Executive Function Tasks Research Articles

Randomized Controlled Trial of Social Ballroom Dancing and Treadmill Walking: Preliminary Findings on Executive Function and Neuroplasticity From Dementia-at-Risk Older Adults.

This randomized controlled trial (NCT03475316) examined the relative efficacy of 6months of social ballroom dancing and treadmill walking on a composite executive function score, generated from digit symbol substitution test, flanker interference, and walking while talking tasks. Brain activation during functional magnetic resonance imaging (fMRI) versions of these executive function tasks were secondary outcomes. Twenty-five dementia-at-risk older adults (memory impairment screen score of ≥3 to ≤6 and/or an Alzheimer's disease-8 Dementia Screening Interview of ≥1) were randomized in June 2019 to March 2020-16 completed the intervention before study termination due to the COVID-19 (eight in each group). Composite executive function scores improved post-intervention in both groups, but there was no evidence for between-group differences. Social dancing, however, generated greater improvements on digit symbol substitution test than treadmill walking. No intervention-related differences were observed in brain activation-although less hippocampal atrophy (tertiary) was observed following social dancing than treadmill walking. These preliminary findings are promising but need to be confirmed in future large-scale and sufficiently powered randomized controlled trials.

Serum zinc levels in youth with avoidant/restrictive food intake disorder and anorexia nervosa: Clinical correlation with weight and psychopathology.

Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are characterized by restrictive eating and micronutrient deficiencies. While zinc deficiency has been identified in AN, zinc level in ARFID has not been systematically assessed. Examine serum zinc levels and their association with eating pathology, psychopathology, and executive functioning in youth with ARFID and AN. This study included 28 adolescents (Mage = 13, 75% female) receiving treatment for ARFID (n = 13) and AN (n = 15). Demographic data and intake mood metrics were obtained via chart review. Participants completed the Delis-Kaplan Executive Functioning Systems and their mothers completed the behavior rating inventory of executive function (BRIEF-2). Zinc level was collected via blood draw. Independent samples t-tests, Pearson's chi-square, and Pearson's correlations were used to evaluate between-group differences and the relationship between zinc level and clinical correlates. No between-groups differences emerged in zinc levels, though half the sample demonstrated low levels for their ages. No significant correlations were found between zinc level and demographic data, mood measures, or executive functioning tasks. AN had relatively lower zinc levels, higher eating pathology, and anxiety, though ARFID had a longer duration of illness. Correlations between zinc and BRIEF-2 scores were mixed. This is the first study to systematically assess zinc levels in ARFID. While there were no group differences for zinc levels, 50% of the sample had low zinc levels. Zinc level did not correlate with higher psychopathology. Monitoring zinc levels throughout treatment in the context of anabolic processes can inform treatment strategies.

Decision making and executive functions in problematic pornography use.

Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored. This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT). The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks. The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.

Do executive functions differentiate Iranian children with attention-deficit/hyperactivity disorder with and without comorbid obesity?

To compare multiple dimensions of executive function between children with attention-deficit/hyperactivity disorder (ADHD) with and without comorbid obesity. Participants were 90 Iranian children (ages 8-13, 50% female) who were equally dispersed across three study groups: typically developing (TD), ADHD with obesity (ADHD+O), and ADHD without obesity (ADHD-O). Study participants were administered a comprehensive battery of Iranian-adapted "cool" executive function tasks including Digit Span from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V), Victoria Stroop Test (VST), Wisconsin Card Sorting Test (WCST), Tower of London, and dot-probe task (i.e., a task of attentional bias). Parents completed the Children's Scale for Future Thinking Questionnaire, which assesses future-oriented cognition (e.g., saving, planning, episodic foresight, delay of gratification), aligning more with "hot" executive functions. Groups were compared using multivariate and post-hoc univariate general linear models. Significant group effects were observed for all executive function variables, broadly with the gradient pattern of TD > ADHD-O > ADHD+O. ADHD+O had poorer performances than ADHD-O for WISC-V Digit Span (d = -0.84), WCST Categories Completed (d = -0.55) and Perseverative Responses (d = 1.15), VST Interference Errors (d = 0.83) and Interference Time (d = 1.38), and Dot-Probe Task (d = 0.84). Relative to the ADHD-O group, ADHD+O had also poorer parent-reported Prospective Memory (d = -0.62), Episodic Foresight (d = -0.63), and Delay of Gratification (d = -0.54). Children with ADHD-O have poorer executive functioning than those without obesity. We observed stronger effects for "cool" rather than "hot" domains of executive function, though this could be due to the former being performance-based and the latter parent-reported.

Planning ahead: Predictable switching recruits task-active and resting-state networks.

Switching is a difficult cognitive process characterised by costs in task performance; specifically, slowed responses and reduced accuracy. It is associated with the recruitment of a large coalition of task-positive regions including those referred to as the multiple demand cortex (MDC). The neural correlates of switching not only include the MDC, but occasionally the default mode network (DMN), a characteristically task-negative network. To unpick the role of the DMN during switching we collected fMRI data from 24 participants playing a switching paradigm that perturbed predictability (i.e., cognitive load) across three switch dimensions-sequential, perceptual, and spatial predictability. We computed the activity maps unique to switch vs. stay trials and all switch dimensions, then evaluated functional connectivity under these switch conditions by computing the pairwise mutual information functional connectivity (miFC) between regional timeseries. Switch trials exhibited an expected cost in reaction time while sequential predictability produced a significant benefit to task accuracy. Our results showed that switch trials recruited a broader activity map than stay trials, including regions of the DMN, the MDC, and task-positive networks such as visual, somatomotor, dorsal, salience/ventral attention networks. More sequentially predictable trials recruited increased activity in the somatomotor and salience/ventral attention networks. Notably, changes in sequential and perceptual predictability, but not spatial predictability, had significant effects on miFC. Increases in perceptual predictability related to decreased miFC between control, visual, somatomotor, and DMN regions, whereas increases in sequential predictability increased miFC between regions in the same networks, as well as regions within ventral attention/ salience, dorsal attention, limbic, and temporal parietal networks. These results provide novel clues as to how DMN may contribute to executive task performance. Specifically, the improved task performance, unique activity, and increased miFC associated with increased sequential predictability suggest that the DMN may coordinate more strongly with the MDC to generate a temporal schema of upcoming task events, which may attenuate switching costs.

Semantic fluency in 3-6 years old preschoolers: which executive functions?

ABSTRACT Semantic Fluency (SF) increases with age, along with the lexicon and the strategies to access it. Among the cognitive processes involved in controlling lexical access, Executive Functions (EF) play an essential role. Nevertheless, which EF, namely inhibition, working memory, and cognitive flexibility, are specifically tapped by SF during preschool years, when these basic EF components are developing and differentiating, is still unknown. The study had a two-fold aim: 1. to analyze in preschoolers the role of EF basic components on SF; 2. to investigate if EF mediated the effect of age on SF. A total of 296 typically developing preschoolers (M age = 57.86; SD = 9.91; month range = 33–74) were assessed with an SF task and EF tasks measuring the main EF basic components. Results showed that during preschool, response inhibition, working memory, and cognitive flexibility were significant predictors of SF, explaining 27% of its variance. Moreover, the effect of age on the SF task performance correlated with the improvement of these EF components. This study supports the importance of considering cognitive control processes in 3–6 year-old preschoolers as they underline important competencies for the child’s development, such as the ability to quickly access vocabulary.

The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration.

Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.

The Brain's Control Networks in Reading: Insights From Cross-Task Studies of Youth.

Humans engage multiple brain systems to read successfully, including using regions important for vision, language, and control. Control refers to the set of executive processes in the brain that guide moment-to-moment behavior in service of our goals. There is a growing appreciation for the role of the brain's control system in reading comprehension, in reading skill change over time, and in those who have difficulty with the reading process. One way to understand the brain's control engagement in reading may be to study control engagement across multiple tasks in order to study consistencies, or cross-task similarities, relative to reading-specific variations. In this commentary, I briefly summarize some of our recent work studying the brain's control networks across different tasks (e.g., when reading, or doing different executive function tasks). I then review our findings of when control activation does or does not relate to measures of reading ability, and reading growth over time. The utility of cross-task comparisons in neuroimaging is noted, as well as the need to better understand multiple sources of heterogeneity in our developmental samples. I end by discussing a few of the many future directions for further study of the brain with regard to the brain's control processing and academic achievement.

Speed of Cognitive Processing Within a Test of Executive Functions and Information Integration

Rapid Automatic Naming (RAN) has been widely recognized as a reliable predictor of reading proficiency. Although RAN represents the speed of cognitive processing, there are few studies that have addressed RAN as a cognitive process in its own right Furthermore, RAN performance of ELL (English Language Learners) has been less frequently investigated. We have two parts to this study. First, we examine the factor structure of an enlarged composite measure of speed measure by adding four additional tests comprising color naming, and two number naming tasks to the traditional RAN of digit and letter naming. In the second part, we determine the association of Speed with broad cognitive processes comprising Executive Functions, and Information processing. Participants were students in English medium schools in India. They were divided into two age groups (8–14 and 15–20) for statistical analyses of six Speed measures Results show a strong unitary speed factor in the 8 to 14 age group. In contrast, in the 15 to 20 group RAN tests comprising digits and letters showed a very small loading on the same factor. Addressing the second objective, which is the impact of speed on various cognitive tasks, the results show that response speed has a minimal influence on Nonverbal Configurations (simultaneous) tasks, and tasks of executive functions comprising Working Memory, and Visual-Spatial Processing. These tests will enable us to isolate specific cognitive deficiencies from response speed. In a re-examination of the relation between Reading & RAN-type tests, we could suggest that serial articulation is the common and essential feature that binds rapid naming tasks and reading fluency.

Shaping executive function in pre-school: The role of early educational practice

Recent approaches to the development of Executive Function (EF) claim that it is trainable. Purpose-designed programs have proved successful in training EF skills in young children. If the EF is permeable to training from an early age, then the type of educational practice in the first years may as well have an effect. Despite the important implications of this thesis, there is limited evidence of the role of early educational practice in shaping the EF. Previous studies suggest that children in Montessori schools, which promote autonomy and self-regulation, often perform better on EF tasks than children in conventional schools. Evidence to date, however, is not unequivocal across the studies due to a number of factors, including the heterogeneity of the tasks used to assess EF and/or possible baseline differences in the groups that are compared. Here we compare the EF skills of fifty-eight, 4- to 6-year-olds of a similar socio-economic background who had been attending either a Montessori preschool or a conventional preschool for the same period of time. Their performance was assessed with different tasks involving a range of EF processes, such as working memory, cognitive flexibility, inhibitory control, and self-regulation. Results show an advantage of Montessori preschoolers in all EF tasks. More broadly, findings suggest that even when EF skills are not purposely trained, they can be enhanced by specific educational practices.

A-13 Concussion history is related to performance on executive functioning tasks in youth

Abstract Purpose Pediatric traumatic brain injuries (TBIs) are among the most common acquired disabilities in youth. They occur when the brain is rapidly developing and therefore many impact the child into adulthood and can impact executive functioning (EF) skills that are vital to everyday tasks, like maintaining attention, organizing, and inhibiting behaviors. It is important to understand the impact of childhood TBIs to learn how to best intervene. Methods 11,224 children aged 9-10 years old (mean age=9.91, 49.4% male) at baseline completed an extensive battery of interviews and neuropsychological tasks through the Adolescent Brain Cognitive Development (ABCD) study. Based on parent reports on the Ohio State TBI screening measure, children were classified into No/Unlikely TBI, Possible Mild, Mild, Moderate, and Severe TBI. 153 children met criteria for possible mild TBI or higher. They also completed an array of neurocognitive measures, including Matrix Reasoning and several NIH Toolbox executive functioning tasks. Results There were small significant correlations between TBI status and a language task (Picture Vocab, r=.03, p=.002), attention task (Flanker, r=.02, p=.04), set shifting (Dimensional Change Card Sort, r=.02, p=.04), and with the crystallized cognition (r=.03, p=.005) and cognition composite (r=.03, p=.005) scores. Trend-level correlations were found for an oral reading task and fluid cognition composite score. However, when children with no TBI history were removed, no correlations held. Conclusions A history of even a mild TBI may be related to impaired functioning across several domains of executive functioning skills in youth.

A-23 Bouncing Back: The Resilience of Executive Functioning Post-Concussion

Abstract Purpose This study aimed to examine the relationship between concussion history and executive function in a sample of Canadian university students. Methods 247 participants completed an online survey and a web-based assessment battery consisting of nine computerized executive function tasks. Participants self-identified as ‘non-athletes’ (14.75%) or ‘athletes’ (85.25%) and reported having no history of concussion (n=183) or a history of one (n=37), two (n=15), or three or more (n=13) concussions. Bivariate correlations were used to examine the association between concussion history and executive function. The Kruskal-Wallis test was used to assess the effects of concussion history on objective (updating, shifting, and inhibition) and subjective (Total Executive Function Index, [EFI]) executive function. Results Concussion history was not significantly correlated with subjective executive functioning (i.e., EFI, r=-.054, p>.05), or computerized executive functioning, including shifting (r=-.014, p > .05), inhibition (r=-.000, p > .05), and updating (r=-.02, p>.05 ) performance. The Kruskal-Wallis test indicated that there was no significant effect of concussion history on EFI scores (χ2(45)=45.7, p=.36), nor shifting (χ2(202)=204.3, p=.44), inhibition (χ2(207)=207, p=.49), or updating (χ2(178)=180, p=.53) scores. Conclusions Our findings suggest that concussion history does not significantly impact executive functioning among university students with varying levels of athletic expertise. Protective factors (e.g., higher education and physical exercise engagement) may mitigate the detrimental effects of concussion on executive function.

A-22 Beyond Sports and Concussions: The Link between Shifting and Higher-Order Executive Functioning in Young Women

Abstract Purpose Our aim was to investigate the role of lifestyle factors, physical activity, sport, and concussion history, as well as Miyake and colleague’s (2000) three lower-order factors of executive function (shifting, updating, and inhibition) on higher-order decision making and self-reported executive functioning in young women. Methods 180 Canadian female university students (ages 18–25) completed 9 computerized executive function tasks assessing shifting, updating, and inhibition, as well as decision making (Iowa Gambling Task). Participants also completed the Executive Function Index (subjective executive functioning) and reported their age, concussion history, weekly physical activity, and level of sports participation. Linear regression analysis was used to assess the effects of the predictor variables on the Executive Function Index scores and Iowa Gambling Task scores. Results Only shifting significantly predicted both subjective executive functioning scores (b=2.65, p<.05) and Iowa Gambling Task performance (b=269.02, p<.01). Weekly physical activity was significantly associated with subjective executive functioning (b=.10, p<.01), but not Iowa Gambling Task performance. Age, concussion history, sport participation, inhibition, and updating were not significant for either regression. Conclusions These findings suggest that shifting may be a critical component of both higher-order decision making and subjective executive functioning, while physical activity may be important for subjective executive functioning. The lack of predictive value for lifestyle factors such as concussion history and sports participation suggests that there are other factors influencing executive functioning performance in healthy young women. Future studies should explore other factors, such as hormonal variability, that may be impact subjective executive functioning and decision making in young women.

Long-term improvements in executive functions after frontal-midline theta neurofeedback in a (sub)clinical group.

Impairments in executive functions (EFs) are common across disorders and can greatly affect daily functioning. Frontal-midline (FM) theta neurofeedback (NF) has been shown effective in enhancing EFs in healthy adults, prompting interest in exploring its potential as an alternative treatment for EFs in (sub)clinical samples. This study aims to determine the effects of FM theta NF on EFs in a sample of 58 adults (aged 20-60 years) with pronounced subjective EF complaints in daily life. Using a pre/post/follow-up design with a sham NF group, the present study assessed upregulation of FM theta in an eight-session individualized FM theta NF training and its immediate and long-term transfer effects on objective and subjective measures of EFs. These included behavioral performance on EF tasks assessing working memory updating (N-back task), set-shifting (Switching task), conflict monitoring (Stroop task), and response inhibition (Stop-signal task), as well as FM theta power during these tasks, and subjective EFs in daily life (BRIEF-A). The results indicate that there are only differences in FM theta self-upregulation between the NF group and sham group when non-responders are excluded from the analysis. Regarding behavioral transfer effects, NF-specific improvements are found in working memory updating reaction time (RT) and conflict monitoring RT variability at 6-month follow-up, but not immediately after the NF training. The effects on FM theta power during the EF tasks and subjective changes in EFs in daily life were not specific to the NF training. As a next step, research should identify the best predictors to stratify NF training, as well as explore ways to improve NF responsiveness, for instance by increasing neuroplasticity.

The longitudinal contributions of child language, negative emotionality, and maternal positive affect on toddler executive functioning development

Executive functions (EF) develop rapidly across early childhood and play a prominent role in promoting adaptive outcomes later in development. Although the existing literature suggests that the development of early EF is sensitive to the influence of intrinsic and extrinsic factors, limited research has examined the joint contributions of multiple child and contextual factors in infancy/toddlerhood. The purpose of our longitudinal study was therefore to identify early environmental, behavioral, biologically-based factors that influence children’s EF outcomes in late toddlerhood. Participants included 409 mother-child dyads (209 girls) and the data was collected across children’s first three postnatal years. Parent-report measures were used to assess infant negative affectivity (5-months; IBQ-R) and toddler language (age 2; MCDI), and both maternal positive affect (5-months) and toddler frustration (age 2) were coded during mother-child interaction tasks. A battery of behavioral tasks was used to measure child EF in late toddlerhood (age 3). After controlling for maternal education (a proxy for children’s socio-economic environment), path analysis indicated that both infant and maternal affect at 5-months directly predicted toddlers’ language skills and frustration expression at age 2. Toddler language (but not frustration) also predicted child performance on multiple EF tasks at age 3. Finally, 5-month infant and maternal affect indirectly predicted age 3 EF via age 2 language. Our results identify language as a mechanism through which children’s early caregiving environment influences their EF development. Taken together, these findings illustrate the importance of applying a biopsychosocial perspective to the examination of early childhood EF development.

Cerebral Small Vessel Disease Burden: An Independent Biomarker for Anomia Treatment Responsiveness in Chronic Stroke Patients With Aphasia

ObjectiveTo determine whether MRI-based cerebral small vessel disease (cSVD) burden predicts treatment-induced aphasia recovery in chronic stroke patients above and beyond initial aphasia severity and stroke-lesion volume. DesignRetrospective. Four cSVD neuroimaging markers were rated using validated visual scales: white matter hyperintensities, enlarged perivascular spaces, lacunes, and global cortical atrophy. We also calculated a cSVD total score. We employed linear regression models to model treatment response as a function of cSVD burden. We also ran correlation analyses to determine the association among cSVD burden and pre-treatment linguistic and non-linguistic cognition. SettingResearch clinic. ParticipantsThe study includes data from 30 chronic stroke patients with aphasia who received treatment for word finding difficulties and completed additional pre-treatment neuroimaging and behavioral assessments (N=30). Interventions120-minute sessions of anomia treatment 2 times per week for up to 12 weeks. Main Outcome MeasuresChange in accuracy on the treatment probes measured as a percentage (ie, change in accuracy percentage score=post-treatment accuracy percentage minus pre-treatment accuracy percentage). ResultsBaseline cSVD burden predicted response to anomia treatment independently from demographic and stroke-related factors. Patients with lower cSVD burden exhibited enhanced rehabilitation response compared with those with higher cSVD burden (β=-6.816e-02, P=.019). cSVD burden was highly associated with nonverbal executive function at baseline (r=-0.49, P=.005): patients with lower cSVD burden exhibited higher performance on nonverbal executive function tasks compared with participants with higher cSVD burden. No association was observed among cSVD burden and performance on language tasks at the baseline. ConclusionscSVD, a marker of brain reserve and a robust risk factor for post-stroke dementia, may be used as a biomarker for distinguishing patients who are more likely to respond to anomia therapy from those who are less likely to do so and for individualizing treatment parameters (eg, targeting both linguistic and nonlinguistic cognition in severe cSVD).

How white matter hyperintensities impacts Alzheimer’s disease and frontotemporal dementia across underrepresented Latin American samples

AbstractBackgroundWhite matter hyperintensities (WMH) are frequently observed on MRI scans of older people. Usually interpreted as a sign of cerebrovascular disease (CVD), they are also associated with increased risk of cognitive impairment and dementia. While WMH and CVD are highly prevalent in Alzheimer’s disease (AD), this has been less studied in behavioral variant frontotemporal dementia (bvFTD), letting alone their study in underrepresented populations with increased CVD. Here, we investigated WMH in AD and bvFTD patients in Latin America (Argentina, Chile and Colombia), a region with high prevalence of CVD. We analyzed total volume and regional distribution of WMH and its association with cognitive impairment and brain lacunes, a marker of CVD.MethodA total of 66 patients (43 AD, 23 bvFTD) and 66 controls (CN) from the ReDLat consortium underwent high‐resolution brain MRI and neuropsychological examination. WMH were extracted from Flair images using automated segmentation algorithms to perform analyses of total volume and spatial distribution. Brain lacunes were visually quantified from T1 and Flair images. Group differences in total and regional WMH volume and associations with different cognitive domains, age, and brain lacunes were examined.ResultTotal and regional WMH volumes were significant larger in AD patients compared to CN and to bvFTD. No differences were found between CN and bvFTD. Only in AD, regional WMH load correlated with worse performance in a particular executive functioning task. No differences were found in the proportion of lacunes among groups nor in the total load of WMH of subjects with or without lacunes. In CN and AD, but not FTD, there was a positive correlation between total WMH volume and age, with a differential topographic distribution with a selective involvement of the bilateral cingulum‐hippocampus bundle in AD.ConclusionEnhanced WMH was observed in AD but not in FTD. WMH loading in specific brain regions contribute to domain‐specific cognitive deficits in AD. WMH could be partially independent of vascular pathology (it was unrelated to brain lacunes) suggesting a specific neurodegenerative origin in AD. The typical earlier onset of brain abnormalities in FTD could mask the age‐related increase in WMH.

Assessing goal-directed behavior in virtual reality with the neuropsychological task EPELI: children prefer head-mounted display but flat screen provides a viable performance measure for remote testing

Background and objective: EPELI (Executive Performance of Everyday LIving) is a Virtual Reality (VR) task that was developed to study goal-directed behavior in everyday life contexts in children. In this study, we had 72 typically developing 9- to 13-year-old children to play EPELI with an immersive version implemented with a head-mounted display (HMD) and a non-immersive version employing a flat screen display (FSD) in a counterbalanced order to see if the two versions yield similar results. The children’s everyday executive functions were assessed with the parent-rated Behavior Rating Inventory for Executive Functions (BRIEF) questionnaire. To assess the applicability of EPELI for online testing, half of the flat screen display version gameplays were conducted remotely and the rest in the laboratory.Results: All EPELI performance measures were correlated across the versions. The children’s performance was mostly similar in the two versions, but small effects reflecting higher performance in FSD-EPELI were found in the measures of Total score, Task efficacy, and Time-based prospective memory score. The children engaged in more active time monitoring in FSD-EPELI. While the children evaluated the feeling of presence and usability of both versions favorably, most children preferred HMD-EPELI, and evaluated its environment to be more involving and realistic. Both versions showed only negligible problems with the interface quality. No differences in task performance or subjective evaluations were found between the home-based and laboratory-based assessments of FSD-EPELI. In both EPELI versions, the efficacy measures were correlated with BRIEF on the first assessment, but not on the second. This raises questions about the stability of the associations reported between executive function tasks and questionnaires.Conclusions: Both the HMD and FSD versions of EPELI are viable tools for the naturalistic assessment of goal-directed behavior in children. While the HMD version provides a more immersive user experience and naturalistic movement tracking, the FSD version can maximize scalability, reachability, and cost efficacy, as it can be used with common hardware and remotely. Taken together, the findings highlight similarities between the HMD and FSD versions of a cognitively complex VR task, but also underline the specific advantages of these common presentation modes.

Defects in immune response to Toxoplasma gondii are associated with enhanced HIV-1-related neurocognitive impairment in co-infected patients.

Human immunodeficiency virus-1 (HIV-1) and Toxoplasma gondii can invade the central nervous system and affect its functionality. Advanced HIV-1 infection has been associated with defects in immune response to T. gondii, leading to reactivation of latent infections and development of toxoplasmic encephalitis. This study evaluates relationship between changes in immune response to T. gondii and neurocognitive impairment in HIV-1/T. gondii co-infected patients, across different stages of HIV-1 infection. The study assessed the immune response to T. gondii by measuring cytokine production in response to parasite antigens, and also neurocognitive functions by performing auditory and visual P300 cognitive evoked potentials, short term memory (Sternberg) and executive function tasks (Wisconsin Card Sorting Test-WCST) in 4 groups of individuals: HIV-1/T. gondii co-infected (P2), HIV-1-infected/T. gondii-non-infected (P1), HIV-1-non-infected/T. gondii-infected (C2) and HIV-1-non-infected/T. gondii-non-infected (C1). Patients (P1 and P2) were grouped in early/asymptomatic (P1A and P2A) or late/symptomatic (P1B/C and P2B/C) according to peripheral blood CD4+ T lymphocyte counts (>350 or <350/μL, respectively). Groups were compared using T-student or U-Mann-Whitney tests as appropriate, p<0.05 was considered as significantly. For P300 waves, HIV-1-infected patients (P1) had significantly longer latencies and significantly smaller amplitudes than uninfected controls, but HIV-1/T. gondii co-infected patients (P2) had significantly longer latencies and smaller amplitude than P1. P1 patients had significantly poorer results than uninfected controls in Sternberg and WCST, but P2 had significantly worse results than P1. HIV-1 infection was associated with significantly lower production of IL-2, TNF-α and IFN-γ in response to T. gondii from early/asymptomatic stages, when comparing P2 patients to C2 controls. These findings may indicate impairment in anti-parasitic response in co-infected patients, facilitating early limited reactivation of the parasitic latent infection, therefore creating cumulative damage in the brain and affecting neurocognitive functions from asymptomatic stages of HIV-1 infection, as suggested by defects in co-infected patients in this study.

Multivitamin Supplementation Improves Memory in Older Adults: A Randomized Clinical Trial

BackgroundMaintenance of cognitive abilities is of critical importance to older adults, yet few effective strategies to slow cognitive decline currently exist. Multivitamin supplementation is used to promote general health; it is unclear whether it favorably affects cognition in older age. ObjectivesTo examine the effect of daily multivitamin/multimineral supplementation on memory in older adults. MethodsThe COcoa Supplement and Multivitamin Outcomes Study Web (COSMOS-Web) ancillary study (NCT04582617) included 3562 older adults. Participants were randomly assigned to a daily multivitamin supplement (Centrum Silver) or placebo and evaluated annually with an Internet-based battery of neuropsychological tests for 3 y. The prespecified primary outcome measure was change in episodic memory, operationally defined as immediate recall performance on the ModRey test, after 1 y of intervention. Secondary outcome measures included changes in episodic memory over 3 y of follow-up and changes in performance on neuropsychological tasks of novel object recognition and executive function over 3 y. ResultsCompared with placebo, participants randomly assigned to multivitamin supplementation had significantly better ModRey immediate recall at 1 y, the primary endpoint (t(5889) = 2.25, P = 0.025), as well as across the 3 y of follow-up on average (t(5889) = 2.54, P = 0.011). Multivitamin supplementation had no significant effects on secondary outcomes. Based on cross-sectional analysis of the association between age and performance on the ModRey, we estimated that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 y of age-related memory change. ConclusionsDaily multivitamin supplementation, compared with placebo, improves memory in older adults. Multivitamin supplementation holds promise as a safe and accessible approach to maintaining cognitive health in older age. This trial was registered at clinicaltrials.gov as NCT04582617.