Dimensional Change Card Sort Test Research Articles

Prediction of cognitive impairment using higher order item response theory and machine learning models.

Timely detection of cognitive impairment (CI) is critical for the wellbeing of elderly individuals. The MyCog assessment employs two validated iPad-based measures from the NIH Toolbox® for Assessment of Neurological and Behavioral Function (NIH Toolbox). These measures assess pivotal cognitive domains: Picture Sequence Memory (PSM) for episodic memory and Dimensional Change Card Sort Test (DCCS) for cognitive flexibility. The study involved 86 patients and explored diverse machine learning models to enhance CI prediction. This encompassed traditional classifiers and neural-network-based methods. After 100 bootstrap replications, the Random Forest model stood out, delivering compelling results: precision at 0.803, recall at 0.758, accuracy at 0.902, F1 at 0.742, and specificity at 0.951. Notably, the model incorporated a composite score derived from a 2-parameter higher order item response theory (HOIRT) model that integrated DCCS and PSM assessments. The study's pivotal finding underscores the inadequacy of relying solely on a fixed composite score cutoff point. Instead, it advocates for machine learning models that incorporate HOIRT-derived scores and encompass relevant features such as age. Such an approach promises more effective predictive models for CI, thus advancing early detection and intervention among the elderly.

Associations Between Inactivity and Cognitive Function in Older Intensive Care Unit Survivors.

Critically ill older adults are profoundly inactive while in the intensive care unit (ICU), and this inactivity persists after discharge from the ICU. Older ICU survivors who were mechanically ventilated are at high risk for post-ICU cognitive impairment. The present study examined the relationship between the ratio of daytime to nighttime activity and executive function in older ICU survivors. This was a secondary analysis of pooled data from 2 primary studies of older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24 to 48 hours post-ICU discharge. Actigraphy recorded daytime activity (mean activity counts per minute, 6 am to 9:59 pm) and nighttime activity (mean activity counts per minute, 10 pm to 5:59 am). A daytime-to-nighttime activity ratio was calculated by dividing daytime activity by nighttime activity. The NIH Toolbox Dimensional Change Card Sort Test assessed cognitive flexibility (DCCST: fully corrected T score). Multivariate regression examined the association between the daytime-to-nighttime activity ratio and DCCST scores, adjusting for 2 covariates (age in years and NIH Toolbox Grip Strength fully corrected T score). The mean daytime-to-nighttime activity ratio was 2.10 ± 1.17 (interquartile range, 1.42). Ratios for 6 participants (13.6%) were less than 1, revealing higher activity during nighttime hours rather than daytime hours. Higher daytime-to-nighttime ratios were associated with better DCCST scores (β = .364, P = .005). The proportion of daytime activity versus nighttime activity was considerably low, indicating severe alterations in the rest/activity cycle. Higher daytime-to-nighttime activity ratios were associated with better executive function scores, suggesting that assessment of daytime activity could identify at-risk older ICU survivors during the early post-ICU transition period. Promotion of daytime activity and nighttime sleep may accelerate recovery and improve cognitive function.

Elevated homocysteine levels may moderate and mediate the association between HIV and cognitive impairment among middle-aged and older adults in an underserved population in Baltimore, Maryland.

Background: In the antiretroviral therapy (ART) era, HIV-associated neurocognitive disorders (HAND) remain a considerable challenge for people with HIV, yet not all such disorders can be attributed to HIV alone. This study aimed to: (1) identify factors influencing neurocognitive impairment (NCI) utilizing the NIH Toolbox Cognition Battery (NIHTB-CB) as per the revised research criteria for HAND; (2) ascertain the moderating role of high homocysteine levels in the association between NCI and HIV; and (3) assess the mediating effect of elevated homocysteine levels on this association.Methods: We analyzed data from 788 adults (≥45years) participating in a study on HIV-related comorbidities in underserved Baltimore communities, using NIHTB-CB to gauge neurocognitive performance. Special attention was given to results from the Dimensional Change Card Sort (DCCS) test within the executive function domain during causal mediation analysis.Results: Overall, HIV was not associated with NCI presence. However, HIV was associated with NCI among individuals with homocysteine >14μmol/L. Furthermore, HIV was both directly and indirectly associated with NCI in DCCS test scores. Notably, the mediating role of elevated homocysteine in DCCS scores was only observable among individuals who had never used cocaine or had used it for ≤ 10years, suggesting that extended cocaine use may have a substantial influence on cognitive performance.Conclusions: The findings from this study suggest elevated homocysteine levels may moderate and mediate the association between HIV and neurocognitive impairment.

Cognitive and Exercise Training Improves Intraindividual Variability in Cognitive Performance in Older Adults: Secondary Findings of A Randomized Controlled Trial

AbstractBackgroundIncreased intraindividual variability of cognitive performance is a marker of cognitive decline. Whether computerized cognitive training (CCT) and aerobic exercise counteracts cognitive decline by reducing intraindividual variability is unknown. We investigated the effects of CCT with or without aerobic exercise on reaction time intraindividual variability in older adults.MethodThis was a secondary analysis of an 8‐week randomized controlled trial. Older adults (aged 65‐85 years) were randomized to CCT alone (n = 41), CCT with aerobic exercise (n = 41), or an active control group (n = 42). The CCT group trained using the Fit Brains® platform 3×/week for 1 hour (plus 3×/week of home‐based training). The CCT with aerobic exercise group received 15 min of walking plus 45 min of Fit Brains® 3×/week (plus 3×/week of home‐based training). The control group received sham exercise and cognitive training (3×/week for 1 hour). We extracted reaction times from the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test (Flanker), and Pattern Comparison Processing Speed Test (PACPS). Intraindividual variability was measured as residual intraindividual standard deviation (residual ISD) of raw reaction time latencies. Residual ISD is an unbiased measure of variability that accounts for within and between participant source of variation that could influence reaction time latencies. We also calculated reaction time intraindividual SD (raw‐score ISD) and intraindividual coefficient of variation (ICV).ResultCompared with the control group, residual ISD improved in a processing speed task (PACPS) following CCT alone (mean difference [95% confidence interval]: ‐0.147 [‐0.230 to ‐0.065], p<0.001) and CCT with aerobic exercise (‐0.111 [‐0.195 to ‐0.027], p<0.01). Also, for processing speed, both CCT (‐0.173 [‐0.261 to ‐0.084], p<0.001) and CCT with aerobic exercise (‐0.122 [‐0.213 to ‐0.032], p<0.01) showed greater reduction in raw‐score ISD compared with controls, while only CCT reduced ICV for this task (‐0.108 [‐0.176 to ‐0.040], p<0.001). Inhibitory attention (Flanker) improved only after CCT with aerobic exercise (congruent = ‐0.128 [‐0.250 to ‐0.006], incongruent = ‐0.121 [‐0.237 to ‐0.005], both p<0.05).ConclusionA CCT program promoted cognitive health via reductions in intraindividual variability of cognitive performance and combining it with aerobic exercise resulted in broader benefits.

The risk of sleep‐related cognitive impairment increases in middle‐age to older adulthood

AbstractBackgroundThe association between sleep quality and cognition is widely established but the role of aging in this relationship has been unclear due to inconsistent findings with heterogeneous methods and a lack of studies in wide age ranges. The current study examined how age impacts the sleep‐cognition relationship using a large‐scale dataset with adults from young adulthood to older adulthood. Furthermore, we tested non‐linear effect of age to investigate the presence of age ranges in which the association between sleep and cognition is modified.MethodSample included 711 individuals (ages 36.00‐89.83, 59.66 ± 14.91, 55.7% female) from the Human Connectome Project‐Aging (HCP‐A). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and cognitive outcome measures included the NIH Toolbox fluid cognition (Dimensional change Card Sort Test, List Sorting Working Memory Test, Picture Sequence Memory Test, Pattern comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test) and crystallized cognition composite scores (Oral Reading Recognition Test and Picture Vocabulary Test), the Trail Making Test (TMT) A and B, and the Rey Auditory Verbal Learning Test (RAVLT). The association between sleep quality and cognitive performance was measured using linear regression models, with sex, race, use of sleep medication, and years of education as covariates. Age moderation was tested via the interaction between sleep and age on cognition, with age as linear and non‐linear (quadratic) terms.ResultThere was a significant interaction term between the PSQI and non‐linear age term (age2) on TMT‐B (p = 0.02) and NIH Toolbox crystallized cognition (p = 0.02), indicating that the association between poor sleep quality and cognitive performance was moderated by age. Further analyses indicated that there were “critical age ranges” in which the sleep‐cognition association was more salient (ages 50‐75 for TMT‐B and 66‐70 for crystallized cognition).ConclusionThe association between sleep quality and cognitive performance may be modified by age. Individuals of the middle‐age to early older adulthood may be more vulnerable to sleep‐related cognitive impairment, indicating the clinical importance of detection and treatment of sleep disturbance in this particular age group.

21 Comparison of the NIH Toolbox Cognition Battery to Established Performance-Based Assessments in a Pediatric Cancer Setting

Objective:This study examines the clinical validity of the NIH Toolbox Cognition Battery measures in patients with oncological diagnoses and tumor predisposition syndromes, including Neurofibromatosis, Type 1 (NF1).Participants and Methods:Participants included 158 patients (61% male, 67% White) ages 3 to 25 years (M = 8.38, SD = 4.32) who underwent neuropsychological evaluation between 2019 and 2022. Patients with brain tumors (n = 50) and leukemias (n = 49) accounted for 2/3 of the sample. The remainder had solid tumors, lymphomas, or cancer predisposition syndrome. Forty-eight had a diagnosis of NF1. Performance-based measures of attention, executive functioning, and processing speed were administered as part of neuropsychological evaluations. Patients were administered between 1 to 4 NIH Toolbox Cognition measures, including Flanker Inhibitory Control and Attention Test (Flanker), Dimensional Change Card Sort Test (DCCS), Pattern Comparison Processing Speed Test (PCCS), and List Sorting Test. Parent-reported measures of attention and EF were also obtained. Z-scores were used to compare performance across measures that assessed equivalent constructs. The rates of weak performance (>1 SD below the mean) using Toolbox measures were compared to rates of weak performance on traditional neuropsychological measures (e.g., Digit Span), and rates of functional impairment (e.g., parent-reported concerns, ADHD diagnosis).Results:FSIQ, Coding, and NEPSY Inhibition correlated with all 4 Toolbox measures, while Digit Span correlated with List Sorting, DCCS, and Flanker. DCCS and PCCS correlated with verbal fluency measures. NF1 patients scored lower than non-NF1 patients on Flanker, F(1,126) = 13.01, p<.001 and DCCS, F(1,150) = 6.85, p = .01. Toolbox performance did not differ significantly by age group. Rates of identified weakness were relatively similar on Toolbox measures, some traditional measures, and parent-reported attention problems. In identifying those with and without weakness, the agreement between Flanker and other measures ranged from 52% (Auditory Attention) to 66% (Coding). Agreement between DCCS and traditional measures ranged from 47% (Letter Fluency) to 80% (Switching). For PCCS, concordance ranged from 45% (Semantic Fluency) to 69% (Switching). List Sorting had 80% agreement with Digit Span and Coding.List Sorting had the highest agreement with parent-reported attention problems (76%), EF problems (72%), and ADHD diagnosis (79%). There was relatively high concurrence between DCCS and ADHD diagnosis (69%) and parent-reported attention problems (60%) and EF problems (65%) and between Flanker and ADHD diagnosis (67%). PCCS had less agreement with functional outcomes, ranging from 49% for EF problems to 58% for attention problems and ADHD diagnosis. In comparison, Digit Span had 64% agreement for EF problems, 70% for attention problems, and 73% for ADHD diagnosis.Conclusions:The NIH Toolbox Cognition Battery can be used to identify neurocognitive weaknesses in pediatric oncology patients and provide clinically meaningful data. Evaluation of the Toolbox measures’ sensitivity to change over time is warranted, as monitoring the progression of cognitive late effects is particularly salient in cancer survivorship.

90 Association Between Sedentary-To-Light Physical Activity Time Ratio and Cognitive Function in Bariatric Surgery Candidates

Objective:Class III obesity is associated with increased risk for cognitive impairment. Though hypothesized to be partially attributable to sedentary time (ST), past research examining the association between ST and cognitive function has produced mixed findings. One possible explanation is that studies do not typically account for the highly correlated and almost inverse relationship between ST and light intensity physical activity (LPA), such that ST displaces time engaging in LPA. Therefore, we aimed to evaluate whether: (1) higher ST-to-LPA time ratio associates with poorer performance across multiple cognitive domains in patients with Class III obesity seeking bariatric surgery; and (2) the associations differ by sex.Participants and Methods:Participants (N = 121, 21-65 years of age, BMI > 40 kg/m2) scheduled for either Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) completed the NIH Toolbox, a computerized neuropsychological assessment battery and wore a waist-mounted ActiGraph monitor during waking hours for 7 days to measure minutes/day spent in ST, LPA, and moderate-to-vigorous physical activity (MVPA). A ratio of time spent in ST-to-LPA was calculated by dividing the percentage of daily wear time spent in sedentary behavior (SB) by the percentage of daily wear time spent in LPA.Results:On average, participants (mean age = 43.22 years old and BMI = 45.83 kg/m2) wore the accelerometer for 909±176 minutes/day and spent 642±174 minutes/day in ST, 254±79 minutes/day in LPA, and 14±13 minutes/day in MVPA. Mean daily ST-to-LPA time ratio was 2.81 ± 1.3 (0.73-7.11). Overall, bivariate Pearson correlations found no significant relationships between LPA and cognitive performance on any of the NIH Toolbox subtests (r values = -.002 to -.158, all p values >.05). Additionally, bivariate Pearson correlations also found no significant relationships between daily ST-to-LPA time ratio and cognitive performance on any of the subtests (r values = .003 to .108, all p values >.05). However, higher ST-to-LPA was associated with lower scores on the Dimensional Change Card Sort Test in women (r = -.26, p = .01).Conclusions:Results showed that participants’ mean daily time spent in ST was 2.5 times higher than that spent in LPA and a higher ratio of ST-to-LPA was associated with poorer set-shifting in women with Class III obesity. Future studies should look to clarify underlying mechanisms, particularly studies examining possible sex differences in the cognitive benefits of PA. Similarly, intervention studies are also needed to determine if increasing LPA levels for individuals with Class III obesity would lead to improved cognitive performance by means of reducing ST.

Infant formula containing large, milk phospholipid-coated lipid droplets and dairy lipids affects cognitive performance at school age.

Breastfeeding has been positively associated with infant and child neurocognitive development and function. Contributing to this effect may be differences between human milk and infant formula in the milk lipid composition and milk fat globule structure. To evaluate the effects of an infant formula mimicking human milk lipid composition and milk fat globule structure on childhood cognitive performance. In a randomized, controlled trial, healthy term infants received until 4 months of age either a Standard infant formula (n = 108) or a Concept infant formula (n = 115) with large, milk phospholipid coated lipid droplets and containing dairy lipids. A breastfed reference group (n = 88) was included. Erythrocyte fatty acid composition was determined at 3 months of age. Neurocognitive function was assessed as exploratory follow-up outcome at 3, 4, and 5 years of age using the Flanker test, Dimensional Change Card Sort (DCCS) test and Picture Sequence Memory test from the National Institutes of Health Toolbox Cognition Battery. Mann-Whitney U test and Fisher exact test were used to compare groups. Erythrocyte omega-6 to -3 long-chain polyunsaturated fatty acid ratio appeared to be lower in the Concept compared to the Standard group (P = 0.025). At age 5, only the Concept group was comparable to the Breastfed group in the highest reached levels on the Flanker test, and the DCCS computed score was higher in the Concept compared to the Standard group (P = 0.021). These outcomes suggest that exposure to an infant formula mimicking human milk lipid composition and milk fat globule structure positively affects child neurocognitive development. Underlying mechanisms may include a different omega-3 fatty acid status during the first months of life. https://onderzoekmetmensen.nl/en/trial/28614, identifier NTR3683 and NTR5538.

Prenatal alcohol exposure and cognition at midlife: Evidence of fluid cognition deficits in two cohorts.

Prenatal alcohol exposure (PAE) impacts cognition in childhood and early adulthood. Here we evaluate the cognitive abilities of middle-aged adults with and without a history of PAE. Participants (N = 200) were recruited from longitudinal cohorts in the Atlanta and Seattle metropolitan areas and completed measures comprising the National Institutes of Health Toolbox's Fluid Cognition Composite. We found that individuals with PAE had lower Fluid Cognition Summary scores and lower Dimensional Change Card Sort and Flanker task subtest scores than non-PAE controls, after accounting for both potentially confounding demographic variables using propensity scores and the effects of study site. When we evaluated the effects of PAE with and without dysmorphic physical features, we found that middle-aged adults in both groups had lower fluid cognition scores than non-PAE controls. However, only the presence of PAE with dysmorphic features was associated with lower performance on the Dimensional Change Card Sort Test and Flanker tasks. While all participants with PAE had lower fluid cognition, those with PAE and dysmorphic features also exhibited specific deficits in their performance on measures of inhibition, attention, and cognitive flexibility. Thus, PAE is associated with ongoing cognitive deficits in middle adulthood, which can be observed most clearly among individuals with dysmorphic features.

Effect of Peanut Paste-based Ready-to-use School Meals With and Without Milk on Fluid Cognition in Northern Ghana: A Randomized Controlled Trial

BackgroundFew studies have investigated the role of school feeding in low- and middle-income countries as a means of improving childhood cognition. Peanut/milk ready-to-use food (PM-RUF) or cowpea offers an affordable, scalable option that might improve cognition. ObjectivesTo determine whether micronutrient-fortified PM-RUF or peanut/cowpea ready-to-use food (PC-RUF) would improve fluid cognition as assessed by 4 tests from the National Institutes of Health Toolbox Cognitive Battery when compared with a micronutrient-fortified millet porridge (FP) after a year of school feeding. MethodsAn individually randomly assigned, investigator-blinded, controlled clinical trial was conducted at 6 schools in Mion District in rural northern Ghana. Eight hundred seventy-one school children aged 5–12 y were randomly assigned and allocated to receive PM-RUF (n = 282), PC-RUF (n = 292), or FP (n = 297), each providing ∼400 kcal/d. The primary outcomes were 4 fluid cognition test scores: Dimensional Change Card Sort test, Flanker Inhibitory Control and Attention test, Pattern Comparison Processing Speed test, and a modified List Sorting Working Memory test. Secondary outcomes included a composite median ranking of the 4 primary outcomes and anthropometry changes. ResultsAmong the 871 participants (median age, 8.8 y; 47% female), 795 (91%) completed endline cognitive testing. Median attendance rates exceeded 87% in all groups. PM-RUF group demonstrated better fluid cognition on the Dimensional Change Card Sort test [odds ratio (OR): 1.5; 95% CI: 1.1, 2.0; P = 0.016] and Pattern Comparison Processing Speed test (OR: 1.4; 95% CI: 1.0, 1.9; P = 0.026) than FP, whereas there were no significant differences on Flanker Inhibitory Control and Attention or List Sorting Working Memory tests. PC-RUF group demonstrated no improvement over FP on any cognitive tests. PM-RUF group had superior fluid cognition composite median rankings (OR: 1.5; 95% CI: 1.1, 2.0; P = 0.007). ConclusionsAmong rural Ghanaian children aged 5–12 y, PM-RUF compared with FP resulted in superior fluid cognition.This trial was registered at clinicaltrials.gov as NCT04349007.

Computerized Cognitive Function Does Not Correlate With Choice Reaction Time During a Hopping Task.

Cognitive performance has been shown to be associated with musculoskeletal injury risk. Cognitive assessments are often administered in controlled environments despite sport settings challenging cognition in uncontrolled, less predictable environments. Cognitive assessments should be representative of sport demands; thus, integrating motor with cognitive assessments may be more clinically relevant. Accordingly, the purpose of this research was to investigate the relationship between tablet-based cognitive tests and choice reaction time during a hopping task. Cross-sectional. A total of 20 healthy participants volunteered to participate. Participants completed 3 tablet-based cognitive assessments. Average raw response time and fully corrected scores were used for analysis. In addition, participants completed a choice reaction hopping task to capture neuromuscular-cognitive reaction time. Participants completed a forward hop over a hurdle, landing on a single limb. Light sensors were utilized for the choice reaction component to capture reaction time in seconds, cue them when to hop, and indicate the landing limb. The relationship between the tablet-based cognitive assessments and reaction time during a hopping task was examined with Pearson correlations (α = .05). The choice reaction time from the hop task had a negligible correlation (r = -.20-.07) to the fully corrected tablet-based cognitive tests. The choice reaction time from the hop task had a negligible correlation (r = .02) to the average response time of the Pattern Comparison Processing Speed Test and a low correlation (r = .34-.36) to the Dimensional Change Card Sort Test and Flanker Inhibitory Control and Attention Test. This study determined that tablet-based cognitive assessments had trivial relationships to choice reaction time during a hopping task. This research has implications as clinicians aim to evaluate and analyze cognitive performance. Although reaction time was a critical component of all the assessments in this study, an individual's performance on a tablet-based assessment does not indicate performance during a functional reaction time assessment.

A Network Analysis of Executive Functions in Children and Adolescents With and Without Attention-Deficit/Hyperactivity Disorder.

This study applied network analysis to executive function test performances to examine differences in network parameters between demographically matched children and adolescents with and without attention-deficit/hyperactivity disorder (ADHD) (n = 141 per group; M = 12.7 ± 2.9years-old; 72.3% boys, 66.7% White, 65.2% ≥ 12years maternal education). All participants completed the NIH Toolbox Cognition Battery, including the Flanker, measuring inhibition, Dimensional Change Card Sort, measuring shifting, and List Sorting test, measuring working memory. Children with and without ADHD had comparable mean test performances (d range: .05-0.11) but presented with differences in network parameters. Among participants with ADHD, shifting was less central, had a weaker relationship with inhibition, and did not mediate the relationship between inhibition and working memory. These network characteristics were consistent with the executive function network structure of younger ages in prior research and may reflect an immature executive function network among children and adolescents with ADHD, aligning with the delayed maturation hypothesis.

Effects of home-based exergaming on preschool children’s cognition, sedentary behavior, and physical activity: A randomized crossover trial

PurposeExergaming’s potential to promote young children’s cognition and health remains largely unknown. This randomized crossover trial was to evaluate the preliminary effects of an educational exergaming program (LeapTV™) versus usual practice on preschool children’s executive function (EF), sedentary behavior (SB), and physical activity (PA). MethodsA total of 34 preschool children (17 girls, Mage=4.72 ± 0.73 years; BMI-z = 0.39 ± 1.08) were randomized to either exergaming (30 min/day, 5 days/week) or usual practice condition for 12 weeks, followed by a 1-week washout period (week 13) and a second 12-week crossover phase. The Dimensional Change Card Sort (DCCS) test was used to assess EF; SB, light PA, and moderate-to-vigorous PA (MVPA) were measured by ActiGraph GT3X+ accelerometers. All participants underwent identical assessments at baseline, week 13, and 26. ResultsAfter a 12-week intervention, both conditions displayed significant improvements in EF. Compared with usual practice, yet, exergaming increased children’s EF by 1.9 DCCS unit (95 % confidence interval [95 % CI], −0.34 to 4.04; d=0.22). Despite no other statistical differences were noted, compared with usual practice, exergaming decreased SB by 22.1 min (95 % CI, −25.22 to 18.98; d=0.29) and light PA by 9.56 min (95 % CI, −7.09 to −12.02; d=0.22), and increased MVPA by 4.05 min (95 % CI, 2.35–5.74; d=0.20). ConclusionThis study demonstrates the LeapTV™ would promote meaningful improvements in preschool children’s EF and PA behaviors. Despite the promising efficacy, larger trials are needed to confirm our findings.

240: ASSOCIATIONS BETWEEN ACTIVITY AND COGNITIVE FUNCTION IN OLDER INTENSIVE CARE UNIT SURVIVORS

Introduction: Critically ill older adults are profoundly inactive while in ICU; therefore, activity promotion after ICU discharge is crucial for recovery. Poor cognitive function predicts institutionalization (i.e., discharge to long-term care facility). We calculated a ratio of daytime-to-nighttime activity among older ICU survivors during the early post-ICU transition period. We hypothesized that higher daytime-to-nighttime activity ratios (i.e., proportionally higher activity during daytime hours) would be associated with better cognitive function. Methods: This was a secondary analysis of pooled data from 2 primary studies of older adults (n = 44) who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24-48 hours post-ICU discharge. Actigraphy recorded daytime activity (mean activity counts/minute, 06:00 AM-21:59 PM) and nighttime activity (mean activity counts/minute, 22:00 PM-05:59 AM). We calculated a daytime-to-nighttime activity ratio by dividing daytime activity by nighttime activity. The NIH Toolbox Dimensional Change Card Sort Test assessed cognitive flexibility (DCCST: fully-corrected T score). Multivariate regression examined the association between the daytime-to-nighttime activity ratio and DCCST scores, adjusting for 3 covariates (age, CAM-S delirium severity score, and NIH Toolbox Grip Strength fully-corrected T score). Results: The mean daytime-to-nighttime activity ratio was 2.10 ± 1.17 (IQR: 1.42). Ratios for 6 (13%) participants were less than 1—these participants were proportionally more active during nighttime hours, rather than daytime hours. Higher ratios were associated with better DCCST scores (β = 0.288, p = .015). Conclusions: Among this cohort of older ICU survivors, the proportion of daytime activity versus nighttime activity was considerably low, indicating severe alterations in the rest/activity and sleep/wake cycles. Higher daytime-to-nighttime activity ratios were associated with better executive function scores, suggesting that daytime inactivity and sleepiness may be an indicator of worse cognitive outcomes. Assessment and promotion of daytime activity and nighttime sleep could identify at-risk older ICU survivors during the early post-ICU transition period.

Silent Cerebral Infarction during Immune TTP Remission - Prevalence, Predictors and Impact on Cognition

BACKGROUND: Immune thrombotic thrombocytopenic purpura (iTTP) survivors are at increased risk cardiovascular events including stroke, which is associated with low remission ADAMTS13 activity. In the prospective Neurologic Sequelae of TTP (NeST) study, we evaluated the prevalence of silent cerebral infarction (SCI, ischemic lesions on brain MRI without overt neurodeficits that are a risk factor for future stroke), identified risk factors for SCI, and examined the association of SCI with cognitive impairment, which is prevalent in iTTP survivors. METHODS: We prospectively enrolled adult (age ≥ 18 years) patients with iTTP based on ADAMTS13 activity <10% during an acute episode. All study assessments were performed after achieving hematological remission. Participants undergo annual study visits that include: 1) Brain MRI: SCI is defined as a infarct like lesion (punctate T2 and FLAIR hyperintensity) ≥3 mm in size without corresponding neurodeficits., 2) NIH ToolBox Cognition battery, an extensively-validated tool that tests multiple cognitive domains including executive function (dimensional change card sort test, flanker inhibitory control and attention test), processing speed (pattern comparison test), episodic memory (picture sequence memory test), working memory (list sorting working memory test), language (oral reading recognition, picture vocabulary test). Fully-corrected T scores (normative mean 50, SD 10) adjusted for age, sex, race and educational attainment are computed for individual tests as well as composite scores for fluid cognition, crystallized cognition and total cognition. Mild and major cognitive impairment are defined as a T scores that are 1-2 SD below mean and > 2 SD below mean for any domain, respectively; 3) the Beck depression inventory was also completed since depression is a potential confounder that is common in iTTP and may contribute to impaired cognition. RESULTS: Between September 2020 and July 2022, 39 iTTP patients were enrolled; 32 patients completed MRI (2 excluded due to metal implant/shrapnel, 4 stopped for anxiety/claustrophobia). Median age was 48 years, 71% were female, and 23% had previous stroke (including during acute iTTP). Prevalence and predictors of SCI: MRI showed SCI in 53.1% (Figure 1). Only 47% (8/17) patients with SCI had prior overt stroke. Age [OR 1.07 (95% CI 1.01-1.15, P=0.025) and history of stroke [OR 12.8 (95% CI 1.07-152.9), P=0.044] were associated with SCI in a logistic regression model adjusted for number of iTTP episodes [OR 1.14 (95% CI 0.71-1.86), P=0.570], hypertension [OR 0.77 (95% CI 0.14 - 4.25), P=0.768], and Black race [OR 2.10 (95% CI 0.16-28.20], P=0.574]. SCI is associated with cognitive impairment: Mild and major cognitive impairment were present in 23.1% and 30.8%, respectively. Deficits most commonly involved executive function (flanker inhibitory control and attention test, dimensional change card sort test) and processing speed (pattern comparison test). Compared to patients without SCI, those with SCI had higher rates of cognitive impairment (70.5% vs. 26.7%) including major impairment (52.9% vs. 6.7%) (P=0.014) (Figure 2). In logistic regression models adjusted for age and prior stroke, SCI was associated with major cognitive impairment [OR 18.13 (95% CI 1.3-259.1), P=0.033] as well as mild cognitive impairment [OR 7.76 (95% CI 1.03-58.29]. Patient with SCI had lower composite scores on the NIH ToolBox cognition battery [fluid cognition composite 41 vs. 55, P=0.009, crystallized composite 50 vs. 60, P=0.033, total composite 46 vs, 59, P=0.004), as well as lower scores on tests of executive function (flanker inhibitory control and attention, P=0.020) and processing speed (pattern comparison test, P=0.004), which are most commonly affected in iTTP. Patients with SCI did not have higher mean Beck Depression inventory scores (12.0 ± 7.8 vs. 11.67 ± 11.5, P = 0.659) than those without SCI suggesting that the association with cognitive performance is not due to higher rates of depression in this group. CONCLUSIONS: MRI evidence of brain infarction is common in patients with iTTP with or without a clinical history of stroke. Ongoing follow up with serial MRI continues and will inform whether SCI are progressive in remission and whether low remission ADAMTS13 is a targetable risk factor. The strong association of SCI with impaired cognition suggests that these 'silent infarcts' are neither silent nor innocuous. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Preliminary Exploration of the Psychological Risk Factors for Childhood Animal Cruelty: The Roles of Attachment, Self-Regulation, and Empathy

ABSTRACT Despite growing awareness of the psychological issues associated with childhood animal cruelty, there is a scarcity of research carried out directly with children. This study investigates the psychological factors influencing the likelihood of a child harming animals, specifically the roles of attachment, empathy, executive functioning, issues related to externalizing behavior, and Callous Unemotional (CU) traits. The sample comprised children at high risk of animal harm referred to the Scottish Society for the Prevention of Cruelty to Animal’s Animal Guardians program (n = 9) and low-risk controls (n = 18) matched for age and school class. A range of assessment techniques was used over three interview sessions for each child. Externalizing problems were measured using teacher reports; attachment was blind-coded using the Child Attachment Play Assessment; executive functioning was assessed using a Dimensional Change Card Sort (DCCS); and empathy was measured using self-report and picture-based tasks, the Kids Empathy Development Scale. Children at high risk of animal harm were more likely to be insecurely attached (p = 0.002), scored significantly higher on Strengths and Difficulties (U = 1.5, p < 0.001) and CU traits (U = 6.4, p = 0.001) as rated by their teachers, scored lower on cognitive empathy (U = 36.5, p = 0.043), and performed more poorly on the DCCS test of executive functioning (U = 31.0, p = 0.014). No significant differences were found between high-risk and low-risk children on self-reported empathy or emotion recognition. We also found that insecure attachment was related to an increased score for many psychological risk factors. This exploratory study demonstrates that childhood animal harm can act as an indicator of a range of psychological issues and highlights the importance of designing appropriate interventions for this vulnerable population.

Dissociable language and executive control deficits and recovery in post-stroke aphasia: An exploratory observational and case series study

A growing body of evidence indicates many, but not all, individuals with post-stroke aphasia experience executive dysfunction. Relationships between language and executive function skills are often reported in the literature, but the degree of interdependence between these abilities remains largely unanswered. Therefore, in this study, we investigated the extent to which language and executive control deficits dissociated in 1) acute stroke and 2) longitudinal aphasia recovery. Twenty-three individuals admitted to Johns Hopkins Hospital with a new left hemisphere stroke completed the Western Aphasia Battery-Revised (WAB-R), several additional language measures (of naming, semantics, spontaneous speech, and oral reading), and three non-linguistic cognitive tasks from the NIH Toolbox (i.e., Pattern Comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test, and Dimensional Change Card Sort Test). Two participants with aphasia (PWA) with temporoparietal lesions, one of whom (PWA1) had greater temporal but less frontal and superior parietal damage than the other (PWA2), also completed testing at subacute (three months post-onset) and early chronic (six months post-onset) time points. In aim 1, principal component analysis on the acute test data (excluding the WAB-R) revealed language and non-linguistic executive control tasks largely loaded onto separate components. Both components were significant predictors of acute aphasia severity per the WAB-R Aphasia Quotient (AQ). Crucially, executive dysfunction explained an additional 17% of the variance in AQ beyond the explanatory power of language impairments alone. In aim 2, both case patients exhibited language and executive control deficits at the acute post-stroke stage. A dissociation was observed in longitudinal recovery of these patients. By the early chronic time point, PWA1 exhibited improved (but persistent) deficits in several language domains and recovered executive control. In contrast, PWA2 demonstrated mostly recovered language but persistent executive dysfunction. Greater damage to language and attention networks in these respective patients may explain the observed behavioral patterns. These results demonstrate that language and executive control can dissociate (at least to a degree), but both contribute to early post-stroke presentation of aphasia and likely influence longitudinal aphasia recovery.

An exploratory study of the relationship between motor skills and indicators of cognitive and socio-emotional development in preschoolers

ABSTRACT Motor skills develop rapidly during early childhood and are considered important for optimal child development. However, little is known about the relationship of motor skills with indicators of cognitive and socio-emotional development in typically developing preschoolers. In view of this, the present study examined the association of gross motor and fine motor skills with executive functions and prosocial behaviour in preschoolers. The study sample consisted of 111 participants between 3 and 5 years of age, who were assessed using the short version of the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2); the head-toes-knees-shoulders task; the Corsi block-tapping test (CBTT); the dimensional change card sort test (DCCS); and a teacher-rated prosocial behaviour questionnaire (PBQ). The results revealed significant positive associations between motor skills and executive functions as well as prosocial behaviour. Specifically, fine motor skills were twice as strong as a predictor for response inhibition compared to gross motor skills whereas gross motor skills dominated over fine motor skills in predicting prosocial behaviour. The findings of the study highlight the need to promote motor skills during early years of development.

Skin carotenoid content is associated with speed of processing in cognitively normal older adults

AbstractBackgroundBrain and retinal carotenoid content have been linked to cognitive function in older adults. Although skin carotenoid is correlated with retinal content, the relationship of skin carotenoid and cognition in older adults is unknown. Measurement of skin carotenoid is non‐invasive, quick, and easy to obtain. The purpose of this study was to evaluate the relationship between skin carotenoid concentration and cognitive performance in a population of cognitively normal, older adults.MethodBaseline data from 101 cognitively normal older adults participating in a nutrition intervention study (Nutrition Interventions for Cognitive Enhancement study; NICE study) were analyzed. Skin carotenoid content was measured using pressure‐mediated reflection spectroscopy by the Veggie Meter® (Longevity Link Corporation). A comprehensive cognitive battery was conducted by a trained psychometrician. The NICE cognitive battery includes three age and education corrected cognition tests from the NIH‐Toolbox Cognition Battery – the Pattern Comparison Processing Speed, Flanker Inhibitory Control and Attention, and Dimensional Change Card Sort Tests. We tested the relationship between skin carotenoid content and corrected NIH‐Toolbox test T‐scores using ordinary least squares regression adjusted for sex and BMI. Statistical model assumptions were evaluated through residual analyses. Statistical analyses were performed using R (v. 3.6.2; R Foundation, Vienna, Austria) and statistical significance was set at p &lt; 0.05.ResultMost participants were female (80.2%) and overweight (BMI of 28.3 ± 4.5 kg/m2) with a mean age of 71.8 ± 4.9 years. Mean skin carotenoid content was 275.1 ± 81.8. Higher skin carotenoid content was correlated with faster speed of processing (Pattern Comparison Processing Speed Test: b = ‐0.21, p = 0.03), but skin carotenoids were not related to tests of attention or executive function (Flanker Inhibitory Control and Attention Test: b = 0.12, p = 0.26 and Dimensional Change Card Sort Test: b = 0.07, p = 0.47).ConclusionThe measurement of skin carotenoids may be a useful tool to identify a modifiable risk factor for Alzheimer’s Disease. These findings will be further investigated utilizing the final sample size of the NICE Study (n=200).

Relationships between Freezing of Gait Severity and Cognitive Deficits in Parkinson’s Disease

Freezing of gait (FOG) is one of the most debilitating motor symptoms experienced by patients with Parkinson’s disease (PD), as it can lead to falls and a reduced quality of life. Evidence supports an association between FOG severity and cognitive functioning; however, results remain debatable. PD patients with (PDFOG+, n = 41) and without FOG (PDFOG–, n = 39) and control healthy subjects (n = 41) participated in this study. The NIH toolbox cognition battery, the Montreal Cognitive Assessment (MoCA), and the interval timing task were used to test cognitive domains. Measurements were compared between groups using multivariable models and adjusting for covariates. Correlation analyses, linear regression, and mediation models were applied to examine relationships among disease duration and severity, FOG severity, and cognitive functioning. Significant differences were observed between controls and PD patients for all cognitive domains. PDFOG+ and PDFOG– exhibited differences in Dimensional Change Card Sort (DCCS) test, interval timing task, and MoCA scores. After adjusting for covariates in two different models, PDFOG+ and PDFOG– differed in both MoCA and DCCS scores. In addition, significant relationships between FOG severity and cognitive function (MoCA, DCCS, and interval timing) were also found. Regression models suggest that FOG severity may be a predictor of cognitive impairment, and mediation models show the effects of cognitive impairment on the relationship between disease severity and FOG severity. Overall, this study provides insight into the relationship between cognitive and FOG severity in patients with PD, which could aid in the development of therapeutic interventions to manage both.