Delis-Kaplan Executive Function System Research Articles

Relationship between parental history of dementia, motor-cognitive and executive function performance in African American women

People with parental history (PH) of Alzheimer's Disease (AD) and Alzheimer's Disease and related dementias (ADRD) are themselves at risk of developing dementia. ADRD are more prevalent in African Americans and women. A decline in executive function and motor-cognitive integration can cause an impaired performance of functional skills. The monitoring of cognitive and psychosocial function in individuals with a PH of ADRD is important for implementing interventions to delay or prevent ADRD diagnosis. This study compared 58 African American women (M age = 63.2 ± 7.2 years) with PH of ADRD (n = 34) versus without PH (NPH; n = 24) on the performance of motor-cognitive and executive function tasks, and mental and physical quality of life (QOL) using point biserial correlations and linear regression. Linear regression revealed no difference between participants with and without PH on motor-cognitive tests. However, compared to participants with NPH, participants with PH of ADRD performed significantly worse on the DKEFS (Delis Kaplan Executive Function System) Tower Test (PH: M = 9.9 ± 2.0; NPH: M = 11.5 ± 4.3; p = 0.046), had poorer mental QOL (PH: M = 46.8 ± 10.7; NPH: M = 52.8 ± 7.8 l; p = 0.007); and physical QOL (PH: M = 40.9 ± 9.3; NPH: M = 44.7 ± 8.6; p = 0.023). African American women at risk for ADRD may exhibit deficiencies in executive function and physical and mental quality of life before memory deficits meet the criterion for ADRD diagnosis. Motor-Cognitive tasks may be preserved. Executive function and mental and physical health-related QOL may be important targets for identifying individuals at increased risk for ADRD and developing appropriate rehabilitative interventions.

0690 Greater variability of sleep disturbance is associated with executive functioning among people with schizophrenia

Abstract Introduction Sleep disturbance is common among people with schizophrenia (PwS) and has been found to be related to poorer cognition in both PwS and non-psychiatric comparison participants (NCs). However, previous findings have been inconsistent on which aspects of executive functioning are most impacted by sleep. Additionally, the relationship of sleep variability to cognition in PwS has yet to be explored. This study aims to further understand the link between cognitive dysfunction and disturbed sleep in PwS and inform future sleep interventions to improve functioning and disability in PwS. Methods The current sample includes 36 participants (18 PwS, 18 NCs) from the San Diego area who completed executive functioning assessments (Delis-Kaplan Executive Function System, D-KEFS). Participants wore a wrist-worn Fitbit activity tracker for a 7-day period to monitor their sleep and activity. Independent samples t-tests were used to examine differences in mean and variability of sleep measures (total sleep time or TST, wake after sleep onset or WASO, and efficiency) and cognitive function between patients and controls. Spearman correlations were run to identify preliminary relationships between cognitive performance and sleep in both groups. Results The PwS and NCs were comparable on sex (50% female, age (mean 53 ± 10 years) and race (majority Caucasian). PwS and NCs were similar in mean sleep and variability of sleep measures. PwS had significantly poorer performance in all cognitive domains (p < 0.05). In the PwS, more variable WASO and sleep efficiency were significantly correlated with worse performance on visual-motor sequencing and motor speed tasks (rs = -0.56 to -0.66). Additionally, trending relationships were found between better executive function composite scores with both longer mean TST (rs = 0.43) and higher mean sleep efficiency (rs = 0.30) over the monitoring period. Data collection is ongoing, and updated results will be presented at the conference. Conclusion Poor sleep is a prominent problem in PwS and has been associated with deficits in various cognitive domains. The present study examines the relationships of mean and variability of sleep with executive functioning. Preliminary results found strong associations between worse and more variable sleep and cognitive performance that may strengthen as sample size increases. Support (If Any) National Institutes of Health [NIMH K23MH119375-01 (PI: Ellen E. Lee), NIMH R01MH094151-01 (PI: Dilip Jeste)]

Coupling cognitive and brainstem dysfunction in multiple sclerosis-related chronic neuropathic limb pain.

Chronic pain in multiple sclerosis is common and difficult to treat. Its mechanisms remain incompletely understood. Dysfunction of the descending pain modulatory system is known to contribute to human chronic pain conditions. However, it is not clear how alterations in executive function influence this network, despite healthy volunteer studies linking function of the descending pain modulatory system, to cognition. In adults with multiple sclerosis-associated chronic neuropathic limb pain, compared to those without pain, we hypothesized altered functional connectivity of the descending pain modulatory system, coupled to executive dysfunction. Specifically we hypothesized reduced mental flexibility, because of potential importance in stimulus reappraisal. To investigate these hypotheses, we conducted a case-control cross-sectional study of 47 adults with relapsing remitting multiple sclerosis (31 with chronic neuropathic limb pain, 16 without pain), employing clinical, neuropsychological, structural, and functional MRI measures. We measured brain lesions and atrophy affecting descending pain modulatory system structures. Both cognitive and affective dysfunctions were confirmed in the chronic neuropathic limb pain group, including reduced mental flexibility (Delis Kaplan Executive Function System card sorting tests P < 0.001). Functional connectivity of rostral anterior cingulate and ventrolateral periaqueductal gray, key structures of the descending pain modulatory system, was significantly lower in the group experiencing chronic neuropathic pain. There was no significant between-group difference in whole-brain grey matter or lesion volumes, nor lesion volume affecting white matter tracts between rostral anterior cingulate and periaqueductal gray. Brainstem-specific lesion volume was higher in the chronic neuropathic limb pain group (P = 0.0017). Differential functional connectivity remained after correction for brainstem-specific lesion volume. Gabapentinoid medications were more frequently used in the chronic pain group. We describe executive dysfunction in people with multiple sclerosis affected by chronic neuropathic pain, along with functional and structural MRI evidence compatible with dysfunction of the descending pain modulatory system. These findings extend understanding of close inter-relationships between cognition, function of the descending pain modulatory system, and chronic pain, both in multiple sclerosis and more generally in human chronic pain conditions. These findings could support application of pharmacological and cognitive interventions in chronic neuropathic pain associated with multiple sclerosis.

Reliability and validity of composite scores from the timed subtests of the D-KEFS battery.

Many neuropsychological tests of executive functioning (EF) have test-retest reliabilities below what is considered acceptable. Combining several tests into a composite can improve reliability, although due to concerns about the multifaceted nature of the EF construct, this practice is rarely applied. The present study (a) examined internal consistencies and test-retest reliabilities of two composites of four EF tests (EF-Speed from timed scores and EF-Accuracy from error scores), and (b) preliminarily examined the criterion validity of the composites as a first step toward construct validation. Participants were 576 adults aged 18-93. Participants completed timed subtests of the Delis-Kaplan Executive Function System (D-KEFS) at baseline. A subset of participants was retested twice (at 30 min and 1 year), or once (at 6 weeks). An additional subsample completed Timed Instrumental Activities of Daily Living (TIADLs), which was used to preliminarily examine the composites' criterion validity. Internal consistency and test-retest reliabilities ranged from good to excellent for the EF-Speed composite (.809-.901) but were poor to acceptable for the EF-Accuracy composite (.510-.736). Both composites surpassed reliabilities of individual test or condition scores; one third of the examined individual speed-based scores and none of the individual error-based scores met the acceptable reliability threshold (i.e., < .7). The EF-Speed composite accounted for more variance in TIADL speed, and the EF-Accuracy in TIADL accuracy, than did any of the individual test scores, providing preliminary evidence of clinical utility and criterion validity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Intra-individual variability identifies individuals vulnerable to contextually induced executive lapses

Objective: Contextual stressors, such as engagement in burdensome emotion regulation known as expressive suppression (ES), can result in transient but clinically meaningful decrement in performance on measures of executive functioning (EF). The goal of the present investigation was to examine whether intra-individual variability (IIV-I), which has been identified as an indicator of cognitive weakness, could serve as a marker of vulnerability to EF decrements due to both naturally-occurring and experimentally-manipulated ES. Methods: In Study 1, 180 cognitively healthy older adults completed the Push-Turn-Taptap (PTT) task to assess IIV-I, four Delis-Kaplan Executive Function System (D-KEFS) subtests to assess EF, and the Burden of State Emotion Regulation Questionnaire (B-SERQ) to assess naturally-occurring ES. In Study 2, a subset (n = 81) of participants underwent experimental manipulation to induce ES, followed by second administration of the D-KEFS to examine ES-induced decrements in EF. Results: In Study 1, hierarchical linear regression yielded a significant interaction between ES and IIV-I as predictors of EF performance, demonstrating that high ES was associated with low EF only among individuals with high IIV-I. In Study 2, repeated measures ANOVA demonstrated an interaction between time (pre- vs. post- manipulation), group (ES vs. control), and IIV-I (high vs. low), such that only individuals who exhibited high IIV-I were negatively impacted by the ES manipulation. Conclusions: IIV-I moderates the association between ES and EF, such that only individuals with high IIV-I exhibit vulnerability to the impact of ES. Thus, IIV-I may act as a marker of vulnerability to temporary EF depletion.

Machine Learning to Predict Executive Function in Adolescents with Repaired d-Transposition of the Great Arteries, Tetralogy of Fallot, and Fontan Palliation

To identify predictors of impaired executive function in adolescents after surgical repair of critical congenital heart disease (CHD). We analyzed patient factors, medical and surgical history, and family social class from 3 single-center studies of adolescents with d-transposition of the great arteries (d-TGA), tetralogy of Fallot (TOF), and Fontan repair. Machine learning models were developed using recursive partitioning to predict an executive function composite score based on five subtests (population mean 10, SD 3) of the Delis-Kaplan Executive Function System. The sample included 386 patients (139 d-TGA, 91 TOF, 156 Fontan) of age 15.1±2.1 (mean±SD) years and an executive function composite score of 8.6±2.4. Family social class emerged as the most important predictive factor. The lowest (worst) mean executive function score (5.3) occurred in patients with low to medium social class (Hollingshead index <56) with one or more neurologic events and a diagnosis of TOF. The highest (best) mean score (9.7) occurred in subjects with high social class (Hollingshead index ≥56) and shorter duration of deep hypothermic circulatory arrest. Other factors predicting lower executive function scores included low birth weight and a greater number of catheterizations. In regression tree modeling, family social class was the strongest predictor of executive function in adolescents with critical CHD, even in the presence of medical risk factors. Additional predictors included CHD diagnosis, birth weight, neurologic events, and number of procedures. These data highlight the importance of social class in mitigating risks of executive dysfunction in CHD.

Clinicians’ Approach to Cognitive Impairment After Electroconvulsive Therapy: Current Situations and Challenges

Background: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe refractory mental diseases. Widespread cognitive complications have affected the acceptance of this treatment. Despite current evidence of short-term cognitive impairment, long-term cognition consequences are less determined. Objectives: This study aimed to evaluate the clinical approach of psychiatrists, psychiatry residents, and nurses in psychiatric hospitals to the necessity, method, and frequency of cognitive assessment in candidate patients for ECT. Methods: In this descriptive study, 89 professional members of Roozbeh and Razi hospitals, Tehran, Iran, including nurses, residents, and faculty members of psychiatry, were selected using the purposive sampling method. The research questionnaires were sent, and 58 fulfilled questionnaires were sent back. The data were analyzed using central indicators and statistical dispersion. The designed questionnaire included the items related to the specialists’ views on the necessity of post-ECT cognitive evaluations, best batteries, frequency of performing the tests, and other related domains. Results: After close follow-up, 58 out of 89 participants completed the questionnaires, including 17 psychiatrists (29.3%), 20 nurses (34.5%), and 21 psychiatry residents (36.2%). The results were analyzed and interpreted in detail. The average work experience of respondents in the psychiatry field was 6.89 years (range: 1 - 25 years). Additionally, 97% of the specialists did not have any project in the ECT field and cognitive disorders. More than 80% of the participants believed that cognition evaluation is necessary for ECT-candidate patients; however, only 15% of the specialists referred patients for the assessment. Moreover, 43% of the experts recommended the Wechsler Memory Scale-Revised; nevertheless, nearly 26% of the experts recommended the Delis-Kaplan Executive Function System for the cognitive assessment of these patients. The Rey Auditory Verbal Learning Test was recommended by 20% of the experts. Nearly two-thirds of the respondents believed that a proper assessment should be carried out in about 30 minutes. More than 60% of the experts believed that patients should be evaluated before receiving the first session of ECT, and nearly one-third of the experts recommended only a post-ECT evaluation. More than half of the experts believed that ECT should be discontinued in case of severe cognitive impairment after ECT. Alternatively, less than 30% of the experts believed that it is necessary to make changes in the treatment dose and the interval between sessions. Furthermore, 80% of the experts recommended cognitive rehabilitation for patients with significant cognitive impairment after ECT; nonetheless, less than 20% of the experts recommended treatment with a cholinesterase inhibitor. Conclusions: A large percentage of patients do not undergo a comprehensive cognitive assessment before ECT, which is an important challenge in the estimation of post-ECT cognitive decline. There is a need to design inexpensive and sensitive tests for cognitive assessment. The test could measure different cognitive domains and be acceptable in terms of time. Due to the limited number of specialists working in this field, the frequency of assessment and treatment methods after the identification of cognitive disorders are heterogeneous. Therefore, it is required to design a native and practical guideline. These results could help the researchers design future studies to determine the best method of cognitive evaluation after ECT, appropriate batteries, recommended intervals, and treatment decisions after cognitive decline detection.

Body Mass Index Moderates Brain Dynamics and Executive Function: A Structural Equation Modeling Approach

Obesity is associated with negative physical and mental health outcomes. Being overweight/obese is also associated with executive functioning impairments and structural changes in the brain. However, the impact of body mass index (BMI) on the relationship between brain dynamics and executive function (EF) is unknown. The goal of the study was to assess the modulatory effects of BMI on brain dynamics and EF. A large sample of publicly available neuroimaging and neuropsychological assessment data collected from 253 adults (18–45 years; mean BMI 26.95 kg/m2 ± 5.90 SD) from the Nathan Kline Institute (NKI) were included (http://fcon_1000.projects.nitrc.org/indi/enhanced/). Participants underwent resting-state functional MRI and completed the Delis-Kaplan Executive Function System (D-KEFS) test battery (1). Time series were extracted from 400 brain nodes and used in a co-activation pattern (CAP) analysis. Dynamic CAP metrics including dwell time (DT), frequency of occurrence, and transitions were computed. Multiple measurement models were compared based on model fit with indicators from the D-KEFS assigned a priori (shifting, inhibition, and fluency). Multiple structural equation models were computed with interactions between BMI and the dynamic CAP metrics predicting the three latent factors of shifting, inhibition, and fluency while controlling for age, sex, and head motion. Models were assessed for the main effects of BMI and CAP metrics predicting the latent factors. A three-factor model (shifting, inhibition, and fluency) resulted in the best model fit. Significant interactions were present between BMI and CAP 2 (lateral frontoparietal (L-FPN), medial frontoparietal (M-FPN), and limbic nodes) and CAP 5 (dorsal frontoparietal (D-FPN), midcingulo-insular (M-CIN), somatosensory motor, and visual network nodes) DTs associated with shifting. A higher BMI was associated with a positive relationship between CAP DTs and shifting. Conversely, in average and low BMI participants, a negative relationship was seen between CAP DTs and shifting. Our findings indicate that BMI moderates the relationship between brain dynamics of networks important for cognitive control and shifting, an index of cognitive flexibility. Furthermore, higher BMI is linked with altered brain dynamic patterns associated with shifting.

The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive Function Among Youth With Sickle Cell Disease

ABSTRACT Objective: To examine associations between sleep-disordered breathing (SDB) and executive/attentional function in pediatric sickle cell disease (SCD). Methods: Sixty youth with SCD ages 8–18 years and caregivers completed the Pediatric Sleep Questionnaire (PSQ), Delis Kaplan Executive Function System Trail Making Test (DKEFS TMT), Psychomotor Vigilance Test (PVT), and the Behavior Rating Inventory Of Executive Function, Second Edition (BRIEF-2) Parent Report. Results: The PSQ significantly predicted the BRIEF-2 Parent Report, F(1, 58) = 44.64, p < .001, R2 = 0.44, f2 = 0.77. Conclusions: Sleep-disordered breathing symptoms may predict informant-rated executive dysfunction in pediatric SCD, but not performance-based executive function.

Comparison of language awareness in Kurdish-Persian bilingual children and Persian monolingual children

The present study examines language awareness between bilinguals and monolingual children. Language awareness is a person's explicit understanding of language and its role in thinking, learning, and social life, which is associated with executive functioning. Delis-Kaplan Executive Function System (D-KEFS) test was designed to evaluate executive functioning. The test includes two parts: verbal and non-verbal. In this study, the verbal part including Twenty Questions, Word context, and proverb of D-KEFS was used. Kurdish-Persian bilinguals and Persian monolinguals attended this study. The results showed that in the Twenty Questions, word context, and proverb, there was a significant difference between bilinguals and monolinguals. Bilinguals outperformed monolinguals in both twenty-question and word context tests, while they performed lower on the proverb test. It can be concluded that bilingualism affects language awareness and also influences different aspects of executive functioning in different manners.

D-KEFS trail making test as an embedded performance validity measure

ABSTRACT Objective The Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test (TMT) is a commonly used measure of processing speed and executive functioning that may also be useful as an embedded performance validity test (PVT). We evaluated the utility of several multi-condition indices on the D-KEFS TMT in three independent samples to determine an optimal multi-condition index and cutoff on the D-KEFS TMT. Method Classification accuracy statistics for multiple multi-condition indices on the D-KEFS TMT were evaluated in three independent samples, including a sample with history of mild traumatic brain injury (TBI; n = 267) classified into psychometrically defined performance-valid and performance-invalid subgroups, the D-KEFS national normative sample (n = 1713), and a sample of middle- and older-aged adults diagnosed with mild cognitive impairment (MCI; n = 70). Results The D-KEFS TMT Conditions 1–5 summation index maximized sensitivity at .31 while maintaining adequate specificity at ≥.9. This index also had acceptable classification accuracy in both the D-KEFS national normative and MCI cross-validation samples, with the exception of the oldest subgroup of the national norming sample (i.e., individuals’ ages 80–89), in which the observed failure rates for all multi-condition indices tested were greater than 10%. Conclusion Our study provides support for the use the D-KEFS TMT Conditions 1–5 summation index as an embedded PVT among individuals younger than 80 years-old and from a range of conditions spanning from cognitively normal to mildly impaired; however, further validation is necessary.

Associations between locus coeruleus integrity and diagnosis, age, and cognitive performance in older adults with and without late-life depression: An exploratory study

Late-life depression (LLD) is a risk factor for age-dependent cognitive deterioration. Norepinephrine-related degeneration in the locus coeruleus (LC) may explain this link. To examine the LC norepinephrine system in vivo, we acquired neuromelanin-sensitive MRI (NM-MRI) in a sample of 48 participants, including 25 with LLD (18 women, age 68.08 ± 5.41) and 23 never-depressed comparison participants (ND, 12 women, age 70 ± 8.02), matched on age and cognitive status. We employed a semi-automated procedure to segment the LC into three bilateral sections along its rostro-caudal extent, and calculated relative contrast as a proxy of integrity. Then, we examined associations between integrity and LLD diagnosis, age, and cognition, as measured via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Delis-Kaplan Executive Function System (D-KEFS). We did not identify an effect of LLD diagnosis nor age on LC integrity, but exploratory canonical correlation analysis across the combined participant sample revealed a strong (Rc = 0.853) and significant multivariate relationship between integrity and cognition (Wilks’ λ = 0.03, F(84, 162.44) = 1.66, p = <.01). The first and only significant variate explained 72.83% model variance, and linked better attention and delayed memory performance, faster processing speed, and lower verbal fluency performance with higher integrity in the right rostral but lower integrity in the left caudal LC. Our results complement prior evidence of LC involvement in cognition in healthy older adults, and extend this association to individuals with LLD.

Prenatal Exposure to Chemical Mixtures and Cognitive Flexibility among Adolescents.

Cognitive flexibility, the ability to smoothly adapt to changing circumstances, is a skill that is vital to higher-level executive functions such as problem-solving, planning, and reasoning. As it undergoes substantial development during adolescence, decrements in cognitive flexibility may not become apparent until this time. There is evidence that prenatal exposure to individual chemicals may adversely impact executive functions in children, but few studies have explored the association of co-exposure to multiple chemicals with cognitive flexibility specifically among adolescents. We investigated this association among a diverse group of adolescents living near a Superfund site in New Bedford, Massachusetts. Specifically, using Bayesian kernel machine regression (BKMR) and multivariable regression analyses, we investigated the association of biomarkers of prenatal exposure to organochlorines (DDE, HCB, PCBs) and metals (lead, manganese) with cognitive flexibility, measured with four subtests of the Delis-Kaplan Executive Function System. In BKMR models, we observed adverse joint associations of the chemical mixture with two of the four cognitive flexibility subtests. In covariate-adjusted linear regression models, a two-fold increase in cord blood Mn was associated with poorer performance on two of the subtests: Trail-Making (scaled score difference = −0.60; 95% CI: −1.16, −0.05 points) and Color-Word Interference (scaled score difference = −0.53; 95% CI: −1.08, 0.01 points). These adverse Mn-cognitive flexibility associations were supported by the results of the BKMR. There was little evidence of effect modification by sex and some evidence of effect modification by a measure of social disadvantage, particularly for the associations between HCB and cognitive flexibility. This study is among the first to provide evidence of an adverse association of prenatal exposure to a chemical mixture with cognitive flexibility in adolescence.

Measures of postural control and mobility during dual-tasking as candidate markers of instability in Huntington's disease

Individuals with Huntington's disease (HD) have impairments in performing dual-tasks, however, there is limited information about the effects of changing postural and cognitive demands as well as which measures are best suited as markers of underlying motor-cognitive interference. Forty-three individuals with HD and 15 healthy controls (HC) completed single tasks of walking (Timed Up & Go (TUG), 7m walk), standing (feet together, feet apart and foam surface) and seated cognitive performance (Stroop, Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (DKEFS) Sorting test) and dual cognitive-motor tasks while standing (+ Stroop) and walking (+ DKEFS, TUG cognitive). APDM Opal sensors recorded measures of postural sway and time to complete motor tasks. Individuals with HD had a greater increase in standing postural sway compared to HC from single to dual-tasks and with changes to support surface. Both groups demonstrated a decrease in gait performance during the TUG cognitive, however, this difference was greater in people with HD compared to HC. While those with HD showed a greater dual-task motor cost compared to HC, both groups behaved similarly as condition complexity increased. Standing postural sway is a more sensitive marker of instability than change in standard gait speed, particularly under dual-task conditions. The more complex TUG cognitive is a sensitive measure of walking dual-task performance. The results of this study provide insights about the nature of motor-cognitive impairments in HD and provide support for a distinction between static and dynamic postural control mechanisms during performance of dual-tasks.

Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study

BackgroundDeficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders.Methods189 Swedish patients aged 18–65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test.ResultsMore severe anxiety was associated with lower digit span test scores (R2 = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests.ConclusionsSeverity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.

Contribution of vascular risk factors to the relationship between ADHD symptoms and cognition in adults and seniors

Symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood have been found to be predictive of compromised cognitive function, and possibly even dementia, in later adulthood. This study aimed to test vascular risk as a hypothesized moderator or mediator of this association, because individuals with elevated ADHD symptoms frequently have comorbid vascular disease or risk factors which are recognized to contribute to later-life cognitive decline. Data from 1,092 adults aged 18–85 were drawn from the Enhanced Nathan Kline Institute Rockland Sample. Childhood ADHD symptoms (assessed using the Adult ADHD Clinical Diagnostic Scale) were assessed as predictors of cognitive functioning in adulthood (assessed using subtests from the University of Pennsylvania Computerized Neurocognitive Battery, the Delis-Kaplan Executive Functioning System, and the Wechsler Memory Scale). Vascular risk factors (including diabetes, tobacco use, obesity, hypertension, and hypercholesterolemia) were tested as both a moderator and mediator of this relationship. Childhood ADHD symptoms and vascular risk factors were both independently associated with later-life cognition, but vascular risk was not a significant moderator or mediator of relationships between ADHD symptoms and cognition in statistical models. Results from this large community sample suggest that the relationship between ADHD symptoms and cognition is not accounted for by vascular risk. This question should also be investigated in clinical samples.

Effect of Aerobic Exercise Training on Mood and Cognition in Adults at Risk for Alzheimer’s Disease

AbstractBackgroundAerobic exercise is positively associated with mood and cognition, but its effect on protection against decline in mood and cognition in late‐middle aged adults at risk for Alzheimers disease (AD) is unknown.Method23 late‐middle aged adults from a cohort enriched with family history of AD and the APOE4 allele were randomized into Usual or Enhanced Physical Activity (PA) groups. Enhanced PA completed a progressive 26‐week supervised aerobic exercise program at 70‐80% heart rate reserve for 50 minutes, 3 times per week to achieve or exceed public health guidelines. Usual PA only received materials regarding active lifestyle. The Profile of Mood States (POMS) assessed total mood disturbance (TMD), characterized by fatigue, depression, tension, confusion, anger, and vigor. The California Verbal Learning Test II (CVLT‐II) measured verbal learning and memory via the total, short, and long delayed recall, and learning slope. The Delis‐Kaplan Executive Function System (DKEFS) assessed executive function via the trail‐making, color‐word interference (CWI), verbal fluency, and tower subtests. Graded treadmill exercise testing assessed cardiorespiratory fitness (CRF), and triaxial accelerometry measured moderate‐to‐vigorous physical activity (MVPA). Independent samples t‐tests between groups and Pearson’s correlations were conducted on baseline to post‐intervention change scores.ResultFatigue decreased significantly in Enhanced PA compared to Usual PA (‐1.18 ± 4.05 vs 2.92 ± 2.68, p= .009), and the decreases in TMD (‐7.64 ± 17.78 vs 6.00 ± 16.42, p=.07) and tension (‐2.00 ± 4.41 vs 0.67 ± 2.39, p= .08) among Enhanced PA were nearly significant. Changes in other mood subcategories and in cognition were not different between groups (all p’s&gt; .15), except improved executive function on the DKEFS CWI as previously published (Gaitán et al. 2019). Correlations of mood with verbal learning and memory or executive function were not significant (all r’s &lt; .17, all p’s&gt; .44). Correlations of mood or cognition with CRF or MVPA were not significant (p’s&gt; .175), except between DKEFS CWI and CRF as previously published (Gaitán et al. 2019).ConclusionAerobic exercise training may protect against fatigue in adults at risk for AD. However, change in mood was not associated with cognitive changes in this cohort.

Prenatal Exposure to Chemical Mixtures and Inhibition among Adolescents.

Inhibition, one of the building blocks of executive function, is the ability to focus one’s attention despite interference from external stimuli. It undergoes substantial development during adolescence and may be susceptible to adverse impacts of prenatal exposure to chemical mixtures, yet few studies have explored this association. The New Bedford Cohort (NBC) is a birth cohort of residents living near the New Bedford Harbor Superfund site in Massachusetts. Among adolescents from the NBC, we investigated the association of biomarkers of prenatal exposure to organochlorines (DDE, HCB, PCBs) and metals (Pb, Mn) with inhibition, assessed with the Delis–Kaplan Executive Function System Design Fluency (non-verbal task) and Color–Word Interference (verbal task) subtests. An exploratory mixtures analysis using Bayesian kernel machine regression (BKMR) informed a traditional multivariable regression approach. NBC adolescents are diverse with 29% non-white and 31% in a low-income household at birth. Cord serum organochlorine concentrations and cord blood metals concentrations were generally similar to other birth cohorts. In BKMR models, we observed a suggestive adverse association of the chemical mixture with Color–Word Interference but not Design Fluency. In covariate-adjusted linear regression models including all five chemical exposure measures, a doubling of cord blood Mn was associated with poorer Color–Word Interference completion time scaled scores (difference = −0.74; 95% CI: −1.34, −0.14). This study provided evidence of an adverse joint association between prenatal exposure to a five-chemical mixture and verbal inhibition in adolescence with exposure to Mn potentially driving this overall association.

The Role of Intelligence Profiles and Executive Functions (Selective Attention and Switching) in Predicting Creativity Components

Introduction: In recent decades, researchers in the field of creativity, have become interested in recognizing the factors associated with the growth and development of creativity in children. Therefore, the purpose of this descriptive, correlational study is to detect the role of intelligence profiles and executive functions (selective attention, switching) in predicting creativity components. Materials and Methods: The statistical population included kids aged 13-15 years living in Isfahan City, Iran in 2015, and so 150 kids were selected by purposive sampling method. The study data were collected using the Delis–Kaplan Executive Function System (D-KEFS) CW simple Stroop test, Gardner’s multiple intelligence questionnaire, and Torrance’s creativity questionnaire, and analyzed by simultaneous multiple regression analysis and the Pearson correlation method in SPSS V. 22. Results: There were significant positive relationships between intrapersonal intelligence and fluency component, as well as, between logical-mathematical intelligence and flexibility component. The results also showed a significant positive relationship between bodily- kinesthetic intelligence and naturalist intelligence with the originality component. There were positive and significant relationships between logical-mathematical, bodily-kinesthetic, intrapersonal, and naturalist intelligence with the elaboration component, as well as, between the selective attention and the fluency component. Conclusion: The characteristics of intelligence and selective attention can predict the components of creativity

Low Dose to White Matter Predicts Attention and Processing Speed Decline After Fractionated Brain RT

<h3>Purpose/Objective(s)</h3> Attention and processing speed, an important neurocognitive function, is subserved in the brain by critical white matter (WM): the corpus callosum (CC) and intra-hemispheric white matter tracts (IHWM). We sought to characterize the dose-response relationship of these structures with decline in attention/processing speed at 6 months post-RT in patients with primary brain tumors, with particular attention to low doses. <h3>Materials/Methods</h3> On a prospective trial, 52 primary brain tumor patients receiving fractionated brain RT underwent volumetric MRI, diffusion tensor imaging, and neurocognitive assessments (for processing speed: Delis-Kaplan Executive Function System Trail Making (D-KEFS-TM) Number Sequencing (TM-NS), D-KEFS-TM Letter Sequencing (TM-LS), and Weschler Adult Intelligence Scale (WAIS-IV) Coding; for attention: D-KEFS-TM Visual Scanning (TM-VS) test and WAIS-IV Digit Span Digits Forward (DF) test. Reliable change indices were calculated and adjusted for practice effects (RCI-PE), with decrease in RCI-PE scored as decline. Regions of interest (ROIs) were autosegmented using open source software and atlas-based tractography, including: CC, all WM w/wo CC, total IHWM without CC, and right/left IHWM without CC. Censoring masks excluded tumor, surgical cavity, scarring, and edema. Planning CTs were co-registered to MRIs to extract DVH parameters for each ROI, including V10 Gy and V20 Gy. Univariate logistic regressions were used to test for dosimetric predictors of decline. <h3>Results</h3> Median age was 47y. Most patients (61.5%) had gliomas. Median prescription RT dose was 59.4 Gy. At baseline and 6 months, 37-43 patients completed the neurocognitive assessments, with 61-78% showing decline. Several significant associations between increasing relative volumes exposed to low dose and decline were seen in all assessments except TM-NS (Table). Investigation of mean and maximum dose parameters yielded similar results. <h3>Conclusion</h3> While maximum dose is typically considered the most relevant dosimetric parameter for toxicity endpoints in the brain, we also detected several significant logistic relationships between V10 and V20 to more diffuse white matter networks (CC and IHWM) and decline in attention and processing speed post-RT. Minimization of low dose bath, whether by planning optimization or use of more conformal modalities like protons, may be clinically relevant for preservation of these critical neurocognitive functions.