Delis-Kaplan Executive Function System Research Articles

Mind the gap: trajectory of cognitive development in young individuals with sickle cell disease: a cross-sectional study.

Compared to typically developing children and young adults (CYA-TD), those living with Sickle Cell Disease (CYA-SCD) experience more cognitive difficulties, particularly with executive function. Few studies have examined the relative importance of silent cerebral infarction (SCI), haemoglobin and arterial oxygen content on age-related cognitive changes using cross-sectional or longitudinal (developmental trajectory) data. This study presents cohort data from a single timepoint to inform studies with multiple timepoints. We compared cross-sectional raw and scaled scores as age-related changes in cognition (trajectories) in CYA-SCD and age-and ethnicity-matched CYA-TD. We also compared cross-sectional age-related changes in cognition (trajectories) in CYA-SCD with and without SCI to CYA-TD. General cognitive abilities were assessed using Wechsler Intelligence Scales, including the Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) underpinning IQ. Executive function was evaluated using the Delis-Kaplan Executive Function System (D-KEFS) Tower subtest and the Behaviour Rating Inventory of Executive Function (BRIEF) questionnaire. SCI were identified from contemporaneous 3 T MRI; participants with overt stroke were excluded. Recent haemoglobin was available and oxygen saturation (SpO2) was measured on the day of the MRI. Data were available for 120 CYA-SCD [62 male; age = 16.78 ± 4.79 years; 42 (35%) with SCI] and 53 CYA-TD (23 male; age = 17.36 ± 5.16). Compared with CYA-TD, CYA-SCD experienced a delayed onset in VCI and slower rate of development for BRIEF Global Executive Composite, Metacognition Index (MI), and Behaviour Regulation Index. The rate of executive function development for the BRIEF MI differed significantly between CYA-TD and CYA-SCD, with those with SCI showing a 26% delay compared with CYA-TD. For CYA-SCD with SCI, arterial oxygen content explained 22% of the variance in VCI and 37% in PRI, while haemoglobin explained 29% of the variance in PRI. Age-related cognitive trajectories of CYA-SCD may not be impaired but may progress more slowly. Longitudinal studies are required, using tests unaffected by practice. In addition to initiation of medical treatment, including measures to improve arterial oxygen content, early cognitive intervention, educational support, and delivery of extracurricular activities could support cognitive development for CYA-SCD.Graphical Abstract.

Verbal problem-solving in agenesis of the corpus callosum: Analysis using semantic similarity.

Previous studies demonstrated that individuals with agenesis of the corpus callosum (AgCC) experience difficulties in novel and complex problem-solving. The present study investigated verbal problem-solving, deductive reasoning, and semantic inference in AgCC. Capacity for semantic inference was tested in 25 individuals with AgCC and normal-range intelligence compared to 29 neurotypical controls. The Word Context Test (WCT) of Delis-Kaplan Executive Function System was used, employing a novel method of analysis (semantic similarity) to detect trial-by-trial progress toward a solution. With respect to the typical WCT scores, persons with AgCC had fewer total consecutive correct responses. In addition, semantic similarity to the correct word was significantly lower overall in persons with AgCC than in controls. These findings indicated that individuals with AgCC who have intelligence in the normal range are less able at the WCT taking all trials into account, although they often solve the problem eventually. This outcome is consistent with previous research indicating that callosal absence in AgCC results in a restricted imagination for possibilities, limiting their problem-solving and inferential capacities. The results also highlight the usefulness of semantic similarity as a means of scoring the WCT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the validity of the Delis-Kaplan Executive Function System (D-KEFS) in traumatic brain injury.

This study examines the validity of the Delis-Kaplan Executive Function System (D-KEFS) in a traumatic brain injury (TBI) population compared to participants with orthopaedic injuries and normative controls. The utility of the D-KEFS was examined using a between groups design. One hundred patients with mild uncomplicated to severe TBI were recruited from a consecutive cohort of patients admitted as inpatients to a UK Major Trauma Centre and compared to 823 participants from the D-KEFS normative sample and 26 participants with orthopaedic injuries. Data were filtered for performance validity. Sample discrimination was calculated from D-KEFS subtest scores and derived index scores. Sensitivity to TBI severity was established. The TBI participants performed significantly lower on the D-KEFS Trail Making Test, Colour Word Interference, Colour Word Switching, Letter Fluency and Verbal Fluency Category Switching Total Words Correct. The D-KEFS index scores discriminated between TBI, orthopaedic and normative participants with large and moderate effect sizes, respectively. The D-KEFS demonstrated a dose-response relationship with TBI severity. These effects were robust to differences in premorbid intellectual functioning; however, D-KEFS performance was sensitive to performance on tests of mental processing speed. The use of a D-KEFS index score provides a robust and reliable discrimination of TBI patients from healthy control participants. This discrimination is not accounted for by premorbid intellect or the non-specific effects of trauma. The clinical and conceptual implications of these findings are considered.

Basal forebrain functional connectivity as a mediator of associations between cardiorespiratory fitness and cognition in healthy older women.

Age-related cholinergic dysfunction within the basal forebrain (BF) is one of the key hallmarks for age-related cognitive decline. Given that higher cardiorespiratory fitness (CRF) induces neuroprotective effects that may differ by sex, we investigated the moderating effects of sex on the associations between CRF, BF cholinergic function, and cognitive function in older adults. 176 older adults (68.5years) were included from the Nathan Kline Institute Rockland Sample. Functional connectivity (rsFC) of the BF subregions including the medial septal nucleus/diagonal band of Broca (MS/DB) and nucleus basalis of Meynert (NBM) were computed from resting-sate functional MRI. Modified Astrand-Ryhming submaximal cycle ergometer protocol was used to estimate CRF. Trail making task and inhibition performance during the color word interference test from the Delis-Kaplan Executive Function System and Rey Auditory Verbal Learning Test were used to examine cognitive function. Linear regression models were used to assess the associations between CRF, BF rsFC, and cognitive performance after controlling for age, sex, and years of education. Subsequently, we measured the associations between the variables in men and women separately to investigate the sex differences. There was an association between higher CRF and greater rsFC between the NBM and right middle frontal gyrus in older men and women. There were significant associations between CRF, NBM rsFC, and trail making task number-letter switching performance only in women. In women, greater NBM rsFC mediated the association between higher CRF and better trail making task number-letter switching performance. These findings provide evidence that greater NBM rsFC, particularly in older women, may be an underlying neural mechanism for the relationship between higher CRF and better executive function.

Insulin resistance is associated with cognitive dysfunction in multiple sclerosis patients: A cross-sectional study.

Multiple sclerosis (MS) is a progressive inflammatory neurodegenerative disease of the nervous system accompanied by demyelination. MS-associated cognitive impairments mainly involve recent memory, information processing speed, stable memory, and executive function. Moreover, MS is associated with impaired glucose and insulin metabolism, which can exacerbate cognitive decline. The present study aimed to compare the cognitive status of MS patients with and without insulin resistance. In this cross-sectional study, 74 relapsing-remitting multiple sclerosis diagnosed patients were enrolled. Indicators of insulin resistance, including fasting blood glucose, insulin level, and homeostatic model assessment of insulin resistance (HOMA-IR) index, were measured. They were then divided into two groups based on the results of the HOMA-IR index. Cognition status was evaluated by the minimal assessment of cognitive function in multiple sclerosis battery. The prevalence of insulin resistance was 37.8%, and the prevalence of cognitive decline was estimated to be 67.56%. Mean scores of the California verbal learning test (CVLT), CVLT delayed free recall, controlled oral word association test, and judgment of line orientation tests were significantly lower in MS patients with insulin resistance than without. In addition, a negative correlation was demonstrated between the results of the CVLT, CVLT delayed free recall, controlled oral word association test, judgment of line orientation tests, brief visuospatial memory test, and Delis-Kaplan executive function system sorting tests and fasting insulin levels. Greater verbal memory and spatial comprehension impairments were observed in MS patients with insulin resistance.

0057 The Impact of Cortical Oxygenation During Sleep-Disordered Breathing on Cognition

Abstract Introduction Untreated sleep-disordered breathing (SDB) has been reported as a common risk for dementia. However, the association between current SDB parameters (i.e., AHI) and cognition is not straightforward. To examine the impact of cortical oxygenation during SDB on cognition in older adults, we measured the coherence of oxyHb and SpO2 during SDB, in which a higher level can represent less protection against systemic hypoxia, is associated with cognition in older adults. Methods Thirty-eight community-dwelling, healthy older adults without dementia (20 women) were recruited. The mean and standard deviation (SD) of age was 72.6±6.4years. All participants underwent comprehensive neuropsychiatric evaluation of short and long-term verbal memory(Wechsler Memory Scale & Rey Auditory Verbal Learning Test), Executive Functioning (Delis-Kaplan Executive Function System), verbal naming abilities (Boston Naming Test), and visuo-spatial ability (Judgment of Line Orientation). We performed a simultaneous PSG and NIRS recording overnight at the participants’ houses. We measured the mean max coherence of oxyHb and SpO2 and analyzed its correlation to cognition. Results The mean and SD of total sleep time, N1, N2, N3, and REM were 392.8±71.8 min, 65.5±60.3min, 210.7±68.5min, 53.1±30.9min, and 63.5±25.4 min. The mean and SD of AHI were 21±17.4 events/hour. The mean and SD of the max coherence ratio were 0.78±0.10. Linear regression analysis found higher coherence of oxyHb and SpO2 to be significantly correlated, after Bonferroni Correction, with a poorer score on the age-corrected BNT score (t = -3.174, p = .003), covaried for gender and education. Conclusion Higher coherence of oxyHb and SpO2 during SDB may predict poorer verbal naming abilities in older adult Support (if any) National Instutite on Aging

Cognitive deficits in HTLV-1 patients.

Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus known to be associated with adult T-cell lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Previous researches and brain imaging techniques have suggested cognitive abnormalities as well as brain damage in individuals infected with this virus. Given the insufficient amount of studies on how this virus can impact the affected person's cognition, we aimed to assess and compare the cognitive abnormalities of HAM/TSP patients, asymptomatic HTLV-1 carriers, and healthy controls. This cross-sectional study was conducted on 51 patients divided into 3 groups; a group of HAM/TSP patients, a group of asymptomatic HTLV-1 carriers, and an uninfected control group. Each group contained 17 members. The cognitive state of the studied population was assessed using the Mini-Mental State Exam (MMSE), Symbol Digit Modalities Test (SDMT), Rey-Osterrieth complex figure test (ROCF), the "Verbal Fluency Test" and the "Trail Making Test" (TMT) components of the Delis-Kaplan executive function system (D-KEFS) test, the Rey Auditory Verbal Learning Test (RAVLT), and digit span memory test. Patients diagnosed with HAM/TSP received significantly lower scores on the SDMT, ROCF, TMT, RAVLT, digit span memory test, and the orientation, calculation, and recall component of the MMSE assessment (p-value < 0.001). In addition, the asymptomatic HTLV-1 carriers obtained lower scores on the SDMT, ROCF, digit span memory test, and the orientation, calculation, and recall component of the MMSE assessment compared to the control group (p-value < 0.001). Overall, the findings suggest that HAM/TSP, or an asymptomatic infection with HTLV-1 could lead to cognitive deficits in the affected individuals. This can further emphasize the importance of assessing the cognitive function and psychiatric abnormalities of those infected with this virus.

Neuropsychological deficit profiles for service members with mild traumatic brain injury

ABSTRACT Background Neuropsychological deficits are generally assessed in terms of absolute level of functioning, e.g. high average, average, low average, although there is increased interest in calculating indices of relative degree of decline, e.g. mild, moderate, severe. Objective To examine differences in demographic, psychiatric, and military-specific characteristics for relative degree of decline in neuropsychological profiles attributed to traumatic brain injuries (TBIs) among service members (SMs). Methods Data were drawn from an existing clinical database of 269 SMs who received neuropsychological evaluations for TBI (Wechsler Test of Adult Reading, Wechsler Adult Intelligence Scale, California Verbal Learning Test, Delis-Kaplan Executive Function System) at a military treatment facility between 2013 and 2018. Independent sample t-tests and one-way ANOVA tests with pairwise comparisons were performed. Results Memory and problem-solving abilities were the most and least affected domains, respectively. Greater relative decline was observed among male and White SMs and those with post-traumatic stress disorder (PTSD). By contrast, there were no differences in relative decline according to military rank or work status. Conclusion Relative degree of decline after TBI among SMs is differentially impacted according to neuropsychological domain, with greater impairment among male and White SMs as well as those with PTSD.

Executive Functioning, Daily Self-Regulation, and Diabetes Management while Transitioning into Emerging Adulthood.

Executive functioning (EF) predicts better Type 1 diabetes (T1D) management in the high-risk years after high school, but the daily self-regulation processes involved are unclear. To examine whether EF is associated with daily self-regulation that minimizes one's exposure or buffers adverse reactions to daily diabetes problems, and to determine whether these patterns become stronger during the transition out of high school. A measurement burst design with convenience sampling was used. Seniors in high school with T1D (N = 207; 66% female) completed self-report (i.e., Behavioral Rating Inventory of Executive Functioning) and performance measures of EF (i.e., Delis-Kaplan Executive Function System). A 14-day daily diary assessing self-regulation failures, diabetes problems, affect, and indicators of diabetes management was completed at baseline and 1 year later. Correlations and multilevel modeling were conducted. Lower self-reported EF problems were associated with lower average levels of daily self-regulation failures, and these variables were associated with fewer daily diabetes problems. In contrast, better EF performance was unrelated to average daily self-regulation failures, and was unexpectedly associated with more frequent diabetes problems in year 2. Equally across years, on days participants reported lower than their average levels of daily self-regulation failures, they had fewer diabetes problems, regardless of EF. On days with lower than average diabetes problems, participants reported better diabetes management indicators. EF generally did not buffer daily associations in either year. Regardless of EF, promoting daily self-regulation may prevent diabetes problems and promote T1D management in daily life at this high-risk transitional time.

Fine Motor Skill Decline After Brain Radiation Therapy—A Multivariate Normal Tissue Complication Probability Study of a Prospective Trial

Brain radiation therapy can impair fine motor skills (FMS). Fine motor skills are essential for activities of daily living, enabling hand-eye coordination for manipulative movements. We developed normal tissue complication probability (NTCP) models for the decline in FMS after fractionated brain radiation therapy (RT). On a prospective trial, 44 patients with primary brain tumors received fractioned RT; underwent high-resolution volumetric magnetic resonance imaging, diffusion tensor imaging, and comprehensive FMS assessments (Delis-Kaplan Executive Function System Trail Making Test Motor Speed [DKEFS-MS]; and Grooved Pegboard dominant/nondominant hands) at baseline and 6 months postRT. Regions of interest subserving motor function (including cortex, superficial white matter, thalamus, basal ganglia, cerebellum, and white matter tracts) were autosegmented using validated methods and manually verified. Dosimetric and clinical variables were included in multivariate NTCP models using automated bootstrapped logistic regression, least absolute shrinkage and selection operator logistic regression, and random forests with nested cross-validation. Half of the patients showed a decline on grooved pegboard test of nondominant hands, 17 of 42 (40.4%) on grooved pegboard test of -dominant hands, and 11 of 44 (25%) on DKEFS-MS. Automated bootstrapped logistic regression selected a 1-term model including maximum dose to dominant postcentral white matter. The least absolute shrinkage and selection operator logistic regression selected this term and steroid use. The top 5 variables in the random forest were all dosimetric: maximum dose to dominant thalamus, mean dose to dominant caudate, mean and maximum dose to the dominant corticospinal tract, and maximum dose to dominant postcentral white matter. This technique performed best with an area under the curve of 0.69 (95% CI, 0.68-0.70) on nested cross-validation. We present the first NTCP models for FMS impairment after brain RT. Dose to several supratentorial motor-associated regions of interest correlated with a decline in dominant-hand fine motor dexterity in patients with primary brain tumors in multivariate models, outperforming clinical variables. These data can guide prospective fine motor-sparing strategies for brain RT.

Construct identification in the neuropsychological battery: What are we measuring?

Major obstacles to data harmonization in neuropsychology include lack of consensus about what constructs and tests are most important and invariant across healthy and clinical populations. This study addressed these challenges using data from the National Neuropsychology Network (NNN). Data were obtained from 5,000 NNN participants and Pearson standardization samples. Analyses included variables from four instruments: Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV); Wechsler Memory Scale, 4th Edition (WMS-IV); California Verbal Learning Test, 3rd Edition (CVLT3); and Delis-Kaplan Executive Function System (D-KEFS). We used confirmatory factor analysis to evaluate models suggested by prior work and examined fit statistics and measurement invariance across samples. We examined relations of factor scores to demographic and clinical characteristics. For each instrument, we identified four first-order and one second-order factor. Optimal models in patients generally paralleled the best-fitting models in the standardization samples, including task-specific factors. Analysis of the NNN data prompted specification of a Recognition-Familiarity factor on the WMS-IV and an Inhibition-Switching factor on the D-KEFS. Analyses showed strong to strict factorial invariance across samples with expected differences in factor means and variances. The Recognition-Familiarity factor correlated with age more strongly in NNN than in the standardization sample. Factor models derived from healthy groups generally fit well in patients. NNN data helped identify novel Recognition-Familiarity and Inhibition-Switching factors that were also invariant across samples and may be clinically useful. The findings support efforts to identify evidence-based and optimally efficient measurements of neuropsychological constructs that are valid across groups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Inhibition mediates the relationship between age cohort and virtual reality-based prospective memory

ABSTRACT Introduction Prospective memory has received relatively little attention from a clinical perspective, yet it is an important part of daily functioning. Executive functions have been linked with prospective memory abilities, and age differences are found in both executive functions and prospective memory. The purpose of this study was to investigate whether age cohort differences in prospective memory abilities are mediated by executive functions, specifically inhibition. Method Participants (N = 108) consisted of young adults (n= 53) and older adults (n= 55) without any neurocognitive impairment. Participants completed a clinical interview and a battery of neuropsychological tests that included the Mini-Mental Status Exam–2 Standard Version (MMSE-2-SV), the Wisconsin Card Sorting Test-64 (WCST-64), the Delis-Kaplan Executive Functioning System Color-Word Interference Test (D-KEFS CWIT), and the Virtual Kitchen Protocol (VKP). Results Young adults had higher prospective memory scores than older adults. Inhibition (i.e., D-KEFS CWIT) mediated the relationship between age cohort and prospective memory, while cognitive flexibility did not mediate the relationship. Conclusions Older adults may have diminished inhibition abilities that may negatively affect their ability to complete prospective memory tasks.

Investigating the Latent Structure of Executive Function in the Delis-Kaplan Executive Function System Using Cattell-Horn-Carroll Theory.

To replicate a seven-factor model previously reported for the Delis-Kaplan Executive Function System (D-KEFS). This study used the D-KEFS standardization sample including 1,750 non-clinical participants. Several seven-factor models previously reported for the D-KEFS were re-evaluated using confirmatory factor analysis (CFA). Previously published bi-factor models were also tested. These models were compared with a three-factor a priori model based on Cattell-Horn-Carroll (CHC) theory. Measurement invariance was examined across three age cohorts. All previously reported models failed to converge when tested with CFA. None of the bi-factor models converged after large numbers of iterations, suggesting that bi-factor models are ill-suited to represent the D-KEFS scores as reported in the test manual. Although poor fit was initially observed for the three-factor CHC model, inspection of modification indices showed potential for improvement by including method effects via correlated residuals for scores derived from similar tests. The final CHC model showed good to excellent fit and strong metric measurement invariance across the three age cohorts with minor exceptions for a subset of Fluency parameters. CHC theory extends to the D-KEFS, supporting findings from previous studies that executive functions can be integrated into CHC theory.

Age or age of onset: which is the best criterion to classify late-life depression?

In late-life depression (LLD), several differences between patients whose first episode is reported after age 65 (late-onset depression, LOD) and those with early-onset depression (EOD) might reflect the effects of brain ageing. To test this hypothesis, we analysed the impact of current age and age at illness onset on a number of clinical and cognitive manifestations in 438 outpatients with major depressive disorder aged >60 years, treated with venlafaxine for 12 weeks. When compared to the EOD group, patients with LOD were older ( P < 0.00001) and associated with lower depression severity ( P = 0.0029), lower global cognitive functioning [Mini-Mental State Examination (MMSE): P = 0.0001; Repeatable Battery for the Assessment of Neuropsychological Status: immediate memory, P = 0.0009, and delayed memory, P < 0.00001; Delis-Kaplan Executive Function System measuring executive functions: Trail-Making Test (TMT) - P = 0.0004 and Colour-Word Interference Test, Inhibition - P = 0.0063], and more dyskinesias (Abnormal Involuntary Movement Scale: P = 0.0006). After controlling for its interactions with age of onset, current age was inversely correlated with Montgomery Åsberg Depression Rating Scale scores at baseline ( P < 0.00001) and week 12 ( P = 0.0066), MMSE ( P < 0.00001), delayed memory ( P < 0.00001), and TMT ( P = 0.0021). Age of onset predicted impairment in immediate ( P = 0.023) and delayed memory ( P = 0.0181), and dyskinesias ( P = 0.0006). Although most features of LLD are related to ageing rather than to late-onset, LOD is a possible separate diagnostic entity characterised by memory dysfunction and increased liability to movement disorders.

Cross-Walk Comparison of the DVBIC-TBICoE and LIMBIC-CENC Combat-Related Concussion Prospective Longitudinal Study Datasets

ObjectiveTo describe and compare cohorts between 2 large, longitudinal, federally-funded TBI studies of Service members and veterans across demographic, self-report, and neuropsychological variables. DesignAnalysis of data from the DVBIC-TBICoE and LIMBIC-CENC prospective longitudinal studies (PLS). SettingRecruitment locations spanning Department of Defense and Veterans Affairs hospitals across the U.S. Participants1463 participants (N=1463) enrolled in the DVBIC-TBICoE study and divided among non-injured (NIC) (n=191), injured control (IC) (n=349), mild TBI (mTBI) (n=682), and (severe, moderate, penetrating, and complicated mild traumatic brain injury (smcTBI) (n=241) subgroups. 1550 participants enrolled in the LIMBIC-CENC study and divided between IC (n=285) and mTBI (n=1265) subgroups. IC and mTBI study groups were compared across demographic and military characteristics, self-reported symptoms, and neuropsychological test scores. InterventionsNone. Main Outcome MeasuresNeurobehavioral Symptom Inventory, PTSD Checklist-Military Version, TBI quality of life, Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-IV Visual Puzzles, Symbol Search, Coding, Letter-Number Sequencing, and Digit Span, Trail Making Test, Delis-Kaplan Executive Functioning System Verbal Fluency, Letter Fluency, and Category Fluency, California Verbal Learning Test-II, and Grooved Pegboard. ResultsCompared with DVBIC-TBICoE, LIMBIC-CENC participants have higher enrollment age, education level, proportion of Black race, and time from injury as well as less combat deployments and are less likely to be married. The distribution of military service branches also differed. Further, symptom profiles differed between cohorts. LIMBIC-CENC participants endorsed higher posttraumatic stress disorder symptomatology. DVBIC-TBICoE study IC participants endorsed higher somatosensory and vestibular symptoms (medium effect sizes). Other symptom measure differences had very small effect sizes (≤0.2). Differences were found on many cognitive test results, but are difficult to interpret given the demographic differences and generally very small effect sizes. ConclusionsThe heavy use of National Institutes of Health common data elements in both studies and collaboration with the DVBIC-TBICoE study team on development of the LIMBIC-CENC assessment battery enabled this comparative analysis. Results highlight unique differences in study cohorts and add perspective and interpretability for assimilating past and future findings.

Poorer Inhibitory Control Uniquely Contributes to Greater Functional Disability in Post-9/11 Veterans.

Post-9/11 Veterans endorse greater self-reported functional disability than 80% of the adult population. Previous studies of trauma-exposed populations have shown that increased post-traumatic stress disorder (PTSD) and depressive symptoms are consistently associated with greater disability. Additionally, poorer cognitive performance in the domain of executive functions, particularly inhibitory control, has been associated with disability, though it is unclear if this effect is independent of and/or interacts with PTSD and depression. Three overlapping samples of n= 582, 297, and 183 combat-deployed post-9/11 Veterans completed comprehensive assessments of executive functions, PTSD and depressive symptoms, and self-reported World Health Organization Disability Assessment Schedule-II (WHODAS II). Poorer performance on measures of inhibitory control (Delis-Kaplan Executive Functioning System Color-Word Interference-CWI Test and gradual-onset Continuous Performance Test-gradCPT), but not other executive functions, were significantly associated with greater disability on the WHODAS II (ρ's = -.13 and -.13, p= .002 and .026, respectively). CWI inhibitory control measures accounted for unique variance in disability after controlling for PTSD and depressive symptoms (R2 change = 0.02, p< .001). Further, CWI significantly moderated the effect of depressive symptoms on disability, such that better inhibitory control weakened the relationship between depression and disability. Inhibitory control deficits are uniquely associated with increased disability in combat-deployed post-9/11 Veterans, and better inhibitory control abilities may serve as a protective factor for depressive symptoms leading to increased disability.

Specificity of Embedded Performance Validity Tests in Elderly Veterans with Mild and Major Neurocognitive Disorder.

This study explored the specificity of four embedded performance validity tests (PVTs) derived from common neuropsychological tasks in a sample of older veterans with verified cognitive decline and whose performance was deemed valid by licensed psychologists. Participants were 180 veterans who underwent comprehensive neuropsychological evaluation, were determined to have valid performance following profile analysis/conceptualization, and were diagnosed with mild neurocognitive disorder (i.e., MCI; n = 64) or major neurocognitive disorder (i.e., Dementia; n =116). All participants completed at least one of four embedded PVTs: Reliable Digit Span (RDS), California Verbal Learning Test-2nd ed. Short Form (CVLT-II SF) Forced choice, Trails B:A, and Delis-Kaplan Executive Function System (DKEFS) Letter and Category Fluency. Adequate specificity (i.e., ≥90%) was achieved at modified cut-scores for all embedded PVTs across MCI and Dementia groups. Trails B:A demonstrated near perfect specificity at its traditional cut-score (Trails B:A < 1.5). RDS ≤ 5 and CVLT-II SF Forced Choice ≤7 led to <10% false positive classification errors across MCI and dementia groups. DKEFS Letter and Category Fluency achieved 90% specificity at extremely low normative cut-scores. RDS, Trails B:A, and CVLT-II SF Forced Choice reflect promising embedded PVTs in the context of dementia evaluations. DKEFS Letter and Category Fluency appear too sensitive to genuine neurocognitive decline and, therefore, are inappropriate PVTs in adults with MCI or dementia. Additional research into embedded PVT sensitivity (via known-groups or analogue designs) in MCI and dementia is needed.

Cochlear Implants or Hearing Aids: Speech Perception, Language, and Executive Function Outcomes.

We aimed to determine whether children with severe hearing loss (HL) who use hearing aids (HAs) may experience added value in the perception of speech, language development, and executive function (EF) compared to children who are hard of hearing (HH) or children who are deaf and who use cochlear implants (CIs) and would benefit from CIs over HAs. The results contribute to the ongoing debate concerning CI criteria. We addressed the following research question to achieve this aim: Do children who are HH or deaf with CIs perform better than children with severe HL with HAs with respect to auditory speech perception, and receptive vocabulary and/or EF? We compared two groups of children with severe HL, profound HL or deafness, with CIs or HAs, matched for gender, test age (range, 8 to 15 years), socioeconomic status, and nonverbal intelligence quotient. Forty-three children had CIs (pure-tone average at 2000 and 4000 Hz >85 dB HL), and 27 children had HAs (mean pure-tone average: 69 dB HL). We measured speech perception at the conversational level (65 dB SPL) and the soft speech perception level (45 dB SPL). We established receptive vocabulary using the Peabody Picture Vocabulary Test-III-NL. We tested EF using the Delis Kaplan Executive Function System battery and the Dutch Rey Auditory Verbal Learning Test. We employed the Mann-Whitney U test to compare data between the CI and HA groups. We used Chi-square goodness of fit tests to contrast the CI and HA group distributions with the norm data of children who are typically developing (TD). We harnessed Kendall's Tau-b to investigate relationships between the study variables. Both groups of children, with CIs and Has, obtained ceiling scores for perception of speech on a conversational level. However, the HA group exhibited significantly lower perception on a soft speech level scores (68 %) than the CI group (87%). No difference was present between the receptive vocabulary distributions of the CI and HA groups. The median receptive vocabulary standard scores for both groups were well within the normal range (CI group: 93; HA group: 96). In addition, we did not find any difference in EF between the CI and HA groups. For planning and verbal memory, the distributions of observed scores for children with CIs were different from the expected distributions of children who are TD. In both groups, a large proportion of children obtained below-average scores for planning (CI: 44%; HA: 33%) and for long-term verbal memory (CI: 44%; HA: 35%). In the HA group, perception at a soft speech level was associated with receptive vocabulary and planning. In the CI group, we did not find any associations. Both groups of children with severe and profound HL with HAs exhibit less favorable auditory perception on the soft speech level, but not at a conversational level, compared to children who are HH or deaf with CIs. Both groups, children with CIs and HAs, only exhibit more problems in planning and verbal memory than the norm groups of children who are TD. The results indicate that to obtain age-appropriate levels of receptive vocabulary and EF, the perception at the soft speech level is a necessary but not sufficient prerequisite.

Enhanced Cognitive Training in a Driving Simulator Improves Cognition in Older Adults

<h3>Research Objectives</h3> A few cognitive training studies have purported that maximal gains are achieved with intense, challenging, and multitask training. Yet, proof-of-concept is currently lacking. Our aim was to evaluate the effects of an enhanced cognitive training program to improve cognitive functions in older adults. <h3>Design</h3> Within-group pre- to post-training quasi-experimental design. <h3>Setting</h3> Academic institution. <h3>Participants</h3> Eighteen older adults (age 76±6); 18% women; MMSE scores 28±2) enrolled in the study. Fourteen (78%) completed pre-training and post-training assessments. <h3>Interventions</h3> Participants trained on the driving simulator for four weeks, three days per week for a total of 12 hours. Training involved following a lead car. The difficulty level of the training sessions was altered by changing the speed of the lead car, the following distance of the driver, visibility and weather conditions, and ambient traffic. <h3>Main Outcome Measures</h3> Participants completed a comprehensive battery of cognitive tests evaluating memory, visuospatial skills, word finding, and cognitive flexibility pre- and post-intervention. <h3>Results</h3> Pre- to post-training changes were examined using Wilcoxon Signed Rank test. Participants improved on the California Verbal Learning Test short delay free recall (2.31±1.75; p=0.001) and delayed recall (1.69±1.89; p=0.009); Rey-Osterrieth Complex Figure immediate recall (5.73±6.10; p=0.002) and delayed recall (2.54±4.61; p=0.05); Logical Memory immediate (3.61±4.89; p=0.02) and delayed (4.38±4.77; p=0.009) total scores; and Boston Naming Test total score (3.58±8.67; p=0.002). No changes were observed in performance on Delis-Kaplan Executive Function System and Wechsler Adult Intelligence Scale tests. <h3>Conclusions</h3> The enhanced cognitive training in a driving simulator improved several memory domains. This pilot study warrants an adequately powered randomized controlled trial to better determine the short- and long-term effects of enhanced cognitive training on cognition and daily-life activities in older adults. <h3>Author(s) Disclosures</h3> The authors report a financial conflict of interest. The training scenarios were played on the Portable Driving Simulator. H.D. and A.E.A. stand to profit from the sales of the Portable Driving Simulator. H.D. and A.E.A. were not involved in the training sessions or assessments.

Mental Health Symptoms Mediate the Association of Subjective Cognitive Function with Participation after Stroke

<h3>Research Objectives</h3> To investigate if mental health (MH) symptoms - depression, apathy, and anxiety - mediate the association of subjective (SCF) and objective (OCF) measures of cognitive function with participation after stroke. <h3>Design</h3> A prospective cross-sectional study. We performed a regression-based mediation analysis using Hayes's PROCESS macro. 12 Models were built for three MH mediators in the association of SCF and OCF measures with two participation measures, respectively. <h3>Setting</h3> Community. <h3>Participants</h3> 74 persons with stroke. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> We used Patient Health Questionnaire-9 for depression, Apathy Evaluation Scale, and State-Trait Anxiety Inventory-Trait Anxiety Scale as MH mediators. The dependent variables were participation measured using Reintegration to Normal Living (RNL) and Activity Card Sort (ACS). Independent variables were SCF, measured using Stroke Impact Scale Memory and Thinking, and OCF, measured using Delis-Kaplan Executive Function System Trail-Making Test (Number-letter switching). <h3>Results</h3> In the model of RNL, depression (b=0.093, 95% CI=0.038∼0.157), apathy (b=0.134, 95% CI=0.071∼0.202), and anxiety (b=0.116, 95% CI=0.049∼0.194), were full mediators of the association between the SCF measure and RNL total score. For the ACS, apathy was the only mediator between the SCF measure and ACS total activity retention (b=0.144, 95% CI=0.032∼0.293). In both models, none of the MH measures were significant mediators of the association between the OCF measure and RNL or ACS after stroke (p>0.05). <h3>Conclusions</h3> These findings indicate that depression, apathy, and anxiety may be stronger mediators of the association between SCF with participation than for OCF with participation after stroke. Rehabilitation professionals should pay attention to measures of both SCF and OCF as they have different dynamics with MH symptoms and participation after stroke. <h3>Author(s) Disclosures</h3> None.