Life Cognitive Function Research Articles

Trans‐ethnic meta‐analysis of interactions between genetics and early life socioeconomic status on memory performance and decline in older Americans

AbstractBackgroundLater life cognitive function is influenced both by genetics as well as early‐ and later‐life socioeconomic context, and these factors may also interact with each other. Previous research has demonstrated interactions between adult socioeconomic status and several gene regions that influence memory performance and decline in older adulthood, but few studies have examined whether genetics also interacts with childhood socioeconomic factors.MethodsWe used growth curve modeling to estimate episodic memory performance at age 65 (trajectory intercept) and decline thereafter (trajectory slope) in European ancestry (EA, N = 10,468) and African ancestry (AA, N = 2,252) participants from the Health and Retirement Study. Early‐life socioeconomic context included measures of parental education and financial strain. We selected 39 gene regions previously associated with cognitive performance, dementia, and related traits from GWAS. We tested whether all variants (1000 Genomes imputed data) and/or rare exomic variants (exome chip data) in these gene regions interacted with childhood socioeconomic context to influence memory using gene‐based tests (Interaction Sequence Kernel Association Test (iSKAT) or iSKAT Optimal Unified Test (iSKAT‐O)). For iSKAT analyses, we conducted a trans‐ethnic meta‐analysis.ResultsOf the 39 genes, 22 in EA and 19 in AA had nominally significant interactions (p < 0.05) with at least one childhood socioeconomic measure on memory performance and/or decline; however, all but one (father’s education by SLC24A4 gene region in AA) were not significant after multiple testing correction (FDR <0.1). In trans‐ethnic meta‐analysis, two gene regions interacted with childhood socioeconomic context (FDR <0.05). Both interactions were robust to adjustment for respondent’s own educational attainment and APOE ε4. For both interactions (mother’s education by MS4A4A on memory performance (meta‐analysis p = 0.0005), and father’s education by SLC24A4 on memory decline (meta‐analysis p = 0.0009)) in both EA and AA, the genetic effect was stronger in participants with low parental education.ConclusionsExamination of common and rare variants in genes discovered through GWAS shows that childhood socioeconomic context may interact with a few key gene regions to jointly impact memory function and decline in later life. Genetic effects may be more salient for those with lower childhood socioeconomic status.

The long-term consequences of trauma and posttraumatic stress disorder symptoms on later life cognitive function and dementia risk

Stress may be a risk factor for dementia, however it is unknown whether post-traumatic stress disorder (PTSD) symptoms are associated with incident dementia in community-dwelling older individuals. The aim was to determine whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with later-life cognition and dementia risk. Participants were 1,700 community-dwelling older adults (65+) in the longitudinal ESPRIT study followed over 14 years. Lifetime major traumatic exposure and PTSD were assessed using Watson's PTSD Inventory. Cognitive tests assessed global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Incident dementia was diagnosed according to DSM-IV criteria. Lifetime major trauma (versus no trauma) was associated with significantly increased executive function and increased global function in men, however women with lifetime trauma and re-experiencing symptoms had a significantly increased risk of low global cognition. Over 14 years, lifetime trauma without re-experiencing symptoms was associated with a significantly decreased risk of incident dementia, particularly for women. Lifetime major trauma without re-experiencing symptoms (but not with) may be protective for later life cognitive function. However, the mechanisms and moderating factors underlying these association requires further investigation.

Consequences of early life exposure to the 1983-1985 Ethiopian Great Famine on cognitive function in adults: a historical cohort study.

ObjectivesTo investigate the association between early life famine exposure and cognitive function in adults.DesignHistorical cohort studySettingNorth Wollo Zone, Northeast Ethiopia.ParticipantsWe recruited 1047 adult men and women aged 30–38 years who had history of early life exposure to Ethiopian great famine. Based on self-reported age and birth date, participants were categorised into famine exposed in early life (prenatal/postnatal) and non-exposed groups.Outcome measuresThe primary outcome measure of this study was cognitive function in adults after early life exposure to famine. Cognitive function was measured using Montreal Cognitive Assessment—basic. Associations between exposure and outcome variables were examined by linear regression analysis models.ResultsAdjusted for covariates, early life exposure to famine showed 1.29 (β=−1.29; 95% CI −2.16 to -0.52) points lower cognitive function score compared with non-exposed. Based on subanalysis for timing of famine exposure, postnatal exposure to famine resulted in 2.26 (β=−2.26; 95% CI −3.12 to -1.36) points lower cognitive function score compared with non-exposed groups. Prenatal famine exposure had 1.26 (β=−1.26; 95% CI −2.35 to 0.94) points lower cognitive function score although not statistically significant.ConclusionsFamine exposure in early life was associated with cognitive functions in adults. While the overall findings highlight the importance of optimal nutrition in early life for brain growth and development, the association observed between postnatal famine exposure and adult cognitive function may indicate the relative importance of learning and experience during early childhood for optimal brain development after birth. Further studies are needed to elucidate the potential mechanism behind this association.

Late-life cognition: Do childhood conditions play any role?

Individual's cognitive ability tends to reduce with ageing. Recently, whether and how to buffer this age-related decline is one of the greatest concerns. One well-established hypothesis argues that early life conditions play a particularly crucial role in developing individual's cognitive skills. People who grew up in good conditions are more likely to obtain a higher level of cognitive stocks and are more efficient producers of cognitive skills. In this paper, we analyze the impact of childhood conditions on the individuals' late life cognitive functioning by addressing the question whether the same change in age will have different consequences on the late life cognition given different levels of childhood conditions based on the China Health and Retirement Longitudinal Study (CHARLS) data. Our empirical evidence supports that more advantageous childhood conditions can shave off the decline of cognition as measured by word recall with ageing after controlling for individual fixed effects.

Association Between Cognitive Function and Early Life Experiences in Patients with Alcohol Use Disorder.

IntroductionEarly life experiences could be potential risk factors for the development of alcohol use disorder. In similar circumstances, it might also influence cognitive impairment in later life. However, the relationship between early life experience and cognitive function in people with alcohol use disorders is unclear. The current study examined the effects of early social environments and experiences on cognitive function in patients with alcohol use disorder.MethodsA total of 37 adult male patients with alcohol use disorder and 30 healthy control (HC) subjects were enrolled. The MATRICS Cognitive Consensus Battery (MCCB) was used to evaluate cognitive function. The Childhood Trauma Questionnaire (CTQ) and the Revised Adult Attachment Scale (RAAS) were used to evaluate early life experiences of the participants. The RAAS was used to evaluate the attachment patterns of participants.ResultsCompared with the HC group, the alcohol use disorder group reported higher levels of childhood abuse and were more likely to form an insecure attachment style. Patients with alcohol use disorder who experienced trauma performed worse in terms of discrete cognitive parameters such as social cognition, reasoning and problem solving compared to patients without trauma. Importantly, emotional neglect and social comfort were significantly associated with individual social cognitive skills.ConclusionsOur results suggest that the cognitive function of patients with alcohol use disorder, especially social cognitive function, is affected by early life experiences.

The Association of Late Life Cognitive Activity with Healthcare and Financial Decision-Making in Community-Dwelling, Nondemented Older Adults

ObjectiveThe purpose of this study was to test the hypothesis that late life cognitive activity is associated with decision-making in older adults and to examine whether this association varies by level of cognitive function. DesignThis study employed a cross-sectional design. SettingAll data were collected in participants’ community-based residences. ParticipantsParticipants were 1,084 older adults (mean age = 81.05 years, standard deviation = 7.53) without dementia (median Mini-Mental State Examination score = 29, interquartile range = 27.86–30.00). MeasurementsParticipants completed assessments of late life cognitive activity, cognitive function, and decision-making. We used linear regression models to examine the associations of late life cognitive activity and cognitive function with decision-making. ResultsIn a regression model adjusted for age, gender, and education, more frequent late life cognitive activity was associated with better decision-making, as was higher cognitive function. Furthermore, in an additional model that included the interaction of late life cognitive activity and cognitive function, the interaction was significant, such that late life cognitive activity was most strongly associated with decision-making among participants with lower levels of cognitive function. ConclusionFrequent engagement in late life cognitive activity may help maintain decision-making among older persons, particularly among those with lower levels of cognitive function.

A Genome-Wide Integrative Association Study of DNA Methylation and Gene Expression Data and Later Life Cognitive Functioning in Monozygotic Twins.

Monozygotic twins are genetically identical but rarely phenotypically identical. Epigenetic and transcriptional variation could influence this phenotypic discordance. Investigation of intra-pair differences in molecular markers and a given phenotype in monozygotic twins controls most of the genetic contribution, enabling studies of the molecular features of the phenotype. This study aimed to identify genes associated with cognition in later life using integrated enrichment analyses of the results of blood-derived intra-pair epigenome-wide and transcriptome-wide association analyses of cognition in 452 middle-aged and old-aged monozygotic twins (56–80 years). Integrated analyses were performed with an unsupervised approach using KeyPathwayMiner, and a supervised approach using the KEGG and Reactome databases. The supervised approach identified several enriched gene sets, including “neuroactive ligand receptor interaction” (p-value = 1.62∗10-2), “Neurotrophin signaling” (p-value = 2.52∗10-3), “Alzheimer’s disease” (p-value = 1.20∗10-2), and “long-term depression” (p-value = 1.62∗10-2). The unsupervised approach resulted in a 238 gene network, including the Alzheimer’s disease gene APP (Amyloid Beta Precursor Protein) as an exception node, and several novel candidate genes. The strength of the unsupervised method is that it can reveal previously uncharacterized sub-pathways and detect interplay between biological processes, which remain undetected by the current supervised methods. In conclusion, this study identified several previously reported cognition genes and pathways and, additionally, puts forward novel candidates for further verification and validation.

The need to belong: A parallel process latent growth curve model of late life negative affect and cognitive function

ObjectiveLate life negative affect (NA) often co-occurs with poor cognitive function (CF); however, very little is known about the mechanism of the relationship between them. We examined the longitudinal relationship between NA and CF over a 12-year period and the effects of several related risk factors in a general sample. MethodsFive waves of data on Chinese Longitudinal Healthy Longevity Survey (CLHLS) were collected from a total of 1,314 elderly Chinese, aged 60 and over. A parallel process latent growth curve model with two time-invariant covariates and seven time-varying covariates was used to demonstrate the joint trajectories of NA and CF to assess their related factors in the elderly during a 12-year period. ResultsSignificant association of negative affect and cognitive decline was found at baseline and over time for our sample. Poorer initial cognitive performance predicted a faster increase in negative affect over time. Being female was associated with worse initial performance and a faster rate of deterioration of NA and CF. Regular exercise, married status, social activities, and Mahjong playing were associated with slower rates of negative affect increase and cognitive decline. ConclusionThese findings demonstrated that the late life negative affect co-occurs with cognitive decline and negative affect might be a mutative mental reaction to cognitive dysfunction. Gender difference, exercise benefit, and the “need to belong” effect were observed over time, highlighting the importance of exercise and socialization for older females.

Women's Work-Family Histories and Cognitive Performance in Later Life.

Long-term exposures to the stress and stimulation of different work, parenting, and partnership combinations might influence later life cognition. We investigated the relationship between women's work-family life histories and cognitive functioning in later life. Analyses were based on data from women born between 1930 and 1957 in 14 European countries, from the Survey of Health, Ageing and Retirement in Europe (2004-2009) (n=11,908). Multichannel sequence analysis identified 5 distinct work-family typologies based on women's work, partnership, and childrearing statuses between ages 12 and 50 years. Multilevel regressions were used to test the association between work-family histories and later-life cognition. Partnered mothers who mainly worked part-time had the best cognitive function in later life, scoring approximately 0.63 (95% confidence interval (CI): 0.18, 1.07) points higher than mothers who worked full-time on a 19-point scale. Partnered mothers who were mainly unpaid caregivers or who did other unpaid activities had cognitive scores that were 1.19 (95% CI: 0.49, 1.89) and 0.93 (95% CI: 0.20, 1.66) points lower than full-time working mothers. The findings are robust to adjustment for childhood advantage and educational credentials. This study provides new evidence that long-term exposures to certain social role combinations after childhood and schooling are linked to later-life cognition.

Late life education and cognitive function in older adults

The potential role of education attained after the age of 50, for example, vocational training or recreational courses, in cognitive reserve has been unexplored. We examined the cross-sectional and prospective associations between late life education (LLE) and global cognitive function in older adults. A total of 5306 participants (50+ years) in The Irish Longitudinal Study of Ageing answered questions about highest level of education completed and LLE (2010). Cognitive function was defined as the number of errors on the Montreal cognitive assessment (MoCA) assessed in 2010 and 2014. The association between LLE and MoCA-errors was examined using Poisson regression stratified by level of education. Sensitivity analyses were done to examine reverse causation and selection bias. In those with primary/no (n = 1312, incidence rate ratio [IRR] = 0.83, 95%CI = 0.70-0.99) and secondary education (n = 2208, IRR = 0.88, 95%CI = 0.80-0.97), but not tertiary education (n = 1786, IRR = 0.93, CI = 0.86-1.00), participating in LLE was associated with lower rate of MoCA errors. The prospective association between LLE and 4-year change in MoCA-errors was (borderline) statistically significant in those with primary/no education only (IRR = 0.86, CI = 0.74-1.00). Sensitivity analyses supported robustness of the findings. LLE may contribute to cognitive reserve and be a useful intervention to mitigate the increased risk of cognitive decline associated with low levels of education.

Neurology-related protein biomarkers are associated with cognitive ability and brain volume in older age

Identifying biological correlates of late life cognitive function is important if we are to ascertain biomarkers for, and develop treatments to help reduce, age-related cognitive decline. Here, we investigated the associations between plasma levels of 90 neurology-related proteins (Olink® Proteomics) and general fluid cognitive ability in the Lothian Birth Cohort 1936 (LBC1936, N = 798), Lothian Birth Cohort 1921 (LBC1921, N = 165), and the INTERVAL BioResource (N = 4451). In the LBC1936, 22 of the proteins were significantly associated with general fluid cognitive ability (β between −0.11 and −0.17). MRI-assessed total brain volume partially mediated the association between 10 of these proteins and general fluid cognitive ability. In an age-matched subsample of INTERVAL, effect sizes for the 22 proteins, although smaller, were all in the same direction as in LBC1936. Plasma levels of a number of neurology-related proteins are associated with general fluid cognitive ability in later life, mediated by brain volume in some cases.

Playing Analog Games Is Associated With Reduced Declines in Cognitive Function: A 68-Year Longitudinal Cohort Study.

ObjectivesPlaying analog games may be associated with better cognitive function but, to date, these studies have not had extensive longitudinal follow-up. Our goal was to examine the association between playing games and change in cognitive function from age 11 to age 70, and from age 70 to 79.MethodParticipants were 1,091 nonclinical, independent, community-dwelling individuals all born in 1936 and residing in Scotland. General cognitive function was assessed at ages 11 and 70, and hierarchical domains were assessed at ages 70, 73, 76, and 79 using a comprehensive cognitive battery of 14 tests. Games playing behaviors were assessed at ages 70 and 76. All models controlled for early life cognitive function, education, social class, sex, activity levels, and health issues. All analyses were preregistered.ResultsHigher frequency of playing games was associated with higher cognitive function at age 70, controlling for age 11 cognitive function, and the majority of this association could not be explained by control variables. Playing more games was also associated with less general cognitive decline from age 70 to age 79, and in particularly, less decline in memory ability. Increased games playing between 70 and 76 was associated with less decline in cognitive speed.DiscussionPlaying games were associated with less relative cognitive decline from age 11 to age 70, and less cognitive decline from age 70 to 79. Controlling for age 11 cognitive function and other confounders, these findings suggest that playing more games is linked to reduced lifetime decline in cognitive function.

TOWARD AN OPERATIONAL DEFINITION OF COGNITIVE LIFESTYLE: MODELING RESERVE ACROSS THE LIFESPAN

A recent systematic review of current definitions of cognitive reserve across the lifespan was undertaken by our group and five reserve constructs were identified: Educational attainment, sociological position, occupational complexity, cognitive ability, and engagement in leisure activities. The aim of this study was to test whether the different constructs are predictive of cognitive performance in older adults. A theoretical model of cognitive lifestyle was designed to assess reserve across the lifespan and the different measures were mapped in individuals aged >=65 years (N=7,762; 54.47% women) from the Cognitive Function and Ageing Study (CFAS II). Multivariable logistic regression analyses, controlling for age and sex, were used to determine the relationship between later life cognitive function and the five identified measures of reserve. In support of previous findings, the results show that risk of cognitive decline decreases with additional education (OR=0.89; 95% CI= 0.86, 0.94), increasing fluid intelligence (OR=1.00; 95% CI= 0.99, 1.00), and participation in leisure activities (OR= 0.27; 95% CI=0.17, 0.42), and that the lower the hierarchical position of a person’s social strata, the greater their odds of cognitive impairment in later life (OR=1.02; 95% CI=1.00, 1.05). However, though greater occupational complexity with data (OR=1.11; 95% CI=1.03, 1.19) and with people (OR=1.10; 95% CI= 1.03, 1.19) was found to be protective of cognitive decline as expected, greater occupational complexity with things was associated with greater decline (OR=0.98; 95% CI=0.93, 1.04). Given the cross-sectional nature of the present study, further longitudinal work is needed to ascertain what is driving these results.

ASSOCIATION OF RESTRICTED LIFE SPACE MOBILITY WITH COGNITIVE FUNCTION WITHIN OLDER BLACKS AND WHITES WITH DIABETES

The Centers for Disease Control and Prevention have reported that approximately one of every eight older adults self-report experiencing confusion or memory loss that is becoming more frequent or getting worse. Thus, identifying individuals who are at-risk for cognitive problems is essential. The purpose of this investigation was to assess the relationship between life space mobility and cognition within older Blacks and Whites with diabetes. Baseline data from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health (DASH) were utilized. Multiple regression models adjusted for age, education, income, gender, and race were utilized to assess the association between restricted life space (a score of less than 60 on the UAB Life Space Assessment) and cognitive function as assessed by the Telephone Interview for Cognitive Status (TICS-M). The analytic sample consisted of 224 older adults with diabetes (mean age = 73.52) with 54% being female and 53% White. Of the participants, 75 (32%) had a restricted life space and individuals with restricted life space on average had cognition scores that were over 2 points lower than participants categorized as not having restricted life space (B = -0.18, p < .01). Additionally, Black participants had lower levels of cognition when compared to Whites in the covariate-adjusted models (B = -0.23, p < .01). Results of this investigation provide additional evidence to support the relationship between mobility and cognition. Longitudinal investigations assessing the association between mobility and cognition within older adults with diabetes are needed.

THE CEREBELLUM MAY MITIGATE OBESITY-DRIVEN COGNITIVE IMPAIRMENT IN LATE LIFE

Mice that overexpress mutant human tau in forebrain neurons develop many features of Alzheimer’s disease (AD), including behavioral impairments and neurodegeneration by 5 months of age. While an appropriate model to study AD-like pathology, the transgene’s high neurotoxicity makes it difficult to investigate how aging impacts AD onset and progression. The removal of endogenous mouse tau decreases the transgene’s neurotoxicity in young mice, which has allowed us to age mice to 20 months of age and investigate behavior at a more AD-relevant stage of life. Interestingly, the tau transgenic mice show increased discrimination between familiar and unfamiliar objects than non-transgenic littermates (p = 0.02) suggesting tau transgenic mice have better memory. The transgenic mice also displayed increased physical activity in the Open Field Test than non-transgenic littermates (distance traveled, p = 0.0102, and gait speed, p = 0.0219). Their improved behavioral performance occurred despite significant forebrain atrophy (20% smaller, p=0.0003). Interestingly, the non-transgenic control mice lacking endogenous mouse tau developed insulin resistance and obesity, and had significantly smaller cerebellum than transgenic mice (10% smaller, p = 0.0007). These data suggest that insulin resistance and obesity contribute more profoundly to poor behavioral performance than forebrain neurodegeneration. Moreover our study suggests that the cerebellum, recognized primarily for its role in coordination and motor function, may be an important mediator of late life cognitive function, especially in the presence of insulin resistance and obesity.

Health-Related Quality of Life and Cognitive Functioning in Pediatric Liver Transplant Recipients.

The goal of this work was to examine the change in health-related quality of life (HRQOL) and cognitive functioning from early childhood to adolescence in pediatric liver transplantation (LT) recipients. Patients were recruited from 8 North American centers through the Studies of Pediatric Liver Transplantation consortium. A total of 79 participants, ages 11-18years, previously tested at age 5-6years in the Functional Outcomes Group study were identified as surviving most recent LT by 2years and in stable medical follow-up. The Pediatric Quality of Life 4.0 Generic Core Scale, Pediatric Quality of Life Cognitive Function Scale, and PROMIS Pediatric Cognitive Function tool were distributed to families electronically. Data were analyzed using repeated measures and paired t tests. Predictive variables were analyzed using univariate regression analysis. Of the 69 families contacted, 65 (94.2%) parents and 61 (88.4%) children completed surveys. Median age of participants was 16.1years (range, 12.9-18.0years), 55.4% were female, 33.8% were nonwhite, and 84.0% of primary caregivers had received at least some college education. Median age at LT was 1.1years (range, 0.1-4.8years). The majority of participants (86.2%) were not hospitalized in the last year. According to parents, adolescents had worse HRQOL and cognitive functioning compared with healthy children in all domains. Adolescents reported HRQOL similar to healthy children in all domains except psychosocial, school, and cognitive functioning (P=0.02; P<0.001; P=0.04). Participants showed no improvement in HRQOL or cognitive functioning over time. For cognitive and school functioning, 60.0% and 50.8% of parents reported "poor" functioning, respectively (>1 standard deviation below the healthy mean). Deficits in HRQOL seem to persist in adolescence. Over half of adolescent LT recipients appear to be at risk for poor school and cognitive functioning, likely reflecting attention and executive function deficits.

Contemporary Chinese centenarians: Health profiles, social support and relationships in Suixi County

BackgroundCentenarians are the fastest growing population worldwide. However, this group has been less studied in developing countries. Contemporary centenarians in China have experienced many ups and downs due to historical reasons, which may have resulted in a population with different characteristics from those in other countries. This study aimed to investigate the current sociodemographic characteristics, health profiles, and social relationships of Chinese centenarians. MethodsWe conducted face-to-face surveys in April 2017 with centenarian residents in Suixi County, the first “International Healthy Longevity Area” in China. A total of 100 centenarians were involved, including 67 females and 33 males. Information for socioeconomic and demographics characteristics, quality of life (physical, cognitive, and psychological function), and social support and relationships was collected. Sex differences in each measure were examined. ResultsWe find that good self-reported health, good life satisfaction, intact memory function, independence, and unsatisfied healthcare needs were reported by 24.4%, 45.9%, 31.6%, 46.3%, and 33.4% of the respondents respectively. Subjective symptoms among males were less prevalent (p < 0.05). There were no statistical significant sex differences in cognitive and psychological function. The major source of care provision has been family. Generally, the centenarians had intimate relationships within families but maintained distant relationships with friends and communities. ConclusionOur results bring attention to family-based care to provide informal care, and health education to promote healthy behaviors and healthcare utilization, for the oldest-old in China. The findings also imply a crucial role of good relationships with family in exceptional longevity.

The Relationship Between the Effects of Adverse Childhood Experiences with Emotion Regulation and Cognitive Flexibility in Teenage Students

Background: Adolescence is a developmental period when the adverse childhood experiences have a significant impact due to the changes in the brain structure and functioning during this period. This is mainly related to cognitive and emotional functioning. Childhood treatment, relationships, and health are the key factors involved in predicting later life emotional and cognitive growth and function. Objectives: This research aimed to investigate the relationship between adverse childhood experiences with emotion regulation and cognitive flexibility in teenage students. The research method was descriptive correlational. Methods: The population of the study included all enrolled teenage students in English language institutes of Ardabil city in 2019; 135 individuals were selected as the sample of the study. The research tools were Adverse Childhood Experiences Questionnaire, Cognitive Flexibility Questionnaire, and Emotional Regulation Scale. Results: The results showed that there was a significant negative correlation between adverse childhood experiences with emotion regulation (r=-0.409), (P=0.001) and cognitive flexibility(r=-0.435), (P=0.001). The results of the regression analysis showed that 29.5% of emotion regulation was explained by adverse childhood experiences. Also, 50.6% of cognitive flexibility was explained by adverse childhood experiences. Conclusion: There was found a negative and significant correlation between adverse childhood experiences with emotion regulation and cognitive flexibility in teenage students. From this finding, it can be concluded that the early development period and family member treatment, relationships, and health are the key factors in predicting later life emotional and cognitive growth and function.

Executive function training in chronic traumatic brain injury patients: study protocol

BackgroundSome individuals who sustain traumatic brain injuries (TBIs) continue to experience significant cognitive impairments chronically (months to years post injury). Many tests of executive function are insensitive to these executive function impairments, as such impairments may only appear during complex daily life conditions. Daily life often requires us to divide our attention and focus on abstract goals. In the current study, we compare the effects of two 1-month electronic cognitive rehabilitation programs for individuals with chronic TBI. The active program (Expedition: Strategic Advantage) focuses on improving goal-directed executive functions including working memory, planning, long-term memory, and inhibitory control by challenging participants to accomplish life-like cognitive simulations. The challenge level of the simulations increases in accordance with participant achievement. The control intervention (Expedition: Informational Advantage) is identical to the active program; however, the cognitive demand level is capped, preventing participants from advancing beyond a set level. We will evaluate these interventions with a military veteran TBI population.Methods/designOne hundred individuals will be enrolled in this double-blinded clinical trial (all participants and testers are blinded to condition). Each individual will be randomly assigned to one of two interventions. The primary anticipated outcomes are improvement of daily life cognitive function skills and daily life functions. These are measured by a daily life performance task, which tests cognitive skills, and a survey that evaluates daily life functions. Secondary outcomes are also predicted to include improvements in working memory, attention, planning, and inhibitory control as measured by a neuropsychological test battery. Lastly, neuroimaging measures will be used to evaluate changes in brain networks supporting cognition pre and post intervention.DiscussionWe will test whether electronically delivered cognitive rehabilitation aimed at improving daily life functional skills will provide cognitive and daily life functional improvements for individuals in the chronic phase of TBI recovery (greater than 3 months post injury). We aim to better understand the cognitive processes involved in recovery and the characteristics of individuals most likely to benefit. This study will also address the potential to observe generalizability or to transfer from a software-based cognitive training tool toward daily life improvement.Trial registrationClinicalTrials.gov, NCT03704116. Retrospectively registered on 12 Oct 2018.

Living labs for health: an integrative literature review.

Living labs are user-focused experimental environments in which users and producers co-create innovative solutions in real-life settings. The aim of this study was to review and synthesize health-related studies that used the living labs approach. An integrative literature review of 15 studies was conducted on the application of living lab principles and their usefulness for investing health problems. Three reviewers independently used methodological assessment tools to evaluate the data quality. Twelve of 15 studies were published during the past 5 years, while 14 of the 15 studies were conducted in Europe. Older adults were the target population in 9 of the 15 studies. The research topics varied, including detecting and monitoring daily life, fall prevention and social support. All the studies applied multi-method approaches and a real-life setting. Use of the living lab approach appeared to improve the quality of life, physical and social health and cognitive function of the target populations. The results showed that the living lab approach was more commonly used to investigate health problems in older adult populations. Living lab appears to be an appropriate method for developing innovative solutions to improve the health of vulnerable groups.