Frontal Lobe Executive Function Research Articles

경도인지장애 환자에서 전산화 인지훈련 프로그램의 효과

Objective: As the elderly population increases, the proportion of neurocognitive disorder is increasing. Accordingly, research on cognitive intervention therapy to prevent neurocognitive disorder is also becoming active. In particular, this study attempted to evaluate changes in cognitive function before and after training and verify their effectiveness by implementing a computerized cognitive training program for patients with mild cognitive impairment.
 Methods: A computerized cognitive training program was conducted for 15 patients with mild cognitive impairment. It was conducted twice a week, 30 minutes, and 16 times for 8 weeks, and neurocognitive function was evaluated before and after training. The neurocognitive function tests are as follows; Seoul Neuropsychological Screening Battery, Korean version of Montreal Cognitive Assessment (K-MoCA), Clinical Dementia Rating (CDR), Korean Instrumental Activity of Daily Living (K-IADL), Korean Neuropsychiatric Inventory (K-NPI), and Memory Age-associated Complaint Questionnaire (MAC-Q).
 Results: There was a statistically significant improvement in memory domain after the implementation of the computerized cognitive training program, but no significant changes in attention, language ability, visuospatial function, and frontal lobe executive function. Among the memory areas, the Seoul Verbal Learning Test: Delayed Recall, Rey Complex Figure Test: Delayed Recall, and Rey Complex Figure Test: Recognition are showed significant improvement. In addition, there was a significant improvement in CDR (sum of box) and K-MoCA scores. There was no statistically significant difference in K-IADL and K-NPI.
 Conclusion: Computerized cognitive training programs have been effective in improving memory in patients with mild cognitive impairment. In order to verify the effectiveness of dementia prevention, a long-term study of a larger number is needed. The results of this preliminary study will help develop and apply cognitive training contents in the future.

The Effects of Cognitive Rehabilitation Targeting Frontal Lobe Executive Function in Mild Cognitive Impairment

The Effects of Cognitive Rehabilitation Targeting Frontal Lobe Executive Function in Mild Cognitive Impairment

Abstract WP454: Multi-modal Neuroimaging Biomarkers of Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates and survivors of aSAH often experience persistent deficits across multiple domains, including language, memory, perception and frontal lobe executive function. At present, little is known about the alterations in brain structure and function associated with aSAH, and specific brain biomarkers of post-stroke impairment. In this study, N=28 individuals were scanned using a comprehensive multi-modal neuroimaging battery, including 14 with chronic aSAH and 14 matched controls. Using a 3T Magnetic Resonance Imaging (MRI) scanner, we acquired resting state functional MRI (rs-fMRI), diffusion tensor imaging (DTI) and T1-weighted voxel-based morphometry (VBM). Comparing aSAH patients to controls, we observed elevated rs-fMRI measures of global connectivity and decreased VBM measures of grey matter, primarily within the midcingulate cortex, but no consistent alterations were seen in DTI measures of white matter. Within-group analysis of aSAH patients subsequently showed that greater impairments in executive function were associated with altered DTI measures, including elevated diffusivity and reduced fractional anisotropy, mainly within posterior corona radiata. These findings indicate that brain function and cortical volume are reliably altered post-stroke, whereas the effects on white matter microstructure depend on the severity of post-stroke impairment. These results provide novel information about potential neuroimaging biomarkers of recovery following aSAH.

Regional leukoaraiosis and cognition in non-demented older adults.

Frontal lobe-executive functions are heavily dependent on distal white matter connectivity. Even with healthy aging there is an increase in leukoaraiosis that might interrupt this connectivity. The goal of this study is to learn 1) the location, depth, and percentage of leukoaraiosis in white matter among a sample of non-demented older adults and 2) associations between these leukoarioasis metrics and composites of cognitive efficiency (processing speed, working memory, and inhibitory function), and episodic memory. Participants were 154 non-demented older adults (age range 60-85) who completed a brain MRI and neuropsychological testing on the same day. Brain MRIs were segmented via Freesurfer and white matter leukoaraiosis depth segmentations was based on published criteria. On average, leukoaraiosis occupied 1 % of total white matter. There was no difference in LA distribution in the frontal (1.12%), parietal (1.10%), and occipital (0.95%) lobes; there was less LA load within the temporal lobe (0.23%). For cortical depth, leukoaraiosis was predominantly in the periventricular region (3.39%; deep 1.46%, infracortical 0.15%). Only increasing frontal lobe and periventricular leukoaraiosis were associated with a reduction in processing speed, working memory, and inhibitory function. Despite the general presence of LA throughout the brain, only frontal and periventricular LA contributed to the speeded and mental manipulation of executive functioning. This study provides a normative description of LA for non-demented adults to use as a comparison to more disease samples.

Topographical Analysis of Frontal Lobe Executive Functions in Patients Following a Stroke

Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wisconsin Card Sorting Test) included sixteen patients with a clinical diagnosis of CVA and frontal lobe impairment. Results from the two groups were compared (patients with right frontal lobe impairment and patients with left frontal lobe impairment). Statistical analysis was performed using the program “Statistical Package for Social Sciences” (SPSS) Version 20.0. For comparison between groups was used Mann-Whitney test and considered the alpha level of 0.05 on the statistically significant results. Results: There was no statistically significant difference between the groups, thus showing that executive functions are symmetrically distributed across the frontal lobes. Conclusion: Executive functions are symmetrically organized across the two frontal lobes, since the comparison between the groups did not demonstrate a statistically significant difference for any of the variables of WSCT.

The Mental Status Examination

Summary The mental status examination is an instrument of behavioural neurology that is used to identify and characterise specifi c disturbances of cerebral function relating to cognitive functions (such as memory and language), emotion and overt behaviour. It is conducted in a systematic fashion but is simple enough to be used at the bedside. Neurological conditions in which the mental status examination can provide clinically important information include stroke, encephalitis, dementia, hypoxic or metabolic encephalopathy, cerebral tumours and traumatic brain injury. This chapter describes methods to assess the following brain functions: level of consciousness, attention, concentration and mental control, language, memory, constructional ability, higher level sensory and motor functions, frontal lobe (executive) functions, and neuropsychiatric control functions.

Quantitative electroencephalographic and neuropsychological investigation of an alternative measure of frontal lobe executive functions: the Figure Trail Making Test.

The most frequently used measures of executive functioning are either sensitive to left frontal lobe functioning or bilateral frontal functioning. Relatively little is known about right frontal lobe contributions to executive functioning given the paucity of measures sensitive to right frontal functioning. The present investigation reports the development and initial validation of a new measure designed to be sensitive to right frontal lobe functioning, the Figure Trail Making Test (FTMT). The FTMT, the classic Trial Making Test, and the Ruff Figural Fluency Test (RFFT) were administered to 42 right-handed men. The results indicated a significant relationship between the FTMT and both the TMT and the RFFT. Performance on the FTMT was also related to high beta EEG over the right frontal lobe. Thus, the FTMT appears to be an equivalent measure of executive functioning that may be sensitive to right frontal lobe functioning. Applications for use in frontotemporal dementia, Alzheimer’s disease, and other patient populations are discussed.

Differences in cognitive function between patients with viral and alcoholic compensated liver cirrhosis.

As alcohol induces change in frontal cortex primarily involved in cognition, cognitive function may be different between viral and alcoholic liver cirrhosis (LC). This study aimed to determine the differences of cognitive function between viral and alcoholic compensated LC. From October 2011 to March 2013, 80 patients (viral: 37; alcohol: 43) with compensated LC were prospectively enrolled. Neuropsychological functions including attention, language, visuospatial, verbal memory, visual memory, and frontal/executive function were evaluated between two groups and compared with age-matched normal group (n = 1000). Cumulative incidence rate of overt hepatic encephalopathy (HE) was calculated. In the comparison with normal group, both two groups showed decreased memory function, frontal/executive function, and Korea-Mini Mental Status Examination. In the analysis of two groups, memory function by Verbal Learning Test (recognition: 20.1 ± 3.6 and 17.8 ± 4.8, p = 0.022), visuospatial function by Ray-Complex Figure Copy Test (recognition: 19.0 ± 2.6 and 17.3 ± 4.0, p = 0.043), frontal/executive function by Controlled Oral Ward Association (semantic: 17.1 ± 6.9 and 12.7 ± 6.9, p = 0.004), and the Korea-Mini Mental Status Examination (27.5 ± 1.9 and 26.2 ± 3.1, p = 0.03) showed low scores in alcoholic compensated LC patients. The 1-, 2-, and 3-year cumulative incidence rates of overt HE were 23%, 26%, and 26% and 33%, 43%, and 49% in the viral and alcoholic compensated LC group, respectively (p = 0.033). Impaired memory and frontal lobe executive functions and early development of overt HE were more common in patients with alcoholic LC. For patients with alcoholic LC, more integrated tests for early detection of minimal HE and intensive treatment should be considered to prevent overt HE.

FDG-PET scans in patients with Kraepelinian and non-Kraepelinian schizophrenia.

We recruited 14 unmedicated patients with Kraepelinian schizophrenia (12 men and 2 women; mean age=47years old), 27 non-Kraepelinian patients (21 men and 6 women; mean age=36.4years old) and a group of 56 age- and sex-matched healthy volunteers. FDG positron emission tomography and MRI scans were coregistered for both voxel-by-voxel statistical mapping and stereotaxic regions of interest analysis. While both Kraepelinian and non-Kraepelinian patients showed equally lower uptake than healthy volunteers in the frontal lobe, the temporal lobes (Brodmann areas 20 and 21) showed significantly greater decreases in Kraepelinian than in non-Kraepelinian patients. Kraepelinian patients had lower FDG uptake in parietal regions 39 and 40, especially in the right hemisphere, while non-Kraepelinian patients had similar reductions in the left. Only non-Kraepelinian patients had lower caudate FDG uptake than healthy volunteers. While both patient groups had lower uptake than healthy volunteers in the medial dorsal nucleus of the thalamus, Kraepelinian patients alone had higher uptake in the ventral nuclei of the thalamus. Kraepelinian patients also showed higher metabolic rates in white matter. Our results are consistent with other studies indicating that Kraepelinian schizophrenia is a subgroup of schizophrenia, characterized by temporal and right parietal deficits and normal rather than reduced caudate uptake. It suggests that Kraepelinian schizophrenia may be more primarily characterized by FDG uptake decreased in both the frontal and temporal lobes, while non-Kraepelinian schizophrenia may have deficits more limited to the frontal lobe. This is consistent with some neuropsychological and prognosis reports of disordered sensory information processing in Kraepelinian schizophrenia in addition to deficits in frontal lobe executive functions shared with the non-Kraepelinian subtype.

Sleep disorders in adults with epilepsy: past, present, and future directions.

To summarize recent studies on the complex relationships between sleep disorders, sleep, and epilepsy. Insomnia in adults with epilepsy (AWE) warrants consideration of depression, anxiety, and suicidal ideation. Daytime sleepiness in AWE is more often due to undiagnosed sleep disorders. Sleep deprivation is an important provoker of seizures in juvenile myoclonic epilepsy. Abnormalities in frontal lobe executive function with difficulties making advantageous decisions may explain failure of juvenile myoclonic epilepsy patients to adhere to treatment recommendations and regulate their sleep habits. Sleep architecture in AWE is more likely to be abnormal if seizures are poorly controlled or occur during sleep. Obstructive sleep apnea is much more common in AWE who are man, older, heavier, or whose seizures are poorly controlled. Chronobiology and chronopharmacology of epilepsy is an emerging field worthy of future research and clinical applications. Identifying and treating unrecognized sleep disorders and understanding the impact of circadian rhythms on epilepsy can improve quality of life and seizure control in AWE.

P.1.j.025 Abnormal cognitive salience but not WCST scores are associated with poor outcome in patients with schizophrenia

Purpose of study: Psychopathology and cognitive impairment are poor predictors of functional outcome in patients with schizophrenia. In contrast, recent data have demonstrated that dopamineassociated functions such as baseline motivational deficits and social cognition are more relevant to predict patient functionality. Social cognition is a complex entity that includes several information processes such as reasoning, attention and memory, all involved in social adjustment. These cognitive dimensions are known to be particularly impaired in schizophrenia patients. Among several components, it comprises cognitive salience, a measure of the aberrant dopamine signalling in brain. In the present study, functional outcome was correlated to (i) psychopathology, (ii) attention and frontal lobe executive function, and (iii) cognitive salience in a population of stabilised patients with schizophrenia (SCZ). Method: Chronic medicated patients with schizophrenia (n = 35) have been examined and compared to a healthy control population (n = 34). Clinical characteristics, prefrontal functioning, and cognitive salience were assessed using PANSS (Positive and Negative Syndrome Scale), CGI (Clinical Global Impression), WCST (Wisconsin Card Sorting Test), SAT, and CPTAX tests respectively. CPT-AX (Continuous Performance Test-AX version) and SAT (Salience Attribution Test) are two standardised and computerised tests to study cognitive salience. SAT: is a probabilistic reward learning game that employs cues that vary across task-relevant and task-irrelevant dimensions; it provides behavioural indices of adaptive and aberrant reward teaching. CPT-AX with salient stimuli doesn’t use words but colour stimuli and assesses working memory by varying inter stimulus interval. Global Assessment of functioning (GAF) evaluated the overall functioning of patients. Results: Compared to control subjects, 60% of SCZ patients showed a significant decrease in performance for WSCT (perseverative responses, perseverative and non-perseverative errors, and errors). SAT (Explicit Adaptive Salience) values were significantly different for 42% of subjects, while CPT-AX scores (Hit-score, False Alarm Rate, Response Time) were abnormal in only 27% of patients. Only the latter subgroup had abnormal scores in WSCT showing a possible participation of prefrontal involvement in this salience test. Interestingly and in accordance with data of literature, abnormal responses to WCST did not predict low GAF score in our study. In contrast, subjects with low SAT scores and CPT-AX separately were significantly (p< 0.05) more frequent in the group of patients with low GAF scores. We also tested the hypothesis that the CPTAX and SAT evaluate two different dimensions of salience. We reviewed patients with low scores on both SAT and CPT-AX. This subpopulation had indeed scores significantly (p = 0.02) lower in the GAF compared to patients without this combination. Conclusion: Alteration of the cognitive salience tests CPTAX and SAT is associated with functional outcome impairment in patients with schizophrenia. Preliminary data are indicating that these two tests can describe the activity of two separated neurobiological networks involved in cognitive salience.

Alcohol increases hypnotic susceptibility

One approach to hypnosis suggests that for hypnotic experience to occur frontal lobe activity must be attenuated. For example, cold control theory posits that a lack of awareness of intentions is responsible for the experience of involuntariness and/or the subjective reality of hypnotic suggestions. The mid-dorso-lateral prefrontal cortex and the ACC are candidate regions for such awareness. Alcohol impairs frontal lobe executive function. This study examined whether alcohol affects hypnotisability. We administered 0.8 mg/kg of alcohol or a placebo to 32 medium susceptible participants. They were subsequently hypnotised and given hypnotic suggestions. All participants believed they had received some alcohol. Participants in the alcohol condition were more susceptible to hypnotic suggestions than participants in the placebo condition. Impaired frontal lobe activity facilitates hypnotic responding, which supports theories postulating that attenuation of executive function facilitates hypnotic response, and contradicts theories postulating that hypnotic response involves enhanced inhibitory, attentional or other executive function.

The Characteristic of Frontal Lobe's Executive Function in Internet Addiction

The Characteristic of Frontal Lobe's Executive Function in Internet Addiction

Differences of Frontal Lobe Executive Function according to Delinquency Juveniles Type: with special reference to Life Course Persistent Type and Adolescents Limited Type

Differences of Frontal Lobe Executive Function according to Delinquency Juveniles Type: with special reference to Life Course Persistent Type and Adolescents Limited Type

The failure of the schizophrenia concept and the argument for its replacement by hebephrenia: applying the medical model for disease recognition

The failure of the schizophrenia concept and the argument for its replacement by hebephrenia: applying the medical model for disease recognition

Greater Activation in Left Hemisphere Language‐Related Regions During Simple Judgment Tasks Among Substance‐Dependent Patients in Treatment for Alcoholism

Alcoholism is often associated with impaired emotional control. Alcoholics have also been found to have deficits in frontal lobe executive functions. Recent functional imaging studies have suggested that alcoholics show greater activation than nonalcoholics in circuits involving frontal lobes, as well as more posterior brain regions, when engaged in executive-type tasks. In this study, we compared brain activations of alcohol-dependent patients and healthy nonalcoholics while they performed 2 simple judgment tasks designed to activate frontal circuits involved in a basic form of decision making. Participants completed 1 judgment task that required an emotional judgment and 1 task that did not, which enabled us to study whether alcoholics had greater brain activation while performing executive tasks, and to determine if emotional tasks elicited even greater activation than nonemotional tasks. We performed functional magnetic resonance imaging scans while alcoholic patients and nonalcoholic controls viewed pictures from the International Affective Picture System. In 3 separate runs, participants viewed the images without making a judgment, determined whether the images were indoor or outdoor scenes, or decided if they liked or disliked the images. There was little difference in brain activation between alcoholics and controls when no judgment was required. When participants made judgments about either the location or whether they liked or disliked an image, however, we observed significantly increased activation in frontal, limbic, and temporal regions in the patients relative to the controls. Increases were particularly robust in the frontal lobe and in areas of the brain associated with language. When we compared the emotional to the nonemotional judgment, the alcoholics, but not the controls, showed greater activation in the ventral mesial frontal cortex. Alcoholic patients appear to use brain language areas more than nonalcoholics while making judgments about the setting or liking of emotionally arousing visual images. This increased activation may reflect a compensatory recruitment of brain regions to perform simple decision-making tasks.

Frontal Lobe Executive Function and Emotional Recognition Ability of Psychopathic Inmates

This article is based on the frontal lobe dysfunction hypothesis and integrated emotion system model related to executive function and emotional recognition abilities of the psychopath and investigates whether the same types of frontal lobe dysfunction and damage to emotional recognition abilities occur in similar groups within the country. For specific research design, PCL-R was conducted with inmates in prisons and based on the results, psychopathic criminals and non-psychopathic criminals were classified. In order to investigate the executive function and emotional recognition in each of two groups, the Wisconsin Card Sorting Test, Stroop Test, and a revised version of Emotional Recognition Test were administered. As for the control variable, intelligence of the subjects was measured by Korean-Wechsler Adult Intelligence Scale. As a result of the three tests, there were differences between groups, as we expected. Psychopathic criminals showed lower performance ability than did the non-psychopathic group in terms of executive function. However, there was no significant difference in the Emotional Recognition Test. In conclusion, the result that psychopath criminals were showed relatively lower executive function means a specific treatment program are needed to care some criminals who have neurological dysfunction, in the Criminal Justice System.

Assessing Attention in Children with Williams Syndrome and Down's Syndrome Using a New Comprehensive Attention Battery: Do These Problems Relate to Visual Dorsal Cortical Stream Deficits?

Event Abstract Back to Event Assessing Attention in Children with Williams Syndrome and Down's Syndrome Using a New Comprehensive Attention Battery: Do These Problems Relate to Visual Dorsal Cortical Stream Deficits? K. Breckenridge1* and J. Atkinson1 1 University College London, Visual Development Unit,, United Kingdom Purpose: There are many anecdotal reports of attention problems in both Williams syndrome (WS) and Down’s syndrome (DS), with some recent studies suggesting difficulties on frontal lobe executive function tasks (e.g. Atkinson et al, 2003). However, for many children with WS and DS who have a mental age below 6 years, there has been no standardized single battery to assess the different components of attention (selective attention, sustained attention and attentional / executive control) which are thought to be underpinned by different neural networks of brain areas in the adult brain and in typically developing older children (e.g. Posner & Petersen, 1990; Manly et al, 2001). In the Visual Development Unit, we have recently devised and normalized a new battery designed to assess different attention components in children of 3-6 years mental age (MA), including children with developmental disorders. We report the results of a study using this battery to map profiles of attention in children with WS and DS and consider the relationship between attentional deficits and dorsal stream deficits, as manifested in the comparison of motion and form coherence thresholds (e.g. Atkinson et al, 1997; Braddick et al, 2003). Methods: There were 8 short subtests in the battery, each test lasting between 2 and 10 minutes. These subtests included a visual search and a flanker task, intended to tap selective attention; vigilance-type sustained attention tasks in visual and auditory modalities; and tests of verbal inhibition, motor inhibition, and sorting with rule shifts to assess aspects of attentional / executive control. Children in the current study completed these new attention tasks, plus measures of verbal and non-verbal intelligence, dorsal and ventral stream processing (motion and form coherence computer game), and global vs. local level visual processing with Navon figures. Results and discussion: Results to date confirm earlier preliminary data showing marked delays for both groups compared to chronological age and MA, and suggest that sustained attention is less affected than selective or executive attention in both syndrome groups. We will discuss how profiles of attention in these groups relate to (i) the changes in attention seen over the preschool years in typical development, (ii) vulnerability of the dorsal visual stream in developmental disorders, and (iii) known structural and functional brain abnormalities in these groups. Conference: 12th International Professional Conference on Williams Syndrome, Garden Grove,CA, United States, 13 Jul - 14 Jul, 2008. Presentation Type: Oral Presentation Topic: SESSION 6: Updates on Cognition in Williams Syndrome Citation: Breckenridge K and Atkinson J (2009). Assessing Attention in Children with Williams Syndrome and Down's Syndrome Using a New Comprehensive Attention Battery: Do These Problems Relate to Visual Dorsal Cortical Stream Deficits?. Conference Abstract: 12th International Professional Conference on Williams Syndrome. doi: 10.3389/conf.neuro.09.2009.07.020 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Apr 2009; Published Online: 30 Apr 2009. * Correspondence: K. Breckenridge, University College London, Visual Development Unit,, London, United Kingdom, k.breckenridge@ucl.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers K. Breckenridge J. Atkinson Google K. Breckenridge J. Atkinson Google Scholar K. Breckenridge J. Atkinson PubMed K. Breckenridge J. Atkinson Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Cognitive Accuracy and Intelligent Executive Function in the Brain and in Business

This article reviews research on cognition, language, organizational culture, brain, behavior, and evolution to posit the value of operating with a stable reference point based on cognitive accuracy and a rational bias. Drawing on rational-emotive behavioral science, social neuroscience, and cognitive organizational science on the one hand and a general model of brain and frontal lobe executive function on the other, I suggest implications for organizational success. Cognitive thought processes depend on specific brain structures functioning as effectively as possible under conditions of cognitive accuracy. However, typical cognitive processes in hierarchical business structures promote the adoption and application of subjective organizational beliefs and, thus, cognitive inaccuracies. Applying informed frontal lobe executive functioning to cognition, emotion, and organizational behavior helps minimize the negative effects of indiscriminate application of personal and cultural belief systems to business. Doing so enhances cognitive accuracy and improves communication and cooperation. Organizations operating with cognitive accuracy will tend to respond more nimbly to market pressures and achieve an overall higher level of performance and employee satisfaction.

Microalbuminuria is a negative correlate for cognitive function in older adults with peripheral arterial disease: results from the U.S. National Health and Nutrition Examination Survey 1999–2002

Microalbuminuria (MA) has been increasingly identified as a marker of cardiovascular risk. Although poor cognitive function has been implicated as a sequelae of increased cardiovascular burden, little is known about the association between MA and cognitive function. Population-based cross-sectional study. National Health and Nutrition Examination Survey 1999-2002 in the USA. 2049 noninstitutionalized adults (>/=60 years) with nonmissing values in cognitive test, urinary albumin-to-creatinine ratio (UACR) and ankle-brachial blood pressure index (ABPI) was analysed. Participants with UACR >300 microg mg(-1) were excluded. The UACR, in the unit of microg mg(-1), was calculated by dividing the urinary albumin value by the urinary creatinine concentration. MA was defined as UACR between 30 and 300 microg mg(-1). Cognitive function was measured by a 2-min Digit Symbol Substitution Test (DSST). Peripheral artery disease (PAD) was defined as an ABPI <0.9 in either leg. Overall speaking, MA was inversely associated with DSST score after controlling for age, sex, race, body mass index and educational level (regression coefficient = -2.8, P = 0.002). There was an effect modification of PAD on the association between MA and the DSST score. Amongst participants with PAD, the DSST score for those with MA was lower than those without MA (beta = -6.3, P = 0.003) after multivariate adjustment. Moreover, participants with PAD in the highest quartile of UACR had significantly lower DSST score compared to those in the lowest quartile (beta = -8.7, P = 0.001). There was no association between MA and cognitive function amongst participants without PAD. We observed an additive effect of MA and PAD on DSST score. Participants with both MA and PAD had a lower mean DSST score compared to those without both conditions (beta = -6.2, P = 0.003). The presence of MA or a higher level of urinary albumin excretion was inversely associated with cognitive function in participants with PAD.