinicians and researchers are encouraged to consider these multivariate base rates when assessing and attempting to identify executive functioning impairment among children and adolescents with the D-KEFS.

Efficacy of fingolimod and interferon beta-1b on cognitive, MRI, and clinical outcomes in relapsing\u2013remitting multiple sclerosis: an 18-month, open-label, rater-blinded, randomised, multicentre study (the GOLDEN study)

Cognitive impairment (CI) affects 40–65% of multiple sclerosis (MS) patients. This study attempted evaluating the effects of fingolimod and interferon beta-1b (IFN β-1b) on CI progression, magnetic resonance imaging (MRI) and clinical outcomes in relapsing–remitting MS (RRMS) patients over 18 months. The GOLDEN study was a pilot study including RRMS patients with CI randomised (2:1) to fingolimod (0.5 mg daily)/IFN β-1b (250 µg every other day). CI was assessed via Rao’s Brief Repeatable Battery and Delis–Kaplan Executive Function System test. MRI parameters, Expanded Disability Status Scale scores and relapses were measured. Overall, 157 patients were randomised, of whom 30 discontinued the study (fingolimod, 8.49%; IFN β-1b, 41.18%; p ≤ 0.0001). Patients randomised to fingolimod had more severe clinical and MRI disease characteristics at baseline compared with IFN β-1b. At Month (M) 18, both treatment groups showed improvements in all cognitive parameters. At M18, relapse rate, total number and volume of T2/T1 gadolinium-enhancing lesions were higher with IFN β-1b, as well as the percentage brain volume change during the study. Safety and tolerability of both treatments were similar to previous studies. Both treatments showed improvements in cognitive parameters. Fingolimod demonstrated significantly better effects on MRI parameters and relapse rate. Imbalance in baseline characteristics and the drop-out pattern may have favoured IFN β-1b. A longer duration trial may be needed to observe the complete expression of differential effects on CI scales reflecting the between-groups differences on MRI. Although limited in size, the GOLDEN study confirms the favourable benefit–risk profile of fingolimod reported in previous studies.

Core executive functions are associated with success in young elite soccer players.

Physical capacity and coordination cannot alone predict success in team sports such as soccer. Instead, more focus has been directed towards the importance of cognitive abilities, and it has been suggested that executive functions (EF) are fundamentally important for success in soccer. However, executive functions are going through a steep development from adolescence to adulthood. Moreover, more complex EF involving manipulation of information (higher level EF) develop later than simple executive functions such as those linked to simple working memory capacity (Core EF). The link between EF and success in young soccer players is therefore not obvious. In the present study we investigated whether EF are associated with success in soccer in young elite soccer players. We performed tests measuring core EF (a demanding working memory task involving a variable n-back task; dWM) and higher level EF (Design Fluency test; DF). Color-Word Interference Test and Trail Making Test were performed on an exploratory level as they contain a linguistic element. The lower level EF test (dWM) was taken from CogStateSport computerized concussion testing and the higher level EF test (DF) was from Delis-Kaplan Executive Function System test battery (D-KEFS). In a group of young elite soccer players (n = 30; aged 12–19 years) we show that they perform better than the norm in both the dWM (+0.49 SD) and DF (+0.86 SD). Moreover, we could show that both dWM and DF correlate with the number of goals the players perform during the season. The effect was more prominent for dWM (r = 0.437) than for DF (r = 0.349), but strongest for a combined measurement (r = 0.550). The effect was still present when we controlled for intelligence, length and age in a partial correlation analysis. Thus, our study suggests that both core and higher level EF may predict success in soccer also in young players.

Non-Gaussian diffusion MRI of gray matter is associated with cognitive impairment in multiple sclerosis

Background: Non-Gaussian diffusion imaging by using diffusional kurtosis imaging (DKI) allows assessment of isotropic tissue as of gray matter (GM), an important limitation of diffusion tensor imaging (DTI). Objective: In this study, we describe DKI and DTI metrics of GM in multiple sclerosis (MS) patients and their association with cognitive deficits. Methods: Thirty-four patients with relapsing–remitting MS and 17 controls underwent MRI on a 3T scanner including a sequence for DKI with 30 diffusion directions and 3b values for each direction. Mean kurtosis (MK), mean diffusivity and fractional anisotropy (FA) of cortical and subcortical GM were measured using histogram analysis. Spearman rank correlations were used to characterize associations among imaging measures and clinical/neuropsychological scores. Results: In cortical GM, a significant decrease of MK (0.68 vs. 0.73; p < 0.001) and increase of FA (0.16 vs. 0.13; p < 0.001) was found in patients compared to controls. Decreased cortical MK was correlated with poor performance on the Delis-Kaplan Executive Function System test (r = 0.66, p = 0.01). Conclusion: Mean kurtosis is sensitive to abnormality in GM of MS patients and can provide information that is complementary to that of conventional DTI-derived metrics. The association between MK and cognitive deficits suggests that DKI might serve as a clinically relevant biomarker for cortical injury.

Executive Function in Nephropathic Cystinosis

We studied executive function (EF) in children and adolescents with cystinosis. Cystinosis is a genetic metabolic disorder in which the amino acid cystine accumulates in all organs of the body, including the brain. Previous research has shown that individuals with cystinosis have visuospatial deficits, but normal intelligence and intact verbal abilities. Better understanding of the behavioral phenotype associated with cystinosis could have important implications for treatment. Twenty-eight children with cystinosis and 24 control participants (age range 8 to 17 years) underwent selected Delis-Kaplan executive function system tests for neuropsychological assessment of EF, and the participants' parents completed the behavior rating inventory of executive function. Participants with cystinosis performed significantly more poorly than controls on all Delis-Kaplan Executive Function System indices examined and on the behavior rating inventory of executive function metacognition index and global executive composite. EF is an area of potential risk in cystinosis. Our data have implications not only for the function of affected children and adolescents in school and daily life, but also for disease management and treatment adherence. Our findings can aid in the design and implementation of interventions and lead to a greater understanding of brain-behavior relationships in cystinosis.

Prediction of functional status in older adults: The ecological validity of four Delis–Kaplan Executive Function System tests

This study tested the ecological validity of four Delis-Kaplan Executive Function System (D-KEFS) tests by examining how well performance on D-KEFS measures predicted observed daily functioning in community-dwelling older adults. Older adults ages 65 to 92 years completed four D-KEFS tests requiring planning and cognitive fluency. The four combined D-KEFS measures accounted for approximately 26% of the variance in observed functional ability, when controlling for education and depression, thus supporting the ecological validity of the D-KEFS (Pearson r = .66). However, in a multiple regression analysis, the D-KEFS Trail Making Test-4 was the only measure of executive functioning that accounted for unique, independent variance in observed functional ability.

Language Ability and Verbal and Nonverbal Executive Functioning in Deaf Students Communicating in Spoken English

The internal use of language during problem solving is considered to play a key role in executive functioning. This role provides a means for self-reflection and self-questioning during the formation of rules and plans and a capacity to control and monitor behavior during problem-solving activity. Given that increasingly sophisticated language is required for effective executive functioning as an individual matures, it is likely that students with poor language abilities will have difficulties performing complex problem-solving tasks. The aim of this study was to investigate the relationship between language ability and verbal and nonverbal executive functioning in a group of deaf students who communicate using spoken English, as measured by their performance on two standardized tests of executive function: the Delis-Kaplan Executive Function System (D-KEFS) 20 Questions Test and the D-KEFS Tower Test. Expressive language ability accounted for more than 40% of variability in performance on the D-KEFS 20 Questions Test. There was no significant relationship between language ability and performance on the D-KEFS Tower Test. There was no relationship between language ability and familiarity with the specific problem-solving strategies of both D-KEFS Tests. Implications of the findings are discussed.