Lower Executive Function Performance Research Articles

Validation of the European Cross‐Cultural Neuropsychological Test Battery (CNTB) for the assessment of mild cognitive impairment due to Alzheimer’s disease and Parkinson’s disease in Spain

AbstractBackgroundThe Cross‐Cultural Neuropsychological Test Battery (CNTB) is a novel comprehensive neuropsychological battery developed from a multicultural approach. We aimed to validate the CNTB in patients from the majority population with Alzheimer’s disease (AD), including mild cognitive impairment (MCI) and mild dementia stages, and Parkinson’s disease with MCI (PD‐MCI).MethodsThirty patients with AD‐MCI, 30 with AD‐dementia (AD‐D), and 30 with PD‐MCI were enrolled. Each clinical group had a specific healthy control group (HC) with no differences in sex, age, or years of education. We performed intergroup comparisons, ROC analysis, and calculated the corresponding cut‐off points based on Youden’s index.ResultsAD‐MCI showed lower scores than HC in those subtests associated with episodic memory and verbal fluency, while AD‐D also scored lower in executive function and visuospatial tests with large effect sizes. Participants with PD‐MCI showed lower performance in memory and executive function, particularly on error scores, with large effect sizes, compared with HC. While AD‐MCI showed lower memory scores, PD‐MCI had a lower performance in executive functions, comparing both groups. We found evidence of convergent validity with standardized neuropsychological tests measuring the same cognitive domains. Cut‐off scores were similar to previous studies conducted in other cultures.ConclusionsThe CNTB showed appropriate diagnostic properties and convergent validity in AD and PD, including the early stages of the disease. This supports the utility of the CNTB for the early detection of cognitive impairment in AD and PD.

Multiple Chronic Conditions and Midlife Cognitive Function in Black and White Adults: The Bogalusa Heart Study

AbstractBackgroundIn late‐life, multiple chronic conditions (MCCs) has been associated with cognitive decline and Alzheimer’s Disease and related dementias. However, this relationship has not been investigated in a middle‐aged population, a time when MCCs first begin to develop, or in rural and low socioeconomic settings, where individuals are at a higher risk of MCCs. We examined the relationship between MCCs and midlife cognitive function among Black and White men and women from a rural, community‐based cohort in Bogalusa, Louisiana.MethodsThis cross‐sectional study includes 1,223 Black (33%) and White (67%) individuals (mean age 48.10 ± 5.26; 59% female) from the Bogalusa Heart Study with a complete neuropsychological (NP) assessment, and no history of stroke. Six chronic conditions were selected from the CMS (Centers for Medicare & Medicaid Services) Data Warehouse, and defined using self‐reported data, medication use, and physiological/laboratory measures (Table 1). MCCs was defined as the coexistence of ≥2 conditions. NP performance was measured by global cognitive z‐scores (GCS) and by domain specific z‐scores for attention and processing, episodic memory, and executive function. All z‐scores were standardized for age, sex, and race. Regression models assessed the association between MCCs and cognitive outcomes, adjusting for alcohol consumption, smoking status, and education.ResultsA total of 66% participants had MCCs; 44.4% (n = 543) had 2 CCs, 17.8% (n = 218) had 3 CCs, and 3.8% (n = 46) had 4+ CCs. Compared to no chronic conditions, having 2,3, and ≥4 CCs was significantly associated with poorer executive function z‐scores after adjusting for covariates (all p’s < 0.05). Having three MCCs had the worst impact on executive function z‐scores (‐0.88(.20), p <0.001) (Table 2). The most prevalent conditions in this group were hypertension, dyslipidemia, and diabetes which co‐occurred in 87.7% (n = 165) of participants with three CCs.ConclusionThis study suggests that the presence of MCCs is associated with lower executive function performance as early as midlife. Hypertension and dyslipidemia commonly occur together and are particularly prevalent in midlife. These findings highlight the importance of addressing chronic conditions earlier in life, a less studied and critical time window for potential prevention of adverse cognitive outcomes in late life.

Association of regional white matter hyperintensities with hypertension and cognition in the population-based 1000BRAINS study.

White matter hyperintensities of presumed vascular origin (WMH) are frequent in cerebral magnetic resonance imaging of older people. They are promoted by vascular risk factors, especially hypertension, and are associated with cognitive deficits at the group level. It has been suggested that not only the severity, but also the location, of lesions might critically influence cognitive deficits and represent different pathologies. In 560 participants (65.2 ± 7.5 years, 51.4% males) of the population-based 1000BRAINS study, we analyzed the association of regional WMH using Fazekas scoring separately for cerebral lobes, with hypertension and cognition. WMH most often affected the frontal lobe (83.7% score >0), followed by the parietal (75.8%), temporal (32.7%), and occipital lobe (7.3%). Higher Fazekas scores in the frontal, parietal, and temporal lobe were associated with higher blood pressure and antihypertensive treatment in unadjusted ordinal regression models and in models adjusted for age, sex, and vascular risk factors (e.g., age- and sex-adjusted odds ratio=1.14, 95% confidence interval=1.03-1.25 for the association of frontal lobe WMH Fazekas score with systolic blood pressure [SBP] [per 10 mm Hg]; 1.13 [1.02-1.23] for the association of parietal lobe score with SBP; 1.72 [1.19-2.48] for the association of temporal lobe score with antihypertensive medications). In linear regressions, higher frontal lobe scores were associated with lower performance in executive function and non-verbal memory, and higher parietal lobe scores were associated with lower performance in executive function, verbal-, and non-verbal memory. Hypertension promotes WMH in the frontal, parietal, and temporal lobe. WMH in the frontal and parietal lobe are associated with reduced executive function and memory.

Predictors of Functional Outcome in Patients with Bipolar Disorder

Introduction Bipolar disorder is a severe disorder that is often accompanied by deficits in both neurocognitive (1) and psychosocial function (2). At the Department of Psychiatry and Psychotherapy of the Medical University of Vienna we performed a study to further identify potential cognitive, clinical and treatment-dependent predictors for functional impairment, symptom severity and early recurrence in bipolar patients (3). Methods Forty-three remitted bipolar patients and 40 healthy probands were assessed with a cognitive battery. In a randomized controlled trial, remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy (CPEGT) over 14 weeks or treatment-as-usual. At 1 year after therapy, functional impairment and severity of symptoms were assessed. Results As compared to healthy probands, bipolar patients showed lower performance in executive function, sustained attention, verbal learning and verbal fluency. Both attention and CPEGT predicted occupational functioning. In our study verbal memory recall was a predictor for symptom severity. Discussion Our data suggest that bipolar patients benefit from CPEGT in the domain of occupational life. Implications for treatment strategies are discussed. Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, Varo C, Grande I, Valls E, Salagre E, Sanchez-Moreno J, Martinez-Aran A, Carvalho AF, Vieta E. Int J Neuropsychopharmacol (2017) 20:670–80. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ. Am J Psychiatry (2003) 160:2099–107. Sachs G, Berg A, Jagsch R, Lenz G, Erfurth A. Front Psychiatry (2020) 23;11:530026.DisclosureNo significant relationships.

Structural and functional brain alterations in patients with myasthenia gravis.

Myasthenia gravis is an autoimmune disease affecting neuromuscular transmission and causing skeletal muscle weakness. Additionally, systemic inflammation, cognitive deficits and autonomic dysfunction have been described. However, little is known about myasthenia gravis-related reorganization of the brain. In this study, we thus investigated the structural and functional brain changes in myasthenia gravis patients. Eleven myasthenia gravis patients (age: 70.64 ± 9.27; 11 males) were compared to age-, sex- and education-matched healthy controls (age: 70.18 ± 8.98; 11 males). Most of the patients (n = 10, 0.91%) received cholinesterase inhibitors. Structural brain changes were determined by applying voxel-based morphometry using high-resolution T1-weighted sequences. Functional brain changes were assessed with a neuropsychological test battery (including attention, memory and executive functions), a spatial orientation task and brain-derived neurotrophic factor blood levels. Myasthenia gravis patients showed significant grey matter volume reductions in the cingulate gyrus, in the inferior parietal lobe and in the fusiform gyrus. Furthermore, myasthenia gravis patients showed significantly lower performance in executive functions, working memory (Spatial Span, P = 0.034, d = 1.466), verbal episodic memory (P = 0.003, d = 1.468) and somatosensory-related spatial orientation (Triangle Completion Test, P = 0.003, d = 1.200). Additionally, serum brain-derived neurotrophic factor levels were significantly higher in myasthenia gravis patients (P = 0.001, d = 2.040). Our results indicate that myasthenia gravis is associated with structural and functional brain alterations. Especially the grey matter volume changes in the cingulate gyrus and the inferior parietal lobe could be associated with cognitive deficits in memory and executive functions. Furthermore, deficits in somatosensory-related spatial orientation could be associated with the lower volumes in the inferior parietal lobe. Future research is needed to replicate these findings independently in a larger sample and to investigate the underlying mechanisms in more detail.

Data-driven approaches to executive function performance and structure in aging: Integrating person-centered analyses and machine learning risk prediction.

Objective: Executive function (EF) performance and structure in nondemented aging are frequently examined with variable-centered approaches. Person-centered analytics can contribute unique information about classes of persons by simultaneously considering EF performance and structure. The risk predictors of these classes can then be determined by machine learning technology. Using data from the Victoria Longitudinal Study we examined two goals: (a) detect different underlying subgroups (or classes) of EF performance and structure and (b) test multiple risk predictors for best discrimination of these detected subgroups. Method: We used a classification sample (n = 778; Mage = 71.42) for the first goal and a prediction subsample (n = 570; Mage = 70.10) for the second goal. Eight neuropsychological measures represented three EF dimensions (inhibition, updating, shifting). Fifteen predictors represented five domains (genetic, functional, lifestyle, mobility, demographic). Results: First, we observed two distinct classes: (a) lower EF performance and unidimensional structure (Class 1) and (b) higher EF performance and multidimensional structure (Class 2). Second, Class 2 was predicted by younger age, more novel cognitive activity, more education, lower body mass index, lower pulse pressure, female sex, faster balance, and more physical activity. Conclusions: Data-driven modeling approaches tested the possibility of an EF aging class that displayed both preserved EF performance levels and sustained multidimensional structure. The two observed classes differed in both performance level (lower, higher) and structure (unidimensional, multidimensional). Machine learning prediction analyses showed that the higher performing and multidimensional class was associated with multiple brain health-related protective factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Neuroanatomy of complex social emotion dysregulation in adolescent offenders.

Social emotions require the correct integration of emotional, cognitive, and social processes and are critical for complex social interactions. Adolescent criminal offenders (AOs) show abnormalities in the experience of basic emotions. However, most research has focused solely on basic emotions, neglecting complex social emotions that could be critical for social reintegration. The purpose of this study was to investigate the behavioral and neural correlates of social emotions (envy and Schadenfreude) in AOs. We explored the experience of complex social emotions, as well as their anatomical correlates, in AOs (n = 19) and a nonoffenders control group (NOs, n = 20). Additionally, we assessed the relationship between social emotions, executive functions (EFs), and fluid intelligence (FI). Structural brain imaging was obtained in all participants. The results showed that AOs had significantly lower envy and Schadenfreude ratings and exhibited lower performance in EFs compared with NOs. The measurement of EFs relied on the INECO frontal screening (IFS). Experiencing fewer social emotions was associated with diminished EFs but not with FI. Moreover, in AOs, reduced levels of envy and Schadenfreude were linked with reduced gray matter volumes in regions subserving mentalizing abilities (inferior parietal lobe and precuneus) and socioemotional processing (inferior and middle temporal regions), as well as key hubs of the executive frontoparietal network (inferior parietal lobule, orbital and rectus gyri). Additional analysis on the AOs revealed no associations between the type of crime and our variables of interest (EFs, FI and social emotions). Our findings are the first to provide evidence on abnormalities in the experience of social emotions in AOs that are associated with neurocognitive markers of social cognition and EFs. Understanding social emotions and their abnormalities (under-experience) as complex intertwined processes may have important future translational implications, including risk prediction for social adaptation/reintegration, sociocognitive targeted interventions, and skill training for social emotions in vulnerable populations.

Predicting functional outcome in bipolar patients: Effects of cognitive psychoeducational group therapy after 12 months

IntroductionCognitive impairment is known as a core feature in bipolar patients. Persisting neurocognitive impairment has been associated with low psychosocial functioning.ObjectivesThe goal of this work was to identify clinical and cognitive predictors for functional impairment, symptom severity and early recurrence in bipolar disorder, as well as to compare the neurocognitive performance of bipolar patients with that of healthy probands.Methods43 remitted bipolar patients and 40 healthy controls were compared using a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, the 43 remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed.ResultsAs compared to healthy probands, bipolar patients showed lower performance in executive function (perseverative errors p<0.01, categories correct p<0.001), sustained attention (total hits p<0.001), verbal learning (delayed recall p<0.001) and verbal fluency (pwords p<0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%).ConclusionsOur data show that bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Reductions in sustained attention have an impact on occupational impairment.DisclosureNo significant relationships.

Prediction of functional outcome in bipolar disorder: Effects of cognitive remediation and cognitive psychoeducational group therapy

IntroductionIn bipolar patients cognitive deficits are an important feature. Persisting neurocognitive impairment is associated with low psychosocial functioning.ObjectivesThe aim of this presentation is to discuss potential cognitive, clinical and treatment-dependent predictors for functional impairment in bipolar patients.MethodsIn a first study (1) at the Medical University of Vienna 43 remitted bipolar patients and 40 healthy controls were assessed testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed. In a second, ongoing study, in-patients from a defined catchment area in Vienna (12th, 13th and 23rd district) were assessed via SCIP (Purdon S. 2005. The screen for cognitive impairment in psychiatry: Administration and psychometric properties. Edmonton, Alberta, Canada: PNL Inc.). The SCIP was performed before and after cognitive remediation. The effects of treatment on functioning were measured with the clinical Global Impression Scale (CGI).ResultsCompared to controls, bipolar patients showed lower performance in executive function, sustained attention, verbal learning and verbal fluency. Cognitive psychoeducational group therapy and attention predicted occupational functioning. In the second study, SCIP and CGI values showed improvement after treatment.ConclusionsOur data support the idea that cognition affects outcome. Bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. (1) Sachs G et al. Front. Psychiatry, 23 November 2020 | https://doi.org/10.3389/fpsyt.2020.530026DisclosureNo significant relationships.

Clinical binge eating, but not uncontrolled eating, is associated with differences in executive functions: Evidence from meta-analytic findings

IntroductionBinge eating disorder (BED) is a common psychiatric diagnosis characterized by the presence of episodes of loss of control over food consumption. Understanding the neurocognitive factors associated with binge eating pathology might help to design clinical strategies aimed at preventing or treating BED. However, results in the field are notably heterogeneous. In the current study, we aimed to establish whether binge eating behaviors (both at a clinical and at a non-clinical level) are associated with executive functions. MethodsWe performed a pre-registered meta-analysis to examine the link between executive functions, BED, and uncontrolled eating, a psychobiological construct closely associated with binge eating behaviors. Articles were searched on PubMed and the main exclusion criteria were lack of information about participants’ age or sex distribution or adiposity measurements, studies performed in older populations (age > 65 years old) or studies including participants with purging symptoms. ResultsRelative to healthy controls, patients with BED showed lower performance in executive functions, with a small effect size. At the same time, uncontrolled eating patterns were not associated with differences in executive functions. Neither age nor body mass index (BMI) influenced these results. ConclusionsOur findings suggest that there is no association between performance in executive functions and variations along the non-clinical spectrum of binge eating behaviors. Small deficits in executive functions, however, seem to appear in individuals showing severe binge eating symptoms, that is, individuals meeting diagnostic criteria for BED. We speculate that the close links between BED and emotional distress could partly explain these results.

Predictors of Functional Outcome in Patients With Bipolar Disorder: Effects of Cognitive Psychoeducational Group Therapy After 12 Months

Background: Cognitive deficits are known as a core feature in bipolar disorder. Persisting neurocognitive impairment is associated with low psychosocial functioning. The aim of this study was to identify potential cognitive, clinical and treatment-dependent predictors for functional impairment, symptom severity and early recurrence in bipolar patients, as well as to analyze neurocognitive performance compared to healthy controls.Methods: Forty three remitted bipolar patients and 40 healthy controls were assessed with a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed.Results: Compared to healthy controls, bipolar patients showed lower performance in executive function (perseverative errors p < 0.01, categories correct p < 0.001), sustained attention (total hits p < 0.001), verbal learning (delayed recall p < 0.001) and verbal fluency (p-words p < 0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%).Limitations: Limitations of the present study result mainly from a small sample size. The extent of cognitive impairment appears to impact occupational disability, clinical outcome as well as recurrence rate. This result must be interpreted with caution because statistical analysis failed to show higher significance.Conclusions: Bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Deficits in sustained attention have an impact on occupational impairment. Implications for treatment strategies are discussed. Further evaluation in larger studies is needed.

Cognitive Function in Dementia-Free Subjects and Survival in Old Age: The PROSPER Study

BackgroundImpairment in domain-specific cognitive function is associated with the increased risk of mortality. We prospectively evaluated the association of executive function and memory with the risk of long-term mortality in dementia-free older subjects. Moreover, we investigated the role of structural brain abnormalities in this association. MethodsWe included 547 dementia-free participants (mean age 78 years, 56.5% male) from the nested magnetic resonance imaging sub-study of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Cox proportional hazard models were used to model 10-year risk of all-cause, cardiovascular, and noncardiovascular mortality in relation to performance in executive function and memory. Moreover, we evaluated the role of total brain parenchymal volume, cerebral blood flow, white matter hyperintensity, and the presence of microbleeds and infarcts in the link between cognitive function and mortality. ResultsIn the multivariable model, lower performance in executive function was associated with greater risk of all-cause (hazard ratio [HR] 1.49; 95% confidence interval [CI], 1.31-1.70), cardiovascular (HR 1.69; 95% CI, 1.36-2.11), and noncardiovascular (HR 1.36; 95% CI, 1.15-1.62) mortality. Similarly, poorer performance in memory tests associated with higher risk of all-cause (HR 1.47; 95% CI, 1.29-1.68), cardiovascular (HR 1.45; 95% CI, 1.15-1.83), and noncardiovascular (HR 1.49; 95% CI, 1.27-1.76) mortality. The associations were similar in subjects with various levels of brain structural abnormalities and cerebral blood flow (all P for interaction ≫ .05). ConclusionsPoorer performance in both executive function and memory tests associates with all-cause, cardiovascular, and noncardiovascular mortality in elderly individuals. This association is independent of cardiovascular risk factors and diseases, brain structural abnormalities, and cerebral blood flow.

Elevated Aortic Stiffness is Associated with Lower Brain pH and Executive Function Performance in Middle‐aged and Older Adults

IntroductionElevated aortic stiffness and pulse pressure (PP) are risk factors for development of mild cognitive impairment (MCI) and Alzheimer's disease (AD) mediated in part by the development of cerebrovascular dysfunction. Cerebrovascular dysfunction uncouples cerebral blood flow (CBF) supply from metabolic demand, contributing in part to cerebral hypoperfusion, acidosis and cognitive decline in AD. Brain T1rho is a novel pH‐sensitive magnetic resonance imaging (MRI) biomarker that is increased in patients with MCI and AD compared with healthy controls (HC). T1rho measures the change in T1 relaxation time in the rotating frame with greater T1rho values (i.e., longer relaxation time) associated with a more acidic pH. However, the degree to which higher T1rho signal (i.e., lower brain pH = more acidic) is associated with 1) lower cognitive performance; 2) higher brachial PP and 3) elevated aortic stiffness in middle‐aged/older (MA/O) adults is unknown.Methods/ResultsTwenty‐seven MA/O adults (mean ± SE: 71.8 ± 2.1 years, range: 50–90 years) were recruited to undergo clinic blood pressure (BP), neuropsychological, MRI (structural and T1rho) testing and vascular testing (subset only). Executive function and delayed memory performance were measured using the Trailmaking test (TMT) A &amp; B and Rey Auditory Verbal Learning Test, respectively. In agreement with prior studies, global T1rho signal was elevated in individuals with cognitive impairment (MCI or early AD, n=10) compared with HC (90.7 ± 3.1 vs. 81.8 ± 1.2 ms, p= 0.004). Consistent with our hypothesis, higher T1rho signal was associated with greater time to completion on the TMT B (r = 0.44, p = 0.026), TMT B‐A (r = 0.39, p = 0.047) and lower delayed memory performance (r = −0.48, p = 0.012, all adjusted for age) in the entire cohort. However, T1rho was not related to PP (r = 0.38, p= 0.069) and remained unassociated after adjusting for age (p=0.80). In the subset of MA/O adults with T1rho (n = 15; 70.0 ± 2.0 years, HC, n= 21, MCI, n=2), greater aortic stiffness (carotid‐femoral pulse wave velocity, cfPWV) was associated with higher T1rho signal (r= 0.58, p= 0.039, adjusted for mean arterial pressure). Furthermore, cfPWV was associated with slower TMT B (r = 0.45, p = 0.034) but not TMT B‐A (r = 0.46, p = 0.066) or delayed memory performance (p= 0.77, all adjusted for mean arterial pressure). Additional adjustment for age abolished (p &gt; 0.05) the relation between cfPWV and TMT performance and T1rho signal in the present cohort.ConclusionThese preliminary data indicate that the age‐related increase in aortic stiffness is associated with lower executive function performance on the TMT task and higher T1rho signal, consistent with lower brain pH, in MA/O adults. More studies are needed to determine the mechanism by which elevated aortic stiffness contributes in part to decreased brain pH and how brain pH may potentially modulate reduced executive function with aging.Support or Funding InformationBiological Sciences Funding Program, Office of Vice President for Research, University of Iowa and NIH 1R03AG047306This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Individuals with Overlap Syndrome have Lower Cognitive Performance than Individuals with COPD or Obstructive Sleep Apnea Alone: Role of Carotid Artery Stiffness

BackgroundChronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are two of the most prevalent respiratory disorders in adults and are both independently associated with impaired cognitive function. The coexistence of OSA in individuals with COPD is termed ‘overlap syndrome’ and occurs in up to 65% of all COPD patients. However, it is unknown if individuals with overlap syndrome have lower cognitive function than individuals with COPD or OSA alone. Carotid artery stiffness is associated with cognitive dysfunction among individuals with and without known cardiovascular disease (CVD). Both COPD and OSA are independently associated with greater carotid artery stiffness compared with controls. It is not known if carotid artery stiffness is exacerbated in overlap syndrome patients and if greater carotid artery stiffness is associated with lower cognitive function in this group. We hypothesized that a) individuals with overlap syndrome would have reduced cognitive performance and greater carotid artery stiffness than individuals with either COPD or OSA alone and b) greater carotid artery stiffness would be associated with reduced cognitive performance among individuals with overlap syndrome.MethodsNinety former smokers (n=12 with overlap syndrome, n= 45 with COPD only, n= 12 with OSA only and n=21 controls; age 69 ± 7 yrs; 53M/37F) completed measurements of pulmonary function, common carotid artery stiffness and neuropsychological testing. OSA status was determined by self‐report of previous clinical diagnosis with OSA.ResultsIndividuals with overlap syndrome performed lower in the executive functioning domain after adjusting for age, sex, body mass index (BMI) and FEV1/FVC than individuals in the other groups (overlap 43.5 ± 4.8 vs. COPD 48.3 ± 5.1 vs. OSA 51.8 ± 5.2 vs. controls 50.2 ± 5.4 norm‐based age‐adjusted t‐scores; P=0.019). Individuals with overlap syndrome also had greater carotid β‐stiffness index compared with individuals in the other groups after adjusting for age, BMI, sex and FEV1/FVC (overlap 5.9 ± 2.5 vs. COPD 3.92 ± 1.4 vs. OSA 3.5 ± 1.1 vs. controls 3.5 ± 1.1U; P=0.015). There were no differences in blood pressure, heart rate, resting oxygen saturation (SpO2) or nocturnal mean SpO2 in overlap syndrome patients vs. the other groups. Higher carotid β‐stiffness index was associated with lower executive function performance in the entire cohort (r=−0.32, P=0.002) and in individuals with overlap syndrome (r=−0.58, P = 0.048). There was no relation between carotid β‐stiffness index and executive function in individuals with COPD alone, OSA alone or former smoker controls (all P&gt;0.05).ConclusionThese data suggest that cognitive performance is lower in individuals with overlap syndrome than in individuals with either COPD or OSA alone and that exacerbated carotid artery stiffening may be an underlying mechanism for the lower cognitive performance observed in this group.Support or Funding InformationNIH K23 HL095658; R01 HL089897 NIH/NCATS Colorado CTSI; UL1 TR001082This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Social cognition in bipolar disorder: the role of sociodemographic, clinical, and neurocognitive variables in emotional intelligence.

The main aims of this study were to examine the differences in the Emotional Intelligence (EI), the emotional domain of social cognition (SC), between euthymic patients with bipolar disorder (BD) and healthy controls (HC) and to evaluate the contribution of sociodemographic, clinical, and neuropsychological variables to EI. We recruited 202 patients with BD and 50 HC. EI was evaluated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). The sociodemographic, clinical, and neurocognitive variables that showed a significant association with EI were entered into hierarchical multiple regression analysis. BD patients obtained significantly lower scores compared to HC in the Emotional Intelligence Quotient (EIQ) and in the Understanding Emotions branch score. The best fitting model for the variables associated with EI in the patients group was a linear combination of gender, estimated IQ, family history of affective diagnosis, and executive function. The model, including these previous variables, explained up to 27.6% of the observed variance (R2 =0.276, F=16.406, P<0.001). The identification of variables associated with deficit in EI, such as male gender, lower estimated IQ, family history of affective diagnosis. and lower executive function performance, may help in selecting treatment targets to improve SC, and especially EI, in patients with BD.

CORPUS CALLOSUM VOLUME AND EXECUTIVE FUNCTION: A POTENTIAL EARLY MARKER OF COGNITIVE DECLINE

Several lines of evidence suggest corpus callosum (CC) atrophy in mild cognitive impairment (MCI) and Alzheimer's Disease(AD). While MCI patients have anterior CC atrophy, AD patients have both anterior and posterior atrophy, suggesting progressive atrophy of CC in the course of AD. However, the relation between CC volume and cognitive measures in middle aged individuals without AD is not well-examined. Here, we therefore extend our earlier observations on the relation between CC regional volumes and executive functions in middle-aged individuals (50-65years). 61 healthy volunteers (female=31, age=64.09±8.06, years of education=16.90±4.00) participated in the Tata Longitudinal Study of Aging at Bangalore, India. Of these, a subset of 37 individuals were 50-65 years of age (female=21, age=58.56±4.21, years of education=17.02±4.52). All participants underwent neuropsychological testing and Magnetic Resonance Imaging (MRI) scans as per the Alzheimer's Disease Neuroimaging Initiative (ADNI) protocol. CC volumes were acquired for each individual using Freesurfer Software (http://surfer.nmr.mgh.harvard.edu/). Pearson's correlation analysis was conducted to examine the relation between CC volume and executive functions. Executive functions were tested using Controlled Oral Word Association Test (COWAT), digit span, Stroop test and Trail Making Test (TMT). At baseline (entire group), there was a significant positive correlation between COWAT-A score (higher the score, better the performance) and anterior CC-(r=0.561, p=0.001), central CC-(r=0.403,p=0.022) and posterior CC-(r=0.397,p=0.025) volumes. A significant negative correlation was seen between TMT-A Time (greater the time, poorer the performance) and mid-anterior CC-(r=-0.506,p=0.003), central CC-(r=-0.468,p=0.007), posterior CC-(r=-0.458,p=0.008), mid-posterior CC-(r=-0.424,p=0.016) and anterior CC-(r=-0.399,p=0.024) volumes; Stroop-B interference time and mid-posterior CC volume(r=-0.399,p=0.024); and Stroop-C interference time and mid-posterior CC-(r=-0.487,p=0.005), central CC-(r=-0.467,p=0.007), mid-anterior CC-(r=-0.409,p=0.020) and posterior CC-(r=-0.358,p=0.045) volumes. These findings are mirrored in the middle-aged subset, where there was a significant positive correlation between COWAT-A score and anterior CC-(r=0.558,p=0.007) and posterior CC-(r=0.479,p=0.024) volumes; and a significant negative correlation between TMT-A Time and mid-anterior CC-(r=-0.625,p=0.002), central CC-(r=-0.509,p=0.016), posterior CC-(r=-0.497,p=0.019) and anterior CC-(r=-0.469,p=0.028) volumes. Our findings indicate a significant association between CC volume and executive function. Findings suggest that those with lesser CC volume have lower executive function performance. These relationships observable in middle-age (50-65 years), indicate that CC atrophy is a potential early marker of cognitive decline. Longitudinal observations of these individuals will inform whether CC volumes are early markers of cognitive decline.

Increased CAIDE dementia risk, cognition, CSF biomarkers, and vascular burden in healthy adults.

To investigate the cognitive profile of healthy individuals with increased Cardiovascular Risk Factors, Aging and Dementia (CAIDE) dementia risk score and to explore whether this association is related to vascular burden and CSF biomarkers of amyloidosis and neurodegeneration. Cognitively normal participants (mean age 57.6 years) from the Gipuzkoa Alzheimer Project study were classified as having high risk (HR; n = 82) or low risk (LR; n = 293) for dementia according to a CAIDE score cutoff of 9. Cognitive composites were compared between groups. We explored using generalized linear models the role of APOE genotype, MRI white matter hyperintensities (WMH), and CSF (n = 218) levels of β-amyloid1-42 (Aβ1-42), total tau (t-tau), and phosphorylated tau (p-tau) in the association between CAIDE score and cognition. HR participants obtained lower scores on executive function (EF) (p = 0.001) and visual perception and construction (VPC) (p < 0.001) composites. EF composite was associated with CAIDE score × p-tau (p = 0.001), CAIDE score × t-tau (p = 0.001), and WMH (p = 0.003). VPC composite was associated with APOE (p = 0.001), Aβ1-42 (p = 0.004), the interaction APOE × Aβ1-42 (p = 0.003), and WMH (p = 0.004). Performance on global memory was associated with Aβ1-42 (p = 0.006), APOE (p = 0.008), and their interaction (p = 0.006). Analyses were adjusted for age, education, sex, premorbid intelligence, and stress. Healthy participants at increased dementia risk based on CAIDE scores show lower performance in EF and VPC. This difference is related to APOE, WMH, and Alzheimer biomarkers.

Orthostatic hypotension associated with executive dysfunction in mild cognitive impairment

IntroductionMidlife hypertension is associated with dementia in longitudinal studies while chronic hypotension in the elderly is associated with dementia onset. Orthostatic hypotension could influence cognitive performance in the elderly. The objective of this study was to assess the relationship between orthostatic hypotension and cognitive functions. MethodsConsecutive participants with complete neuropsychological evaluation from a Memory Clinic were included. Orthostatic hypotension (OH) was defined by a fall≥20/10mmHg systolic/diastolic pressure. Participants were classified into one of 3 groups: 1) subjective cognitive impairment (SCI), 2) mild cognitive impairment (MCI), and 3) dementia. Neuropsychological tests were analyzed for patients with and without OH. ResultsOne hundred and twenty participants were included, of which 16 (13%) were classified as SCI, 42 (35%) as MCI, and 63 (52%) with dementia. Prevalence of OH was 0% for the SCI group, 26% (n=11) for the MCI group, and 38% (n=24) for the dementia group. Age, sex, education, and brief cognitive test scores (MMSE & MoCA) were not different between groups with or without OH. In the MCI group, OH was associated with lower cognitive performance in several executive functions tests: visual working memory (p<0.001), processing speed (p=0.006), Stroop flexibility (p=0.030) and Trail-Making Test part B (p=0.024). There was no difference in episodic memory performance. OH was associated with a diagnosis of hypertension and the use of antihypertensive medication. No differences were observed in vascular brain injury between groups with and without OH. ConclusionsThis study found that orthostatic hypotension prevalence is correlated to severity of cognitive deficits in a Memory Clinic. In MCI, OH is associated with lower performance in executive functions. OH could represent an under-recognized correlate of cognitive performance.

Is there a relationship between accelerometer-assessed physical activity and sedentary behavior and cognitive function in US Hispanic/Latino adults? The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Normative changes in cognitive function are expected with increasing age. Research on the relationship between normative cognitive decline and moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SED) needs further investigation in Hispanic/Latinos adults. We assessed the cross-sectional association between accelerometer assessed MVPA and SED with cognitive function in 7,478 adults aged 45-74years from the Hispanic Community Health Study/Study of Latinos. At baseline, cognitive tests included two executive function tests (Digit Symbol Substitution Test (DSST), a test of language (Word Fluency), and a test of memory (Spanish English Verbal Learning Test). Multiple regression models were used to examine associations of time spent in MVPA and SED with cognitive function by age groups, adjusted for age, education, sex, acculturation, and field center. Mean time spent in sedentary behaviors was 12.3h/day in females and 11.9 h/day in males (75% and 77% of accelerometer wear time, respectively). Higher SED, but not MVPA, was associated with lower DSST raw scores (β -0.03 with each 10-min increment in SED; P<0.05), indicating lower performance in executive function in all age groups. No associations were observed for MVPA and SED with tests of language or memory tests. Our findings suggest a distinct association of SED but not MVPA on executive functioning in middle-aged and older Latino adults. Longitudinal studies are needed to more conclusively determine causal links.

Comparing Executive Function Between Adolescents With Conduct Disorder and the Normal Ones in Iranian Population

Background: Although conduct disorder during the past few decades experienced a rapid extension, few researches are done on the role of executive function in this disorder. The current study aimed to investigate the role of executive functions in task disorder. Materials and Methods: It was a causal-comparative study. The study sample consisted of adolescents with conduct disorder kept in a juvenile institution in Isfahan, Iran, in 2013. The sample of 60 patients included 30 adolescents with conduct disorder and 30 normal ones. The accessible sampling method was used and continuous performance tests and the Wechsler subscale of similarities and numerical memory were performed on them. Results: There was a significant difference in the executive functions of working memory and fluid reasoning, between normal adolescents and the ones with conduct disorder. The mean of fluid reasoning (P > 0.001) and working memory (P > 0.001) in normal adolescents was significantly greater than that of the ones with conduct disorder. But there was no difference between the two groups in sustained attention. The performance of the conduct disorder group in functions of working memory and fluid reasoning (P > 0.001) was lower than the normal group. Conclusions: According to the study findings, compared to the normal group, the conduct disorder group had a lower performance in executive functions. Therefore, to provide therapeutic interventions for conduct disorder, more attention should be paid to the role of deficits in executive functions.