Digit Symbol Research Articles

Comparative Evaluation of Oral Melatonin versus Oral Alprazolam as Premedication in Patients Undergoing Tympanoplasty: A Randomised Control Study

Introduction: Preoperative anxiety is commonly experienced by patients who are admitted to hospital for any surgery and the role of premedication becomes important from an anaesthetist’s point of view, to relieve anxiety, provide sedation and ensure adequate analgesia. Aim: To compare the effects of oral melatonin versus oral alprazolam as premedication and their impact on postoperative recovery characteristics in patients undergoing tympanoplasty. Materials and Methods: In this randomised controlled study which was conducted from August 2022 to March 2024 at the Department of Anaesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India, a total of 70 adult patients were randomly allocated into two groups. Group M (n=35) received oral melatonin 6 mg and group A (n=35) received oral alprazolam 0.50 mg 120 minutes before surgery. The objectives of the study were to compare anxiety, sedation, cognition and pain using the Visual Analogue Scale (VAS), Ramsay Sedation Score (RSS), Digit Symbol Substitution Test (DSST) score and Numerical Rating Scale (NRS), respectively. The Shapiro-Wilk test, Independent t-test, Chi-square test and Fisher’s-exact test were used for statistical analysis. Results: The age distribution, gender, body mass index, American Society of Anaesthesiologists (ASA) status and mean duration of surgery were comparable between the two groups. Mean VAS scores were significantly lower in group M at 60 minutes (3.03±1.29 vs 3.77±1.21) and at 120 minutes (2.17±1.12 vs 2.91±1.12). Even in the postoperative period, compared to group A, the VAS score was lower in group M after extubation at various time intervals. RSS scores were lower in group M compared to group A at 60 minutes and at 120 minutes of drug administration. In the postoperative period, compared to group A, group M had lower sedation scores after extubation at 30 minutes, 60 minutes, 90 minutes and 120 minutes (p-value <0.0001). Compared to group A, group M had statistically significantly higher DSST scores at various time intervals in both the preoperative and postoperative periods (p-value <0.0001). group M had significantly lower NRS scores after extubation at various time intervals (p-value <0.0001) compared to group A, indicating that pain was significantly lower in the postoperative period with the use of melatonin. Conclusion: Oral melatonin (6 mg) is shown to be an effective alternative to alprazolam (0.5 mg) as a premedication. Oral melatonin offered superior anxiolysis while inducing less sedation compared to alprazolam. In addition, there was better preservation of cognitive function with melatonin compared to alprazolam.

Associations between dietary B vitamin intakes and cognitive function among elderly individuals: An observational study.

Associations between dietary B vitamin intakes and cognitive function among elderly individuals: An observational study.

Association between the triglyceride-glucose index and cognitive function in stroke free patients with atrial fibrillation: A cross-sectional study.

Association between the triglyceride-glucose index and cognitive function in stroke free patients with atrial fibrillation: A cross-sectional study.

Association between dietary potassium intake and cognitive function among older adults: A cross-sectional study.

Association between dietary potassium intake and cognitive function among older adults: A cross-sectional study.

Abdominal myosteatosis is associated with lower processing speed in a multiethnic cohort of older adults.

Abdominal myosteatosis is associated with lower processing speed in a multiethnic cohort of older adults.

Work performance measurement of visual inspectors in the automotive industry by considering ergonomic factors.

Visual inspection workers are always performing under various ergonomic factors and are more vulnerable to the effects of physical and organizational aspects, since their work deals highly with cognitive functions and the impact of ergonomic factors has to be identified in automotive industries to improve work performance. To study the combined effect of ergonomic factors that may have an impact on the performance of visual inspection workers in the automotive industry. In this experimental study combined factors such as postures (standing, sitting, Sit-stand) and work shifts (A shift, B shift, C Shift) have been studied at three levels. The study was conducted among selected employes (n = 10) in the automotive manufacturing industry in 2023. During the study, the visual inspectors' work performance was measured using the error study, and the cognitive functions of visual inspectors' were evaluated by taking the Digit Symbol Substitution Test (DSST). The study established that postures significantly impact work performance at 40.08% and cognitive functions at 36.25%. Work shifts significantly impact work performance with 18.18% and cognitive functions with 26.62% of visual inspectors' in the automotive industry. The combined effect of postures and work shifts has significantly impacted the visual inspectors' performance with 13.29% on work performance and 10.12% on cognitive functions. This study draws the inference that individual and combined factors (Posture and Work shift) both possess a significant impact on the work performance and cognitive functions of visual inspectors' in the automotive manufacturing industry.

Symbol Digit Modalities Test incidental learning: Concurrent validity and clinical utility

This project examined the Incidental Learning (IL) procedure from the Symbol-Digit Modalities Test (SDMT) as both a screening tool and as a measure of memory. Participants included undergraduate college students and stroke- and dementia-free older adult volunteers with and without hypertension or chronic kidney disease. In each sample, IL scores were correlated with performances from a variety of cognitive tasks. Results indicated that IL scores were more strongly associated with tests of memory than other cognitive abilities. As a screening instrument for older adults, scores of four or more recalled symbol-digit pairings strongly indicated a lack of difficulties on other tests of memory, whereas scores of three or fewer suggested a need for further assessment, though not necessarily impairment. A novel recognition (IL-r) procedure was introduced to older participants without kidney disease, and results indicated that IL-r uniquely predicted both delayed verbal and visual memory beyond standard IL. Our findings suggest that IL can be regarded as an efficient supplemental or screening test of memory that offers a complementary methodology to a comprehensive assessment of memory.

Cognitive Control and Prefrontal Neural Efficiency in Experienced and Novice E-Gamers

Background: Cognitive control (CC) underpins our ability to maintain task focus, update goals, and flexibly shift between strategies, and it is closely tied to prefrontal cortex (PFC) activity. Electronic gaming (e-gaming), such as the first-person shooter (FPS) genre, is a specialized domain that demands refined CC skills developed over years of practice. Although previous research has demonstrated that PFC hemodynamic activity can effectively evaluate CC in several skilled domains, the impact of prolonged FPS experience on CC and its underlying neural correlates remains unclear. Objectives: In this study, we examined differences in both behavioral performance and PFC hemodynamic responses between 70 novices and 50 experienced FPS gamers (n=120). Methods: We targeted three core CC subdomains—updating, shifting, and inhibition—by employing the Digit–Symbol Substitution Task, Dual Visual Search Task, and Stroop Task, respectively. Functional near-infrared spectroscopy (fNIRS)-based PFC activity was recorded as participants engaged in each task. Results: Experienced gamers showed higher levels of prefrontal neural efficiency for updating and shifting, but minimal differences for inhibitory control. Conclusions: These findings inform neuroergonomic approaches to performance evaluation and may be generalized to other complex, real-world environments that rely on extensive training for skill acquisition.

Exploring the association between hemoglobin glycation index and cognitive function in older adults with hypertension: a cross-sectional study

BackgroundThe Hemoglobin Glycation Index (HGI) quantifies the difference between the actual and expected values of glycosylated hemoglobin (HbA1c), a marker that has been closely linked to various adverse health outcomes. Nonetheless, a significant gap exists in the current literature concerning the association between HGI and cognitive function. This study aims at testing such association in older adults with hypertension, a topic that has not yet been extensively investigated.MethodsA linear regression model between glycated hemoglobin A1c (HbA1c) levels and fasting plasma glucose (FPG) was constructed for the calculation of the HGI. The cross-sectional study focused on evaluating the cognitive function of hypertensive individuals (≥ 60 years old), based on the data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES), by using a series of standardized tests, including the Word List Learning (CERAD-WL) and Delayed Recall (CERAD-DR) tests from the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Weighted logistic and linear regression models served for evaluating the effect of HGI on hypertensive patients’ cognitive function. Restricted cubic spline (RCS) curves assisted in detecting the underlying nonlinear associations between HGI and cognitive outcomes. Furthermore, subgroup analyses and interaction tests were performed to gain deeper insights into these associations.ResultsThe study included 1023 participants ≥ 60 years old from 2011 to 2014 NHANES. Higher HGI was accompanied by lower DSST score (P = 0.009). In the fully adjusted model, participants in the highest quartile (Q4) of HGI possessed a lower DSST score (β = -4.50, 95% CI -8.10– -0.88) versus the lowest quartile (Q1), and were more likely to exhibit low cognitive function as evaluated by the DSST (OR = 2.21, 95% CI 0.98–5.03). According to the results from RCS analysis, HGI presented a linear relevance to cognitive function scores in older adults with hypertension. There is no interaction between HGI and the stratifying variables (sex, age, BMI, alcohol consumption, and smoking status).ConclusionHigh HGI was an important risk factor leading to reduced cognitive performance in hypertensive patients, ensuring HGI to be used for effectively predicting patients’ cognitive decline.

Association of serum 25(OH)D3 and cognitive levels with biological aging in the elderly: a cross-sectional study.

Biological aging, a fundamental process affecting health and longevity, is pivotal to understanding the physiological decline associated with aging. Serum vitamin D3 deficiency and cognitive impairment are common health issues among older adults. However, the joint associations of serum vitamin D levels and cognitive impairment with biological aging remain poorly understood. This study aims to evaluate the independent and combined associations of serum vitamin D3 and cognitive impairment with biological aging in older adults. This cross-sectional study included adults aged 60 years and older from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Biological aging was measured using Phenotypic Age calculated from biomarkers. Cognitive performance was assessed using the Centre for the Establishment of a Registry for Alzheimer's Disease (CERAD) test, the Animal Fluency test (AFT), and the Digit Symbol Substitution test (DSST). Multivariable regression and restricted cubic spline models were used to examine the relationships between serum 25(OH)D3 levels, cognitive performance, and biological aging. After adjusting for all covariates, individuals in the highest quartile of cognitive performance had a reduced risk of biological aging compared to those in the lowest quartile (CERAD: OR 0.91; 95% CI, 0.57-1.46; AFT: OR 0.48; 95% CI, 0.29-0.82; DSST: OR 0.43; 95% CI, 0.24-0.77). A U-shaped relationship was observed between serum 25(OH)D3 levels and biological aging. Combined analyses revealed that individuals with both low serum 25(OH)D3 and low cognitive performance had the highest risk of biological aging across all cognitive tests (CERAD: OR 1.43; 95% CI, 1.02-1.98; AFT: OR 1.70; 95% CI, 1.24-2.32; DSST: OR 1.67; 95% CI, 1.22-2.27). Notably, in the DSST, individuals with normal serum 25(OH)D3 levels and normal cognitive performance showed a reduction in Phenotypic Age by 2.40 years (p < 0.01). In older adults, low serum 25(OH)D3 levels combined with low cognitive performance are strongly associated with an increased risk of biological aging.

Association between relative fat mass and cognitive function among US older men: NHANES 2011–2014

BackgroundRelative fat mass (RFM) is a new metric developed to assess the entire body fat proportion in adults. The objective of this study was to examine the correlation between cognitive performance and RFM in older American males.MethodsA total of 1,321 individuals were selected from the National Health and Nutrition Examination Survey (NHANES) that was carried out between the years 2011 and 2014. Specifically, the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning Test (CERAD-WL), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST) were used in order to achieve the objective of assessing cognitive function. The standardized scores of the three previously mentioned tests were averaged to create the Z-scores, a composite, generalized metric. RFM was ascertained by measuring waist circumference (WC) and height. The relationships that exist between RFM and cognitive performance were investigated using a variety of statistical methods, including multivariate linear regression, threshold effect analyses, smooth curve fitting, and subgroup analyses.ResultsThe study included 1,321 male volunteers aged 60 years or older, and comprehensive data was provided for each individual. Fully adjusted models indicated a negative correlation between RFM and CERAD-WL scores[-0.17, (-0.32,-0.01)], DSST scores[-0.83, (-1.16,-0.50)] and Z-scores[-0.03, (-0.05, -0.01)]. It was observed that the negative correlation that exists between RFM and Z-scores became more pronounced when RFM exceeded 35.78. Furthermore, subgroup analyses showed that the association between RFM and cognitive function was significantly impacted by education level, poverty-income ratio (PIR), smoking status, and drinking status.ConclusionsA higher RFM was linked to lower cognitive function in older men, suggesting that management of RFM may prove advantageous in mitigating cognitive decline among older male populations.

Total and Structural Carotid Artery StiffnessAre Associated With Cognitive Decline and Structural Brain Abnormalities Related to Alzheimer Disease and AlzheimerDisease-Related Dementias Pathology: TheMulti-Ethnic Study ofAtherosclerosis.

Arterial stiffness is associated with pathological changes underlying Alzheimer disease and related dementias. Total pulse wave velocity can be subdivided into 2 main mechanisms: structural arterial stiffness (S-PWV) due to intrinsic remodeling of the artery wall and load-dependent arterial stiffness due to increased blood pressure. In this prospective cohort study, MESA (Multi-Ethnic Study of Atherosclerosis) participants completed B-mode carotid ultrasounds from which carotid total pulse wave velocity was calculated. S-PWV was calculated by adjusting pulse wave velocity to 120/80 mmHgusing a nonlinear pressure-diameter relationship, and load-dependent arterial stiffness was derived by subtracting S-PWV from total pulse wave velocity. Participants had repeated cognitive assessments with the Cognitive Abilities Screening Instrument, Digit Symbol Coding, and Digit Span combined into a global cognitive composite (N=2489). Brain magnetic resonance imaging was used to generate total gray matter volume (N=906), white matter hyperintensity volume (N=896), and total white matter fractional anisotropy (N=810). Multivariable linear fixed and mixed effects regression models related standardized pulse wave velocity components to neuroimaging and cognitive decline parameters, respectively. Greater S-PWV was associated with greater longitudinal cognitive decline in global cognitive composite score (β=-0.05, P=0.002) and subtests, whereas greater load-dependent arterial stiffness was not associated with longitudinal cognitive decline. Greater S-PWV was associated with lower gray matter volume (β=-3183.4, P=0.013) and higher log white matter hyperintensity volume (β=0.20, P<0.001), whereas load-dependent arterial stiffness was associated with lower total white matter fractional anisotropy (β=-0.004, P≤0.001). Higher structural stiffness of the carotid artery is associated with cognitive decline, whereas both structural and load-dependent stiffness are associated with brain structural abnormalities common in Alzheimer disease-related dementias.

Exploring the associations between psychiatric symptoms and cognitive functions in first-episode schizophrenia: A network analysis.

Exploring the associations between psychiatric symptoms and cognitive functions in first-episode schizophrenia: A network analysis.

Combined Effect of HF-rTMS and Whole-Body Vibration Exercise on Cognitive Efficiency in Esports Players With or Without Sedentary Behaviors: A Randomized Controlled Trial.

The present study investigated the effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS), whole-body vibration training (WBVT), and a combination of HF-rTMS and WBVT interventions on cognitive performance in esports players with or without sedentary behaviors. A total of 128 participants, including sedentary and non-sedentary esports players, were randomly assigned to the HF-rTMS group, the WBVT group, the HF-rTMS+WBVT group, or the control group. The interventions were administered daily for 2 weeks, and pretest, mid-test, and posttest assessments were conducted. Cognitive function was assessed using the Digit Symbol Substitution Test (DSST) for response time and accuracy, and gaming performance was measured using first-person shooter (FPS) scores. At baseline, sedentary players demonstrated significantly increased response time in DSST compared to non-sedentary participants. The interventions, both HF-rTMS and WBVT, significantly enhanced cognitive processing speed and accuracy, with these improvements being more pronounced in sedentary esports players compared to non-sedentary esports players. Notably, the combination of HF-rTMS and WBVT was found to be the most effective in boosting cognitive performance among these interventions. Furthermore, FPS scores showed an overall increase in all intervention groups in both sedentary and non-sedentary esports players, and the combination of HF-rTMS and WBVT showed the most pronounced effect on in gaming performance. The study demonstrated that sedentary behavior had a detrimental effect on the cognitive function in esports players. Furthermore, HF-rTMS and WBVT, especially in combination, effectively enhanced cognitive performance in esports players, with a more pronounced effect in those with sedentary lifestyles. These findings suggested potential strategies for cognitive enhancement in the esports context, highlighting the need for tailored interventions based on individual lifestyle factors.

Misfolded α-synuclein co-occurrence with Alzheimer's disease proteinopathy.

Misfolded α-synuclein co-occurrence with Alzheimer's disease proteinopathy.

Decreased neutrophil-to-lymphocyte ratio predicted cognitive improvement in late-life depression treated with vortioxetine: Findings from an eight-week randomized controlled trial.

Decreased neutrophil-to-lymphocyte ratio predicted cognitive improvement in late-life depression treated with vortioxetine: Findings from an eight-week randomized controlled trial.

Gray Matter Covariance Networks Associated with Parental Longevity - Results from the LonGenity Study.

Older adults with exceptional longevity - and their offspring - are protected from age-related diseases and have a prolonged health span. Prior research suggests that offspring of parents with exceptional longevity have larger temporal and sensorimotor cortices in mid to late-adulthood - but the association between brain health and parental longevity is not well understood in older adults. This study aimed to identify a gray matter volume pattern (or network) associated with parental longevity in older adults - and to determine if individual expressions of this gray matter pattern vary with cognitive performance. Participants consisted of one hundred and thirty-nine older adults of Ashkenazi Jewish descent from the LonGenity study (M Age 79.4±6.5 years; 56.11% women). Eighty-four (60.4%) were offspring of parents with exceptional longevity and 55 (39.6%) were offspring of parents with usual survival. A gray matter network associated with parental longevity was derived with multivariate covariance-based analyses that were adjusted for potential confounders. Participant-specific expressions of this network were then regressed against cognitive test performances. The derived gray matter covariance network associated with parental longevity was primarily composed of frontal, insular, and hippocampal regions. The extent to which older adults displayed this pattern was associated with overall cognition, Free Recall, Digit Symbol Substitution, Boston Naming and Trail Making Test A performance. Parental longevity is associated with a widespread network of brain regions in aging. This brain network also varies as a function of cognitive performance.

Effects of Carnosine Supplementation on Cognitive Outcomes in Prediabetes and Well-Controlled Type 2 Diabetes: A Randomised Placebo-Controlled Clinical Trial.

Background: Trends in global ageing underscore the rising burden of age-related cognitive decline and concomitant cardiometabolic diseases, including type 2 diabetes mellitus (T2DM). Carnosine, a naturally occurring dipeptide with anti-inflammatory, antioxidant and anti-glycating properties, has shown promise in animal models and limited human studies for improving cognitive function, insulin resistance and T2DM, but its therapeutic effects on cognition remain unclear. The aim of this study is to assess the effects of carnosine on cognitive function in individuals with prediabetes or well-controlled T2DM. Methods: This is a secondary analysis of a double-blind randomised controlled trial (RCT), whereby 49 adults with prediabetes or early-stage well-controlled T2DM were randomised to receive 2 g of carnosine or identical placebo daily for 14 weeks. At baseline and follow-up, cognitive function was assessed as a secondary outcome using the Digit-Symbol Substitution Test, Stroop test, Trail Making Tests A & B, and the Cambridge Automated Neuropsychological Test Battery (CANTAB). Results: In total, 42 adults (23 males and 19 females) completed the trial. There were no differences in participant anthropometry or cognitive functioning between carnosine and placebo groups at baseline (all p > 0.1). After the 14-week supplementation period, there were no differences between carnosine and placebo groups in change and follow-up values for any cognitive measures including Stroop, Digit Symbol Substitution Sest, Trail Making A/B or CANTAB (all p > 0.05). Adjustments for baseline cognitive scores, diabetic status, level of education, age or interaction effects with participants' sex did not change the results. Conclusions: Carnosine supplementation did not improve cognitive measures in individuals with prediabetes or T2DM in this study. While larger trials may provide further insights, alternative factors-such as the relatively young and healthy profile of our cohort-may have contributed to the lack of observed effect. Future research should examine individuals with existing cognitive impairment or those at higher risk of cognitive decline to better define the therapeutic potential of carnosine in this context.

Association between age at first birth and cognitive function in women 60 years and older: the 2011–2014 cross-sectional National Health and Nutrition Examination Survey (NHANES) study

BackgroundCognitive function is a fundamental capacity essential for maintaining independence and performing complex tasks in daily life. Cognitive abilities gradually decline with age, potentially leading to dementia. Evidence suggests that female reproductive factors may influence cognitive function in later life through various mechanisms. However, the relationship between age at first birth (AFB) and cognitive function requires further investigation.MethodsThis study utilizes data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES), including 1,057 female participants. AFB data are obtained from reproductive health questionnaire. Cognitive function is assessed using the CERAD Word Learning Test, Animal Fluency Test, and Digit Symbol Substitution Test. Multiple linear regression, smoothed curve fitting, threshold analyses, and subgroup analyses are conducted to evaluate the association between AFB and cognitive function.ResultsAFB is significantly and positively associated with cognitive function after adjusting for covariates. Women with AFB ≥ 20 years exhibit a 34% lower prevalence of cognitive impairment and significantly higher cognitive test scores compared to those with AFB < 20 years. A nonlinear relationship is observed, with the positive effect of increasing AFB on cognitive function being more pronounced before age 21. The association between AFB and cognitive function is stronger among individuals without a history of stroke and those with moderate to high levels of waist-to-height ratio (WHtR) and weight-adjusted waist index (WWI).ConclusionLater AFB is associated with a reduced prevalence of cognitive impairment and improved cognitive outcomes, particularly when the first birth occurs after age 21. Considering WHtR and WWI may further optimize the protective effects of AFB on cognitive health. These findings underscore the importance of reproductive timing for long-term cognitive health.

Performance Enhanced Cascaded Digital-Analog Radio-Over-Fiber Enabled by Digital Symbol Remapping for 6G Mobile Fronthaul

Performance Enhanced Cascaded Digital-Analog Radio-Over-Fiber Enabled by Digital Symbol Remapping for 6G Mobile Fronthaul