General Cognitive Level Research Articles

Research on the New Curriculum Module and Exhibition Evaluation Mechanism of Art Education

In response to the deepening reform in the field of education in China, major art education colleges have conducted in-depth analyses of learning topics such as art education and art communication, based on their own educational and teaching needs, academic demands, and operational characteristics. The aim is to establish a cognitive concept that differs from the general depth and cognitive level of thinking, tending towards essential analysis, and to consider art education as the ultimate goal of its own disciplinary development. A new pattern of art education in the public art education bureau’s large classrooms has been gradually constructed. Building upon this, this article analyzes and studies new ideas for setting up art education curriculum modules, the new language of art education dissemination and exhibition, and the new development of art education dissemination and exhibition. The objective is to provide references for education departments and institutions at all stages and to offer theoretical assistance for improving the effectiveness of art education.

The effectiveness of intravenous sedation with midazolam for people with Alzheimer's disease requiring dental extraction

AbstractAimTo assess the effectiveness of the elderly regimen of intravenous sedation (IVS) with midazolam for people with Alzheimer's disease (>65 years old) who required dental extraction.Materials and methodsThis was a retrospective clinical series of people with late, middle and early stages of Alzheimer's disease who had dental extraction under IVS with midazolam. Demographic characteristics such as age, gender and past medical history of the patients were collected from the medical records. Non‐invasive blood pressure, oxygen saturation measured via pulse oximetry and heart rate before and after dental treatment were also collected for each patient. The mental capacity of each patient was assessed using the Mental Capacity Act's four steps. All patients had dental extraction under local anaesthesia and IVS with midazolam. Each patient was injected 1 mg of midazolam over 30 s; pause for 4 min and an additional 0.5 mg increment was added every 2 min until adequate sedation was reached with a minimum of 90% of oxygen saturation. The quality of sedation was assessed using Ellis Sedation Scores.ResultsMidazolam dosage varied between 0.5 and 1.5 mg. All patients showed good (grade II) quality of sedation level as measured by Ellis Sedation Scores. This helped to deliver safe dental extraction.ConclusionsAs the association between general anaesthesia and cognitive level in people with Alzheimer's disease is mixed and still needs further studies, this retrospective clinical series study showed that people with Alzheimer's can benefit from the elderly regimen of IVS with midazolam in providing safe and effective dental extraction when delivered properly.

Cyclic Anaerobic Exercise Performance and Neuromuscular Activity Based on Artificial Intelligence Genetic Algorithm

Anaerobic exercise capacity and neuromuscular activity research is an important content and an emerging research field in sports training research. At present, the understanding of anaerobic exercise ability in academia is still at the general and overall cognitive level, and the understanding and application of anaerobic exercise ability cannot fully meet the needs of competitive sports practice. In order to solve these problems, this paper proposes a cyclic anaerobic exercise performance and neuromuscular activity based on artificial intelligence genetic algorithm, aimed at studying the theory and application mechanism of anaerobic exercise capacity and neuromuscular activity and its application characteristics in competitive sports practice. The approach in this paper is to design genetic operators, compare artificial intelligence genetic algorithms, and test neuromuscular movements. The purpose of these methods is to provide exercisers with a feasible and more effective new method of daily training and to investigate whether this new training method can optimize anaerobic exercise in humans. In this paper, by studying the kinematic basis of anaerobic exercise capacity and the mechanism of neuromuscular regulation, a model of muscle neuron population in anaerobic exercise is established. The results showed that the CMC of the beta band was significantly higher than that of the alpha band at the same strength level, with a difference of 0.03.

Automaticity and cognitive control in bilingual and translation expertise.

It has been observed that different linguistic experiences might exert a differential effect on general cognitive processes. For example, research has shown that language control in professional translation differs from language control applied to other types of bilingual activities. The present study focuses on the construct of automaticity and aims at determining whether different linguistic experiences might modulate the balance between automaticity and cognitive control at the general cognitive level. Hence, monolinguals, bilinguals, and professional translators performed a memory search task that has extensively been employed to observe how automaticity is acquired through consistent practice. Comparisons between the groups showed overall differences in the ease with which the task was performed and, importantly, differences in both automaticity and cognitive control. Specifically, monolinguals showed higher levels of automaticity in the learning phase of the task, while bilinguals and professional translations carried out the task in a more controlled fashion. This pattern might have implied higher cognitive costs for the monolingual group when a switched learning condition was presented. Possibly due to previous control over the initial learning phase, bilinguals and translators were less affected by the cognitive costs associated to the reversal of the learning condition. Differences are explained in terms of professional translation and everyday bilingual practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Multitask brain network reconfiguration is inversely associated with human intelligence.

Intelligence describes the general cognitive ability level of a person. It is one of the most fundamental concepts in psychological science and is crucial for the effective adaption of behavior to varying environmental demands. Changing external task demands have been shown to induce reconfiguration of functional brain networks. However, whether neural reconfiguration between different tasks is associated with intelligence has not yet been investigated. We used functional magnetic resonance imaging data from 812 subjects to show that higher scores of general intelligence are related to less brain network reconfiguration between resting state and seven different task states as well as to network reconfiguration between tasks. This association holds for all functional brain networks except the motor system and replicates in two independent samples (n = 138 and n = 184). Our findings suggest that the intrinsic network architecture of individuals with higher intelligence scores is closer to the network architecture as required by various cognitive demands. Multitask brain network reconfiguration may, therefore, represent a neural reflection of the behavioral positive manifold - the essence of the concept of general intelligence. Finally, our results support neural efficiency theories of cognitive ability and reveal insights into human intelligence as an emergent property from a distributed multitask brain network.

Map Learning in Aging Individuals: The Role of Cognitive Functioning and Visuospatial Factors

Aging coincides with a decline in map learning ability, but it is unclear to what extent different aspects of the mental representation are susceptible. The present study aimed to investigate knowledge about landmarks, their positions and distances (categorical and distance relations, respectively) in relation to aging as well as cognitive functioning (measured with the Montreal Cognitive Assessment [MoCA]), visuospatial abilities, and self-reported wayfinding inclinations. Thirty young adults and 60 older adults (30 aged 63–74 and 30 aged 75–86) learned a map, freely recalled the landmarks and performed a map drawing task (considering the number of landmarks missing, position accuracy and distance accuracy). Before that, older participants were also assessed regarding their general cognitive functioning (MoCA) and a series of visuospatial measures. The results show age-related differences among adults in recalling landmarks and in both categorical and distance relations, with a worsening of performance of old-olds only in the former. Older adults’ MoCA score related to accuracy in the three measures, and an additional role of spatial anxiety was found for distance accuracy. Above and beyond the age-related decline, the quality of older people’s spatial mental representation is related to higher general cognitive level and lower spatial anxiety.

Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group

ABSTRACT Introduction: Deliberate self-harm (DSH) is a common symptom in psychiatric disorders. It is a cross-diagnostic symptom, although it has mainly been associated with borderline personality disorder (BPD). Research has suggested an association between DSH and deficits in executive functioning. The main aim of the current study was to assess three specific aspects of executive functioning (EF) (working memory, inhibition and cognitive flexibility) among psychiatric patients with DSH, compared to a clinical and a healthy comparison group. Methods: Thirty psychiatric patients with DSH, 29 psychiatric patients without DSH and 29 healthy individuals were assessed with regard to psychiatric illness, self-harming behavior, EF, general cognitive functioning level and measures of psychopathology. The results were analyzed by means of ANOVA, regression analysis, Chi-square, and correlation analysis. Results: The patients with DSH showed deficits in cognitive flexibility and inhibition as compared to healthy individuals. In addition, the patients with DSH had greater deficits in cognitive flexibility than the patients without DSH; this effect was independent of concurrent severity of depressive symptoms but not independent of borderline symptomatology. Conclusion: Psychiatric patients with DSH may have deficits in cognitive flexibility as compared to both the healthy and clinical comparison groups. The results partly differ from previous related studies in the field. It is unclear to which extent the deficits in cognitive flexibility are due to other factors. More research is needed to understand the implications of such deficits, and if the results could be used for adapting treatment services and strategies. Future studies should include more similar comparison groups.

The effects of cognitive abilities and task demands on tonic and phasic pupil sizes

Previous studies on individual differences in pupil size of healthy individuals and their relation to performance have been inconclusive. Using a novel approach, we tested the effect of general cognitive abilities and level of task performance on pretrial baseline and task-evoked pupil (TEP) sizes (N = 116) while we manipulated the level of task demands using a multiple object tracking task. Results did not reveal an effect of general cognitive abilities, estimated by working memory capacity and gF scores, on either baseline or TEP sizes. In contrast, we found an interaction in TEP sizes between level of overall MOT performance and task demands. We propose that individual differences in TEP sizes are related to state-specific level of task performance and task demands, probably in combination with other factors like age, personality traits, and state-specific level of motivation and arousal. We also suggest methodological confounds that may cause the previous inconclusive findings.

The Profiling of PASS Cognitive Processing among Children with Learning Difficulties

his study is aimed to explore the profiles of PASS cognitive processes for children with learning difficulties in among primary schools children. The four cognitive processes which are Planning, Attention, Simultaneous and Successive (PASS) operate mental processing in most of the academic tasks. This study had included 279 children with LD among those who follow Literacy and Numeracy Screening System (LINUS) programme in schools. There were 12 schools from 4 clusters of peninsular Malaysia which are Northern, Southern, Central and East Coast of Malaysia selected in this study. The participants were identified through LINUS achievement and recommendation of remedial class teachers according to the criteria of learning difficulties. The identified children were administered with CAS-2 as the instrument to measure general cognitive ability with specific PASS cognitive processes. The individual administered test was conducted on one on one basis by eight research assistants. The findings of the study showed 22.6% of the children who were categorised in LD group had average and above average cognitive ability level. Children with LD showed poor processing in all aspects of cognitive processes especially simultaneous processing. The policymakers, school administrators and teachers need to take individual differences into consideration while designing the curriculum especially for children with LD. Through identification of general cognitive ability level and specific cognitive processing of cognitive ability components would be able to help the children more objectively and meaningfully

Longitudinal associations between hearing loss and general cognitive ability: The Lothian Birth Cohort 1936.

Hearing impairment is associated with poorer cognitive function in later life. We tested for the potential contribution of childhood cognitive ability to this relationship. Childhood cognitive ability is strongly related to cognitive function in older age, and may be related to auditory function through its association with hearing impairment risk factors. Using data from the Lothian Birth Cohort, 1936, we tested whether childhood cognitive ability predicted later-life hearing ability then whether this association was mediated by demographic or health differences. We found that childhood cognitive ability was negatively associated with hearing impairment risk at age 76 (odds ratio = .834, p = .042). However, this association was nonsignificant after subsequent adjustment for potentially mediating demographic and health factors. Next, we tested whether associations observed in older age between hearing impairment and general cognitive ability level or change were accounted for by childhood cognitive ability. At age 76, in the minimally adjusted model, hearing impairment was associated with poorer general cognitive ability level (β = −.119, p = .030) but was not related to decline in general cognitive ability. The former association became nonsignificant after additional adjustment for childhood cognitive ability (β = −.068, p = .426) suggesting that childhood cognitive ability contributes (potentially via demographic and health differences) to the association between levels of hearing and cognitive function in older age. Further work is needed to test whether early life cognitive ability also contributes to the association (documented in previous studies) between older-age hearing impairment and cognitive decline.

EFFECTS OF MUSIC THERAPY IN ELDERLY CARE: COGNITION, BIOMARKERS, MOOD AND SOCIAL BEHAVIOUR

Music therapy (MT) can provide significant benefits for people with cognitive decline living in care homes, enhancing social-cognitive functions and reducing behavioral symptoms1. Nevertheless, RCT studies demonstrating the effectiveness of this intervention are scarce and often methodologically weak, with consequent significant limitations in the generalizability of their results2. To develop further studies aligned with a robust empirical approach, the present study aims to provide both clinical and scientific evidence, based on standardized tests, supported by biomarkers and implicit measures (psychophysiology, brain activity, hormones), and developing protocols that could be replicable. A pre/post 4 months RCT study was conducted. Participants: 54 elderly with mild to moderate cognitive impairment (MMSE range 18-23) living in 5 different care homes, and randomly assigned to either an experimental or active control group. Once a week the experimental group attended one-to-one, 40min MT, while the control group attended one-to-one, 40min Story-Telling activity (ST). Both activities were based on improvisational techniques and the mood-matching approach³, and were carried out by, respectively, professional music therapist (MT) and trained activity-coordinators (ST) who had received specific training on the protocols. Before and after the 4 month intervention the following assessments were conducted: [1] neuropsychological tests to measure general cognitive level, attention, verbal and spatial abilities; [2] a novel neuropsychological test was also used, to assess the cognitive functions directly stimulated by music tasks (Music Cognitive Test, Mangiacotti et al., under validation); [3] behavioral and wellbeing measurements to assess psychiatric behavioral symptoms, mood, locus of control, social abilities, motivation, life-satisfaction and quality of Life; [4] as a measure of autonomic regulation, Respiratory Sinus Arrhythmia (RSA) was collected; [5] Salivary Cortisol/DHEA ratio; [6] EEG cortical entrainment⁴. Results available by May2019. The results will elucidate the relationship between different types of measures in monitoring the effectiveness of treatment for cognitive decline in aging. We expect the result will confirm better outcomes in MT than ST treatment.

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity.

Background: Non-alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce.Methods: We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-alcoholic Wernicke's encephalopathy and subsequent chronic memory problems.Results: All patients had abnormal neuropsychological test results, predominantly in memory. Thus, the neuropsychological findings were compatible with Korsakoff syndrome. However, the neuropsychological findings were not uniform. The impairment of delayed verbal memory of the first patient was evident only when the results of the memory tests were compared to her general cognitive level. In addition, the logical memory test and the verbal working memory test were abnormal, but the word list memory test was normal. The second patient had impaired attention and psychomotor speed in addition to impaired memory. In the third patient, the word list memory test was abnormal, but the logical memory test was normal. All patients had intrusions in the neuropsychological examination. Executive functions were preserved, except for planning and foresight, which were impaired in two patients. Conventional MRI examination was normal. DTI showed reduced fractional anisotropy values in the uncinate fasciculus in two patients, and in the corpus callosum and in the subgenual cingulum in one patient.Conclusions: Non-alcoholic Korsakoff syndrome can have diverse neuropsychological findings. This may partly explain its marked underdiagnosis. Therefore, a strong index of suspicion is needed. The presence of intrusions in the neuropsychological examination supports the diagnosis. Damage in frontotemporal white matter tracts, particularly in the uncinate fasciculus, may be a feature of non-alcoholic Korsakoff syndrome in psychiatric patients.

Longitudinal development of hippocampal subregions from childhood to adulthood

Detailed descriptions of the development of the hippocampus promise to shed light on the neural foundation of development of memory and other cognitive functions, as well as the emergence of major mental disorders. Hippocampus is a heterogeneous structure with a well characterized internal complexity, but development of its distinct subregions in humans has remained poorly described. We analyzed magnetic resonance imaging (MRI) data from a large longitudinal sample (270 participants, 678 scans) using an automated segmentation tool and mixed models to delineate the development of hippocampal subregion volumes from childhood to adulthood. We also examined sex differences in subregion volumes and their development, and associations between hippocampal subregions and general cognitive ability. Nonlinear developmental trajectories with early volume increases were observed for subiculum, cornu ammonis (CA) 1, molecular layer (ML) and fimbria. In contrast, parasubiculum, presubiculum, CA2/3, CA4 and the granule cell layer of the dentate gyrus (GC-DG) showed linear volume decreases. No sex differences were found in hippocampal subregion development. Finally, general cognitive ability was positively associated with CA2/3 and CA4 volumes, as well as with ML development. In conclusion, hippocampal subregions appear to develop in diversified ways across adolescence, and specific subregions may link to general cognitive level.

Memory is Not Enough: The Neurobiological Substrates of Dynamic Cognitive Reserve

Changes in the residual memory variance are considered as a dynamic aspect of cognitive reserve (d-CR). We aimed to investigate for the first time the neural substrate associated with changes in the residual memory variance overtime in patients with amnestic mild cognitive impairment (aMCI). Thirty-four aMCI patients followed-up for 36 months and 48 healthy elderly individuals (HE) were recruited. All participants underwent 3T MRI, collecting T1-weighted images for voxel-based morphometry (VBM). They underwent an extensive neuropsychological battery, including six episodic memory tests. In patients and controls, factor analyses were used on the episodic memory scores to obtain a composite memory score (C-MS). Partial Least Square analyses were used to decompose the variance of C-MS in latent variables (LT scores), accounting for demographic variables and for the general cognitive efficiency level; linear regressions were applied on LT scores, striping off any contribution of general cognitive abilities, to obtain the residual value of memory variance, considered as an index of d-CR. LT scores and d-CR were used in discriminant analysis, in patients only. Finally, LT scores and d-CR were used as variable of interest in VBM analysis. The d-CR score was not able to correctly classify patients. In both aMCI patients and HE, LT1st and d-CR scores showed correlations with grey matter volumes in common and in specific brain areas. Using CR measures limited to assess memory function is likely less sensitive to detect the cognitive decline and predict the evolution of Alzheimer's disease. In conclusion, d-CR needs a measure of general cognition to identify conversion to Alzheimer's disease efficiently.

Deficit in phonological processes: a characteristic of the neuropsychological profile of children with NF1

ABSTRACTLearning disabilities are one of the most frequent complications of neurofibromatosis type 1 (NF1) in children. Studies of the effects of the neurocognitive deficit on academic performance are relatively rare, owing to the small size of the populations concerned. However, research is needed to develop effective rehabilitation programs. In the present study, we explored the impact of a possible phonological deficit on the reading abilities of children with NF1. A multicenter, cross-sectional study was conducted in France on two groups of 75 children with or without NF1 aged 8–12 years, matched for age, sex, handedness, and reading level. All participants underwent a neuropsychological evaluation to assess their general cognitive level, reading skills, phonological processes, visuoperceptual abilities, and attentional capacity. Phonological skills were assessed by means of two phonological awareness tasks and one short-term memory task. In the group of children with NF1, 41% had reading difficulties. Phonological processes were impaired in this group, compared with the children without NF1. Similar differences were found for a phoneme deletion task after adjustment for reading difficulties, IQ level, and visuoperceptual abilities. Phonological awareness, but not phonological short-term memory, was impaired in children with NF1, and not just those whose reading was impaired. Results suggest that children with NF1 have a phonological awareness deficit, whatever their reading level. Identification of reduced phonological skills may warrant the implementation of a specific rehabilitation program before early reading difficulties emerge.

No cross-sectional evidence for an increased relation of cognitive and sensory abilities in old age

Objectives: A key question in gerontological research concerns whether good functioning can be maintained in some cognitive abilities in old age, even if deficits occur in other cognitive or sensory abilities. Our goals were to investigate relations of cognitive and sensory abilities in old age, whether these relations differed in size across old age, and whether this was affected by general cognitive ability (processing speed), educational level, and/or general health status.Methods: Two thousand eight hundred and twelve older adults (aged 65–101, M = 77.9 years) from the Vivre–Leben–Vivere survey served as cross-sectional sample for the present study. We administered psychometric tests on processing speed (the speed of cognitive processing), cognitive flexibility (the ability to alternate between cognitive operations), and verbal abilities (vocabulary). In addition, we interviewed individuals on their hearing, eyesight, educational level, and general health status. We regressed sizes of relations between abilities (calculated within each 1-year age tranche) on mean age within the corresponding age tranche, with the number of participants within the corresponding age tranche as case weights.Results: We observed a decrease in relations between processing speed and cognitive flexibility in old age that was particularly pronounced in individuals with high educational level (r = −.41). In contrast, we did not find differences in relations between other cognitive and sensory abilities across old age, which held for different levels of general cognitive ability, education, and general health status.Conclusion: Present data do not support the view of a generally increased relation of cognitive and sensory abilities in old age.

Multiprofessional follow-up programmes are needed to address psychosocial, neurocognitive and educational issues in children with brain tumours.

AimThe aim of this study was to coordinate the structured psychosocial, neurocognitive and educational follow‐up of children treated for brain tumours with the medical protocol and apply the model in two Swedish healthcare regions.MethodsWe invited all children living in the two regions, who had been diagnosed with a brain tumour from October 1, 2010, through June 30, 2012, to participate along with their parents. The follow‐up programme evaluated the emotional status of the parents and patients and assessed the children's general cognitive level, working memory, speed of performance, executive functions and academic achievement from diagnosis through to adult care.ResultsDuring the study period, 61 children up to the age of 17.1 years were diagnosed with a brain tumour, but 18 of these were excluded for various reasons. The majority of the mothers (70%) displayed significantly poor emotional status, as did 34% of the fathers and 21% of the children. The majority of the children (57%) also showed poor neurocognitive performance and needed special adaptations at school (66%).ConclusionOur findings indicate the need for coordinated, multiprofessional follow‐up programmes, well anchored in the healthcare organisation, for children diagnosed with brain tumours

Cognitive complexity, religious cognition, cognitive development, and religious judgment: An empirical study of relationships amongst “normal” and “gifted” young people.

This study examined whether level of cognitive complexity in religious cognition, using measures rooted in the Model of Hierarchical Complexity, mediates the relationship between level of general cognitive development, and religious judgment, in children and adolescents. The study was conducted with 189 children and adolescents drawn from Catholic schools in France. General cognitive development level was measured using the WISC and WAIS. Level of cognitive complexity in religious cognition was measured using the Religious Cognition Questionnaire: PastorParishioner Scenario (RCQ). Religious judgment levels were measured using the Religious Reflection Questionnaire (RRQ). Results indicate that the relationship between IQ and religious judgment is mediated by level of complexity in religious cognition. The results provide further empirical evidence for the conceptual validity and research utility of the Model of Hierarchical Complexity in the domain of religious cognition, and the power of the concept of complexity in religious cognition for explaining relationships between general cognitive development using IQ measures and other domains where the judgment of social, moral, and philosophical issues are concerned. The results also provide further empirical evidence for the distinctive, and relatively advanced, capacity of gifted young people to think critically about religious and philosophical issues.

Motor role of parietal cortex in a monkey model of hemispatial neglect

Parietal cortex is central to spatial cognition. Lesions of parietal cortex often lead to hemispatial neglect, an impairment of choices of targets in space. It has been unclear whether parietal cortex implements target choice at the general cognitive level, or whether parietal cortex subserves the choice of targets of particular actions. To address this question, monkeys engaged in choice tasks in two distinct action contexts--eye movements and arm movements. We placed focused reversible lesions into specific parietal circuits using the GABAA receptor agonist muscimol and validated the lesion placement using MRI. We found that lesions on the lateral bank of the intraparietal sulcus [lateral intraparietal area (LIP)] specifically biased choices made using eye movements, whereas lesions on the medial bank of the intraparietal sulcus [parietal reach region (PRR)] specifically biased choices made using arm movements. This double dissociation suggests that target choice is implemented in dedicated parietal circuits in the context of specific actions. This finding emphasizes a motor role of parietal cortex in spatial choice making and contributes to our understanding of hemispatial neglect.

Visuo-spatial ability in individuals with Down syndrome: is it really a strength?

Down syndrome (DS) is associated with extreme difficulty in verbal skills and relatively better visuo-spatial skills. Indeed, visuo-spatial ability is often considered a strength in DS. However, it is not clear whether this strength is only relative to the poor verbal skills, or, more impressively, relative to cognitive ability in general. To answer this question, we conducted an extensive literature review of studies on visuo-spatial abilities in people with Down syndrome from January 1987 to May 2013. Based on a general taxonomy of spatial abilities patterned after Lohman, Pellegrino, Alderton, and Regian (1987) and Carroll (1993) and existing studies of DS, we included five different domains of spatial abilities - visuo-spatial memory, visuo-spatial construction, mental rotation, closure, and wayfinding. We evaluated a total of 49 studies including 127 different comparisons. Most comparisons involved a group with DS vs. a group with typical development matched on mental age and compared on a task measuring one of the five visuo-spatial abilities. Although further research is needed for firm conclusions on some visuo-spatial abilities, there was no evidence that visuo-spatial ability is a strength in DS relative to general cognitive ability. Rather, the review suggests an uneven profile of visuo-spatial abilities in DS in which some abilities are commensurate with general cognitive ability level, and others are below.