Executive Functions In Patients Research Articles

Association between the performance of executive function and the remission of depressive state after clinical treatment in patients with depression

BackgroundPrevious studies have reported that patients with depression have significant cognitive impairment. The aim of this study is to comprehensively evaluate the impairment of executive functions in patients with depression and whether the cognitive behavior performance of executive function is association with remission of depressive state after clinical treatment. MethodsWe used cognitive-behavioral test to evaluate the performance of executive functions of 95 inpatients with depression before hospitalization and conducted two follow-up evaluations of their depression status on the 15th day of hospitalization and approximately 9 months after discharge. ResultsThe performance of executive function except the accuracy of inhibition control in patients with depression were significantly worse than that of healthy controls. Multivariate linear regression analysis found that the reaction time of working memory not only had a significant linear relationship with the baseline depression scores of patients with depression, but also had a significant linear relationship with the reduced depression scores after two follow-up visits. LimitationsWe only used cognitive-behavioral data as indicators to evaluate the cognitive performances of participants and only measured three components of executive function. ConclusionsThe reaction time of working memory was a stable and effective predictor of symptom relief in patients with depression after clinical treatment. These results provide initial evidence for working memory to predict the clinical prognosis of inpatients with depression prospectively, which could be further leveraged to improve intervention approaches and analyze the heterogeneity of depression.

H-coil repetitive transcranial magnetic stimulation does not improve executive function in patients with chronic peripheral neuropathic pain: a randomized sham-controlled crossover study

IntroductionDeep rTMS is an increasingly popular noninvasive brain stimulation technique which has shown promise for treating cognitive impairments. However, few studies have investigated the cognitive effects it could exert in patients with chronic peripheral neuropathic pain. Therefore, we aimed to assess the effects of deep rTMS on executive functioning in patients with peripheral neuropathic pain, in a randomized, double-blind crossover trial.MethodsIn total, 17 patients were randomly assigned to receive both active and sham deep H-coil rTMS targeting the primary motor cortex. Each treatment period consisted of five daily rTMS sessions. Selected tests of executive functioning from the CANTAB test battery (paired associates learning, stop signal task, spatial working memory and multitasking test) were performed at baseline, and at 1 week and 3 weeks follow-ups.ResultsWe did not find any significant interactions between time and treatment for the measures of executive functioning for the patient group, or for patients with reduced cognition compared to normative means.ConclusionHigh-frequency deep H-coil rTMS targeting the hand area of the primary motor cortex and delivered over 5 consecutive days did not improve executive functioning in patients with chronic peripheral neuropathic pain.Clinical trial registrationhttps://clinicaltrials.gov/, identifier NCT05488808.

Performance of the Wisconsin Card Sorting Test in Oncopediatric Patients in an Oncology Unit in Cali, Colombia: A Cross-Sectional Observational Study

Background: In 2020, the prevalence of cancer rose to 844,778 cases among the population aged 0–19 years. Approximately 90% of individuals under 18 years of age reside in low- and middle-income countries, where cancer survivors report adverse outcomes that negatively impact their general health, emotional state, and external factors such as academic performance due to the effect of these outcomes on executive functions. The Wisconsin Cart Sorting Test (WCST) is the gold standard for evaluating executive functioning. Therefore, this article (1) reports the performance of the Wisconsin Card Sorting Test (WCST) in oncopediatric patients from Cali, Colombia; (2) indicates the reliability of the WCST; (3) describes the association between cancer type and executive functioning in patients; (4) describes the differences between patients with various executive deficits and their executive total scores; and (5) describes the association between cancer type and the presence of brain deficits based on the WCST. Methods: In this cross-sectional observational study, 24 oncopediatric patients were interviewed and evaluated via the WCST. Results: The mean age was 12.08 years (SD 3.98); 20.8% of the patients were women, 70.8% had a primary diagnosis of leukemia, 8% exhibited acquired brain deficits, and more than 75% displayed adequate functional indicators of executive functions. Robust statistics were employed to explore the differences between the types of diagnosis and performance in executive functions, and no statistically significant differences were found (p = 0.156). We found that the WCST has a reliable Cronbach’s α of 0.804. Oncopediatric patients without brain deficits presented strong results in terms of executive functions (p = 0.002), with a moderate effect size (0.727). Conclusions: The WCST is reliable for discriminating executive functioning among pediatric cancer patients. The evidence suggests that there were no differences in the executive functioning of the participants based on the types of cancer being evaluated.

Executive Functions’ Alterations In Obsessive-Compulsive Disorder: A Systematic Literature Review

Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder characterized by persistent obsessive and compulsive symptoms. Dysfunctions in two inhibitory systems related to cognitive and behavioral processes are believed to be associated with the pathophysiology of OCD. These dysfunctions can affect not only the cognitive and behavioral symptoms, but also the neuropsychological deficits observed in this disorder, such as attention, memory, planning, and decision-making. This study presents a systematic literature review aiming to investigate alterations in executive functions in individuals with OCD. The search was conducted in the Scopus and Scielo databases, resulting in a final sample of 13 articles that met the inclusion criteria. The results indicated deficiencies in executive functions and non-verbal memory in patients with OCD when compared to healthy control groups. However, there were inconsistencies in the results across studies, possibly due to the variety of tests used and the complexity of the disorder. Therefore, it is important to consider factors such as cultural differences, medication use, and socioeconomic factors when interpreting the results, as these aspects can influence the study outcomes. Additionally, there are still gaps in understanding the alterations in executive functions in patients with OCD, requiring further research for a better comprehension of this relationship.

The comparison of hot and cold executive functions in patients with bipolar II disorder, borderline personality disorder, and healthy individuals.

Differential diagnosis of bipolar II disorder (BD-II) and borderline personality disorder (BPD) has always been challenging for clinicians due to symptoms' overlap. This study aimed to compare hot and cold executive functions (EFs) in BD-II patients, as well as BPD and healthy controls (HCs), in order to differentiate these two disorders. In the present study, 30 BD-II and 30 BPD patients undergoing the drug therapy with mood stabilizers, and 30 HC were examined using EFs evaluated tests. The data were then analyzed using ANOVA and Tukey post hoc test. The BD-II Patients performed significantly less in all cold EFs than the HC. Also, BPD patients had meaningfully lesser performance compared to HC in all cold EFs except sustained attention. No significant difference was perceived between the two patient groups in the cold EFs. In BD-II patients, the risky decision-making as a hot EFs' component was not significantly different from HC; nevertheless, its amount was significantly higher in BPD than in the HC and BD-II patients. These findings underline the differences between the two mentioned disorders based on the hot EFs, which may indicate further disorder in the emotional information processing system among the BPD patients.

Executive function in patients with Parkinson disease

Executive function in patients with Parkinson disease

Abnormalities of regional brain activity and executive function in patients with temporal lobe epilepsy: A cross-sectional and longitudinal resting-state functional MRI study.

We decided to track changes in regional brain activity and executive function in temporal lobe epilepsy (TLE) patients based on cross-sectional and longitudinal designs and sought potential imaging features for follow-up observation. Thirty-two TLE patients and thirty-three healthy controls (HCs) were recruited to detect changes in fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) and to evaluate executive function both at baseline and at two-year (23.3 ± 8.3months) follow-up. Moreover, multivariate pattern analysis (MVPA) was used for follow-up observation. TLE patients displayed lower fALFF values in the right superior frontal gyrus (SFG) and higher ReHo values in the left putamen (PUT) relative to the HCs. Longitudinal analysis revealed that TLE patients at follow-up exhibited higher fALFF values in the left postcentral gyrus (PoCG), higher ReHo values in the left PoCG and the right middle frontal gyrus (MFG), lower ReHo values in the bilateral PUT and the right fusiform gyrus (FFG) compared with these patients at baseline. The executive function was impaired in TLE patients but didn't deteriorate over time. No correlations were discovered between regional brain activity and executive function. The MVPA based on ReHo performed well in differentiating the follow-up group from the baseline group. We revealed the abnormalities in regional brain activity and executive function as well as their longitudinal trends in TLE patients. The ReHo might be a good imaging feature for follow-up observation.

Effects of movement training based on rhythmic auditory stimulation in cognitive impairment: a meta-analysis of randomized controlled clinical trial.

According to the World Alzheimer's Disease Report in 2015,there were 9.9 million new cases of dementia in the world every year. At present, the number of patients suffering from dementia in China has exceeded 8 million, and it may exceed 26 million by 2040.Mild cognitive impairment (MCI) refers to the pathological state of pre-dementia with the manifestation of the progressive decline of memory or other cognitive functions but without decline of activities of daily life. It is particularly important to prevent or prolong the development of MCI into dementia. Research showing effects of rhythmic auditory stimulation based-movement training(RASMT) interventions on cognitive function is also emerging. Therefore, the present meta-analysis briefly summarize findings regarding the impacts of RASMT programs on cognitive impairment. Data from Pubmed, Embase, and Cochrane Library were utilized. The impact of RASMT on cognitive functions was evaluated using indicators such as overall cognitive status, memory, attention, and executive functions. The REVMAN5.3 software was employed to analyze bias risks integrated into the study and the meta-analysis results for each indicator. A total of 1,596 studies were retrieved, of which 1,385 non-randomized controlled studies and 48 repetitive studies were excluded. After reviewing titles and abstracts of the remaining 163 articles, 133 irrelevant studies were excluded, 30 studies were downloaded and read the full text. Among 30 articles, 18 articles that did not meet the inclusion criteria were excluded, the other 12 studies were included in this meta-analysis. Utilizing the Cochrane Collaborative Network Bias Risk Assessment Scale, it was found that 11 studies explained the method of random sequence generation, nine studies did not describe allocation concealment, four were single-blinded to all researchers, and eight reported single-blinding in the evaluation of experimental results. In the meta-analysis, the main outcomes showed statistically significant differences in overall cognitive status [MD = 1.19, 95%CI (0.09, 2.29), (p < 0.05)], attention [MD = -1.86, 95%CI (-3.53, -0.19), (p < 0.05)], memory [MD = 0.71, 95%CI (0.33, 1.09), (p < 0.01)], and executive function [MD = -0.23, 95% CI (-0.44, -0.02), (p < 0.05)]. Secondary outcomes indicated no statistically significant differences in verbal fluency [MD = -0.51, 95%CI (-1.30, 0.27), (p = 0.20)], while depression [MD = -0.29, 95% CI (-0.42, -0.16), (p < 0.01)] and anxiety [MD = 0.19, 95% CI (0.06, 0.32), (p < 0.01)] exhibited statistically significant differences. The GRADEpro GDT online tool assessed the quality of evidence for the outcome measures, revealing one low-quality outcome, two moderate-quality outcomes, and one high-quality outcome in this review. This study shows that RASMT can improve the general cognitive status, memory, attention and executive function of patients with cognitive impairment. The quality of evidence revealed that MMSE was low, attention and memory were moderate, and executive function was high. The RAMST program (type of exercise: play percussion instruments; time of exercise: 30-60 min; frequency of exercise: 2-3 times/week; duration of exercise: more than 12 weeks) was proved to be more effective in improving cognitive function. However, the sample size is relatively insufficient, the future needs further study. PROSPERO, identifier: CRD42023483561.

Attention and executive function impairments in obstructive sleep apnea are associated with decreased sleep spindles.

Sleep spindles play a key role in sleep-mediated cognitive processes. Cognitive functions are well-known to be affected in obstructive sleep apnea (OSA). Here, we analyzed attention and executive functions in patients with OSA and investigated the relationship between sleep spindles and cognitive abilities. Sixty patients with OSA (18-65years, 19 females and 41 males) and a control group (n = 41) including age-and sex-matched healthy individuals were consecutively and prospectively enrolled. All participants had a full-night polysomnography, and sleep spindles were analyzed using a semi-automated program. For the evaluation of short-term memory, attention and executive functions, Stroop test, forward and backward digit span tests were applied to all participants upon awakening following polysomnography. Scores of forward and backward digit span and Stroop tests were worse in OSA patients in compared to those in controls. Mean density of sleep spindles was decreased in OSA patients than those in controls (p = 0.044). A positive correlation was found between fast sleep spindle frequency and forward digit span (r = 2.222; p = 0.038) and backward digit span test scores (r = 2,157; p = 0.042) in OSA patients. In patients with moderate to severe OSA, sleep spindle density was positively correlated with forward (r = 2.323, p = 0.029) and backward (r = 2.500, p = 0.016) DSTs, and the duration of sleep spindles had positive correlation with backward DST (r = 2.452, p = 0.010). Our findings demonstrated that the disturbances in sleep spindle characteristics in OSA are associated with the cognitive impairments in attention, short-term memory, and executive functions, especially in patients with moderate to severe OSA.

The Effects of Different Exercise Interventions on Patients with Subjective Cognitive Decline: A Systematic Review and Network Meta-Analysis

Background and ObjectiveExercise is a promising non-pharmacological therapy for subjective cognitive decline, but it is unclear which type of exercise is most effective. The objective was to assess the comparative effects and ranks of all exercise-based interventions on cognitive function in patients with subjective cognitive decline (SCD).MethodIn this network meta-analysis, Online databases for Web of Science, PubMed, Embase, Medline, Cochrane Library and PsycINFO were searched from inception to April 30, 2023. The included studies are randomized controlled trials assessing the efficacy of exercise interventions for individuals with SCD. The primary outcome measure is memory, while secondary outcome measures encompass executive function, attention, verbal fluency, and global cognitive function. Represented using Standardized Mean Differences (SMDs) along with their 95% Confidence Intervals (CIs). Bias assessment was conducted in accordance with the ‘Cochrane Risk of Bias Assessment Tool, 2nd Edition’ (RoB 2). Pairwise meta-analysis was carried out using the ‘meta-analysis’ module within STATA 14.0, and network meta-analysis was performed using the ‘mvmeta’ and ‘network’ packages available in STATA 14.0. Registration number CRD42023289687.ResultThis study included a total of 11 randomized controlled trials, encompassing 1,166 patients. Mind-body exercise was found to be efficacious in enhancing or sustaining memory (SMD: 0.58, 95%CI: 0.06 ∼ 1.10) and executive function (SMD: 0.41, 95%CI: 0.09 ∼ 0.73) in individuals with subjective cognitive decline. Furthermore, mind-body exercise exhibited the highest probability of being the most effective measures for improving or preventing the decline in memory (surface under cumulative ranking curve (SUCRA) value: 90.4) and executive function (SUCRA value: 91.8). The second-ranked moderate-intensity aerobic exercise has also shown a positive effect on the improvement of executive function in patients with subjective cognitive decline (SMD: 0.23, 95%CI: 0.03 ∼ 0.43, SUCRA value: 68.2). However, we did not observe a significant effectiveness of exercise interventions on verbal fluency, attention, and overall cognitive function in subjective cognitive decline.ConclusionMind-body exercise may potentially be the optimal strategies for enhancing memory and executive function in individuals with subjective cognitive decline. Additionally, moderate-intensity aerobic exercise has shown a modest positive effect on executive function in subjective cognitive decline. When resources permit, practical application of these findings may be considered. Nevertheless, further support for the conclusions of this study is warranted through larger sample sizes and well-designed multicenter trials.

Executive functions in patients with bilateral and unilateral peripheral vestibular dysfunction.

Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.

Bibliographical Review on Rehabilitation of Executive Functions in Patients With Developmental Coordination Disorder (DCD)

Bibliographical Review on Rehabilitation of Executive Functions in Patients With Developmental Coordination Disorder (DCD)

Abstract WMP32: Effect of Immersive Motor-Cognitive Training on Executive Function in Patients With Vascular Mild Cognitive Impairment: Aquasi-Experimental Study

Background: Cerebrovascular disease is a common cause of vascular cognitive impairment (VCI) and may progress to vascular dementia at a relatively fast rate. Strengthening intervention in patients with mild VCI can delay cognitive decline and prevent vascular dementia. Purpose: To investigate the effect of an immersive motor-cognitive training program on executive function in patients with mild VCI. Methods: A total of 60 patients with mild VCI were divided into two groups: the intervention group (n=30) and control group (n=30). The participants were recruited from an outpatient Neurology clinic between May 2021 and January 2022. The intervention group was received immersive motor-cognitive training for 2 months, while the control group was received traditional motor-cognitive training during the same duration. Before the intervention and at the end of the first and second months of the intervention, executive function was assessed as the primary outcome using the Trail-Making Test (TMT)-A/B. General cognitive, speech function and balance function were evaluated as secondary outcomes using the Mini-Mental State Examination (MMSE)/Montreal Cognitive Assessment (MoCA), Boston Naming Test, and Berg Balance Scale, respectively. Data analysis was performed using independent sample t-test, Chi-Square test, nonparametric test, and generalized estimation equation model. Results: Among 60 patients, 54 were completed the 2 month-follow-up. Our results showed that there is a significant time effect ( F =14.36, P =0.001) regarding the TMT-A score. In addition, significant time (F=7.28, P =0.001) and interaction effects (F=7.43, P =0.001) on the TMT-B score were noted. The MMSE score showed significant time (F=64.66, P =0.001) and interaction effects (F=12.01, P =0.002), and similar results were observed for the MoCA score with significant time (F=38.29, P=0.001) and interaction effects (F=22.89, P =0.001). The time effect of the Boston Naming Test score was also found to be statistically significant ( F =2.92, P =0.003). However, no significant differences were observed in the Berg Balance Scale score. Conclusion: Immersive motor-cognitive training may improve the executive function and general cognitive function in patients with mild VCI.

Functional MRI to Evaluate Inhibition As a Feature of Executive Function in Patients with Sickle Cell Disease Post HSCT: A Pilot Study

Functional MRI to Evaluate Inhibition As a Feature of Executive Function in Patients with Sickle Cell Disease Post HSCT: A Pilot Study

Screening for Executive Impairment in Patients with Frontotemporal Dementia: Evidence from the Greek Version of the Frontier Executive Screen.

The aim of the present study was to adjust the frontier executive screen (FES) for the Greek population, to develop normative data, and to investigate its ability to discriminate patients diagnosed with frontotemporal dementia from healthy individuals. The FES was administered to 142 community-dwelling healthy adults (age: M = 65.9, SD = 8.5; education: M = 10.8, SD = 4.3; sex: 59% female) and 32 patients diagnosed with frontotemporal dementia (age: M = 69.3, SD = 8.6; education: M = 11.7, SD = 4.8; sex: 31% female). Correlation and regression analyses were performed to determine the association between the FES scores, demographic, and clinical characteristics. Cronbach's α coefficient was used to determine internal consistency. Group differences on the FES were examined with independent samples t-test and Mann-Whitney test. Discriminant and ROC analyses were used to determine diagnostic accuracy and to identify the optimal cutoff score for the discrimination between groups. Regression analyses indicated associations between demographic characteristics and FES scores (age: R2 = .08; education: R2 = .33). Internal consistency was marginally acceptable (α = .69). Patients scored lower than healthy participants on the total FES score (d = 1.91) and its three subscores (verbal fluency: η2 = .60; inhibition: η2 = .52; working memory: d = 0.90). The results indicated high diagnostic accuracy (94%) and the optimal cutoff score was 7 (91% sensitivity, 78% specificity). The Greek version of the FES is a useful tool for the brief evaluation of executive functions in patients diagnosed with frontotemporal dementia.

Effectiveness of Mindfulness-Based Stress Reduction on Executive Functions in Patients with Hypertension: A Randomized Clinical Trial

Background: Hypertension one of the main risk factors of cardiovascular diseases and premature death worldwide. Researches indicate different cognitive activities and executive functions in cardiovascular and hypertension patients compared to non-afflicted people. Objectives: Therefore, the purpose of this study was to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on executive functions in patients with hypertension. Materials &amp; Methods: The present study was a randomized clinical trial based on the pre-test, post-test, follow-up design. The statistical population consisted of all the people with hypertension who referred to Heshmat Heart Hospital in Rasht city, Iran, in 2021. Thirty-four qualified volunteers were included in the study by purposive sampling method and randomly assigned to two groups of MBSR and control. Wisconsin Card Sorting Test (computer version) were the instrument employed in this research; and MBSR sessions were held for 2 months (8 sessions, one 120-minute session each week). The research data were analyzed using repeated measures ANOVA and Bonferroni post-hoc test. Results: In the pre-test design, there wasn't a difference in the completed categories and perseverative errors, between the MBSR group (2±0.485 and 30.06±6.60) and the control group (2.06±0.659 and 29.88±9.4. In the post-test design, a significant difference in the completed categories and perseverative errors was found between the MBSR group (3.29±0.848 and 20.94±5.71) and the control group (2.18±0.636 and 29.94±8.70); which implies the MBSR group outperformed the control group in Improving executive functions of patients with hypertension. Finally, at the follow-up, all changes were still stable. Conclusions: MBSR was effective on executive functions of patients with hypertension. Therefore, it is suggested that the mentioned intervention be used in medical centres to improve the cognitive activities of patients with hypertension, so that its positive results include the condition of these patients.

Executive functions in patients with obstructive sleep apnea: exploring the prefrontal model

According to the prefrontal model, individuals with obstructive sleep apnea (OSA) manifest behaviours mimicking dysexecutive syndrome as a result of blood gas abnormalities and sleep fragmentation. To compare executive functions in OSA patients with normative values and explore their relationship with blood gas abnormalities and sleep fragmentation. Patients were recruited from the wider community and from a tertiary care hospital. The score obtained in the neuropsychological assessment was compared with Student's t-test for a sample. A multiple linear regression analysis was subsequently estimated, using polysomnographic parameters of hypercapnia, hypoxemia and sleep fragmentation as the predictor variables, and the executive function score as the variable to be predicted. Although the neuropsychological assessment performance of 26% of this sample was classified as executive impairment, indicators of sleep fragmentation and gas abnormalities failed to predict the performance of executive functions. A proportion of the patients with OSA presented performance similar to a dysexecutive syndrome; however, the factors underlying and fostering this type of cognitive manifestation remain unclear. Early treatment for this public health problem could be the best tool available for improving quality of life and preventing health risks.

Tau accumulation and its spatial progression across the Alzheimer's disease spectrum.

The accumulation of tau abnormality in sporadic Alzheimer's disease is believed typically to follow neuropathologically defined Braak staging. Recent in-vivo PET evidence challenges this belief, however, as accumulation patterns for tau appear heterogeneous among individuals with varying clinical expressions of Alzheimer's disease. We, therefore, sought a better understanding of the spatial distribution of tau in the preclinical and clinical phases of sporadic Alzheimer's disease and its association with cognitive decline. Longitudinal tau-PET data (1370 scans) from 832 participants (463 cognitively unimpaired, 277 with mild cognitive impairment and 92 with Alzheimer's disease dementia) were obtained from the Alzheimer's Disease Neuroimaging Initiative. Among these, we defined thresholds of abnormal tau deposition in 70 brain regions from the Desikan atlas, and for each group of regions characteristic of Braak staging. We summed each scan's number of regions with abnormal tau deposition to form a spatial extent index. We then examined patterns of tau pathology cross-sectionally and longitudinally and assessed their heterogeneity. Finally, we compared our spatial extent index of tau uptake with a temporal meta-region of interest-a commonly used proxy of tau burden-assessing their association with cognitive scores and clinical progression. More than 80% of amyloid-beta positive participants across diagnostic groups followed typical Braak staging, both cross-sectionally and longitudinally. Within each Braak stage, however, the pattern of abnormality demonstrated significant heterogeneity such that the overlap of abnormal regions across participants averaged less than 50%, particularly in persons with mild cognitive impairment. Accumulation of tau progressed more rapidly among cognitively unimpaired and participants with mild cognitive impairment (1.2 newly abnormal regions per year) compared to participants with Alzheimer's disease dementia (less than 1 newly abnormal region per year). Comparing the association of tau pathology and cognitive performance our spatial extent index was superior to the temporal meta-region of interest for identifying associations with memory in cognitively unimpaired individuals and explained more variance for measures of executive function in patients with mild cognitive impairments and Alzheimer's disease dementia. Thus, while participants broadly followed Braak stages, significant individual regional heterogeneity of tau binding was observed at each clinical stage. Progression of the spatial extent of tau pathology appears to be fastest in cognitively unimpaired and persons with mild cognitive impairment. Exploring the spatial distribution of tau deposits throughout the entire brain may uncover further pathological variations and their correlation with cognitive impairments.

Doxepin is more effective than zolpidem in improving executive function in patients with insomnia disorder.

Patients with primary insomnia were randomly assigned to receive doxepin 6mg/dayorally or zolpidem 5-10mg/day orally. Polysomnography (PSG) and the Pittsburgh Sleep Quality Index (PSQI) were used at baseline and after the 8-week treatment to compare clinical efficacy in the two groups. Safety was assessed using the Treatment Emergent Symptom Scale (TESS). Executive function was evaluated using the Wisconsin sorting card test (WSCT). Of 120 patients enrolled in the study, 60 participants were assignedto each group. A total of 109 participants (53 in the doxepin group and 56 in the zolpidem group) completed the study. After treatment, the wake after sleep onset (WASO) and total sleep time (TST) values in the doxepin group were 80.3 ± 21.4min and 378.9 ± 21.9min, respectively, which were significantly better than those in the zolpidem group (132.9 ± 26.5min and 333.2 ± 24.2min, respectively; (P < 0.05)). The sleep onset latency (SOL) value in the zolpidem group (20.3 ± 4.7min) was significantly better than that in the doxepin group (28.2 ± 5.6min; P < 0.05). The sleep efficiency (SE) in the doxepin group was 77.8 ± 4.2%, which was significantly better than that in the zolpidem group (68.6 ± 5.0%; P < 0.05). The PSQI score of the doxepin group was 6.1 ± 1.1, which was significantly lower than that in the zolpidem group (7.9 ± 1.9; P < 0.05). The treatment adverse eventsin the doxepin group was 23.3%, which was significantly higher than that in the zolpidem group (13.3%; P < 0.05). The WSCT showed a significant improvement in persistent errors (PE), random errors (RE), and categories in the two groups after 8-week treatment, and the improvement in RE and the categories was more obvious in the doxepin group (P < 0.05). Both doxepin and zolpidem were found to be effective in improving sleep quality, but the effects exhibited different patterns. Doxepin improved executive function more effectively than zolpidem in patients with insomnia disorder.

Dopamine in the prefrontal cortex plays multiple roles in the executive function of patients with Parkinson's disease.

Parkinson's disease can affect not only motor functions but also cognitive abilities, leading to cognitive impairment. One common issue in Parkinson's disease with cognitive dysfunction is the difficulty in executive functioning. Executive functions help us plan, organize, and control our actions based on our goals. The brain area responsible for executive functions is called the prefrontal cortex. It acts as the command center for the brain, especially when it comes to regulating executive functions. The role of the prefrontal cortex in cognitive processes is influenced by a chemical messenger called dopamine. However, little is known about how dopamine affects the cognitive functions of patients with Parkinson's disease. In this article, the authors review the latest research on this topic. They start by looking at how the dopaminergic system, is altered in Parkinson's disease with executive dysfunction. Then, they explore how these changes in dopamine impact the synaptic structure, electrical activity, and connection components of the prefrontal cortex. The authors also summarize the relationship between Parkinson's disease and dopamine-related cognitive issues. This information may offer valuable insights and directions for further research and improvement in the clinical treatment of cognitive impairment in Parkinson's disease.