Cognitive Outcome Measures Research Articles

Structural Network Efficiency Predicts Resilience to Cognitive Decline in Elderly at Risk for Alzheimer's Disease.

Introduction: Functional imaging studies have demonstrated the recruitment of additional neural resources as a possible mechanism to compensate for age and Alzheimer’s disease (AD)-related cerebral pathology, the efficacy of which is potentially modulated by underlying structural network connectivity. Additionally, structural network efficiency (SNE) is associated with intelligence across the lifespan, which is a known factor for resilience to cognitive decline. We hypothesized that SNE may be a surrogate of the physiological basis of resilience to cognitive decline in elderly persons without dementia and with age- and AD-related cerebral pathology.Methods: We included 85 cognitively normal elderly subjects or mild cognitive impairment (MCI) patients submitted to baseline diffusion imaging, liquor specimens, amyloid-PET and longitudinal cognitive assessments. SNE was calculated from baseline MRI scans using fiber tractography and graph theory. Mixed linear effects models were estimated to investigate the association of higher resilience to cognitive decline with higher SNE and the modulation of this association by increased cerebral amyloid, liquor tau or WMHV. Results: For the majority of cognitive outcome measures, higher SNE was associated with higher resilience to cognitive decline (p-values: 0.011–0.039). Additionally, subjects with higher SNE showed more resilience to cognitive decline at higher cerebral amyloid burden (p-values: <0.001–0.036) and lower tau levels (p-values: 0.002–0.015).Conclusion: These results suggest that SNE to some extent may quantify the physiological basis of resilience to cognitive decline most effective at the earliest stages of AD, namely at increased amyloid burden and before increased tauopathy.

Methylphenidate for Mild Cognitive Impairment: An Exploratory 3-Day, Randomized, Double-Blind, Placebo-Controlled Trial.

Background: To evaluate the efficacy, safety and tolerability of methylphenidate (MPH) for cognitive function in older patients with mild cognitive impairment (MCI).Methods: Male and female subjects aged 65 years and older with a clinical diagnosis MCI were included in an exploratory randomized, double-blind, placebo-controlled trial. Eligible subjects were assigned to either treatment with immediate-release MPH or placebo. The active compound was administered in an increasing-dose stepwise fashion, namely 10 mg MPH on day 1, 20 mg on day 2, and 30 mg on day 3. Subjects remained under observation for 4 h following drug administration and were monitored for changes in blood pressure and for adverse events. Cognitive outcome measures included the Montreal Cognitive Assessment (MoCA) and the Neurotrax Mindstreams computerized cognitive assessment battery.Results: Of 17 subjects enrolled, 15 subjects completed the study, 7 in the active MPH group and 8 in the placebo group. The average age of the participants was 76.1 ± 6.6 years and 10 (66.7%) were men. Following the final dose a significant benefit on memory (predominantly non-verbal memory) was found in the MPH group. While 12 adverse events were reported, they were all rated as mild to moderate.Conclusions: Our finding of modest beneficial effects of MPH on memory tests in older subjects with MCI in this exploratory study is of interest and should be investigated in further studies.

Effects of Memantine in Patients with Traumatic Brain Injury: A Systematic Review

Traumatic brain injury (TBI) affects millions of people around the world and amongst other effects, causes cognitive decline, neurodegenerative disease and increased risk of seizures and sensory disturbances. Excitotoxicity and apoptosis occur after TBI and are mediated through the N-methyl-D-aspartate (NMDA)-type glutamate receptor. Memantine is effective in blocking excessive activity of NMDA-type glutamate receptors and reduces the progression of dementia and may have benefits after TBI. Here, we performed a systematic review of the literature to evaluate whether memantine is effective in improving outcomes, including cognitive function in patients with TBI. Our search yielded only 4 randomized control trials (RCTs) that compared the effects of memantine to placebos, standard treatment protocols or piracetam. A single RCT reported that serum neuron-specific enolase (NSE) levels were significantly reduced (p = 0.009) in the memantine compared to the control group, and this coincided with reported significant day-to-day improvements in Glasgow Coma Scale (GCS) for patients receiving memantine. The remaining RCTs investigated the effects of memantine on cognitive function using 26 standardized tests for assessing cognition function. One RCT reported significant improvements in cognitive function across all domains whilst the other two RCTs, reported that patients in the memantine group underperformed in all cognitive outcome measures. This review shows that despite laboratory and clinical evidence reporting reduced serum NSE and improved GCS, supporting the existence of the neuroprotective properties, there is a lack of reported evidence from RCTs to suggest that memantine directly leads to cognitive improvements in TBI patients.

Is the Symbol Digit Modalities Test a useful outcome in secondary progressive multiple sclerosis?

It is unclear which cognitive outcome measure is the most useful for clinical trials in multiple sclerosis. To investigate the usefulness of the Symbol Digit Modalities Test (SDMT) as a clinical outcome measure in secondary progressive multiple sclerosis (SPMS), we describe the frequency of worsening and improvement events in a large randomized controlled trial (RCT) dataset. Using original trial data from the ASCEND trial (n=889), a recent large RCT in SPMS, we describe worsening and similarly defined improvement with and without 3-month confirmation on the SDMT in the whole trial cohort and unconfirmed worsening and improvement on the Paced Auditory Serial Addition Test (PASAT) in a smaller subset (n=107). Somewhat unexpectedly, SDMT scores steadily increased throughout the 2years of follow-up in this trial. There were overall few SDMT worsening events throughout the trial (generally fewer than 10% of participants), but improvement events steadily increased from around 50% of participants with improvement at 12weeks to more than 70% at 84weeks and beyond. PASAT scores followed a similar pattern. In this well-characterized clinical trial cohort, the SDMT does not reflect the steady cognitive decline that patients with SPMS experience. Both SDMT and PASAT scores improve throughout follow-up, possibly due to a practice effect. The SDMT may not be a useful outcome measure of disease progression in 2-year clinical trials in SPMS.

Individual cognitive stimulation therapy (iCST) for people with intellectual disability and dementia: a feasibility randomised controlled trial

Objectives To examine the feasibility, acceptability and fidelity of individual Cognitive Stimulation Therapy (iCST) in people with intellectual disability (ID) and dementia. Method We aimed to recruit forty dyads (carer and individual with dementia and ID) who were randomised to iCST or a waiting list control group. Both groups received treatment as usual. Family and paid carers delivered the manualised intervention (40 sessions over 20 weeks). Recruitment and retention of participants, intervention adherence, fidelity and acceptability were assessed. Outcome measures of cognition, adaptive functioning, quality of life (QoL) and carer outcomes were collected at baseline, midpoint (11 weeks) and at 21 weeks. Qualitative interviews were conducted with six carers about their experience of iCST. Results Forty dyads were recruited over 10 months from 12 National Health Service trusts. One dyad dropped out and 87.5% and 97.5% completed the midpoint and end-point assessments respectively. Assessment of fidelity indicated that the correct session structure was not followed; 70% completed at least 20 sessions and there was a high level of satisfaction with iCST. QoL was significantly higher in the iCST arm at 21 weeks (adjusted mean difference: 3.11; 95% CI: 0.64 to 5.58). There were no differences in the other outcome measures. Conclusion The intervention was feasible and acceptable. A full-scale trial is warranted but some modifications are needed, including improved training and supervision for carers to improve fidelity.

The association of birth by caesarean section and cognitive outcomes in offspring: a systematic review.

Studies have reported children born by caesarean section are more likely to have lower cognitive outcomes compared to those born by vaginal delivery. This paper reviews the literature examining caesarean birth and offspring cognitive outcomes. A systematic search for observational studies or case-control studies that compared cognitive outcomes of people born by caesarean section with those born by vaginal delivery was conducted in six databases (Medline, PubMed, EMBASE, PsychInfo, CINAHL, Web of Science) from inception until December 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and a narrative synthesis was undertaken considering the evidence for a causal relationship according to the Bradford Hill Criteria. A total of seven studies were identified. Of these, four found a significant association between elective and emergency caesarean birth and reduction in offspring cognitive performance as measured by school performance or validated cognitive testing. Three studies found no association. There was variability in the quality of the studies, assessment of the reason for caesarean section (emergency vs elective), measurement of outcomes and adjustment for confounding factors. The evidence of an association between CS birth and lower offspring cognitive functioning is inconsistent. Based on currently available data, there is no evidence that a causal association exists. To better examine this association, future studies should (a) distinguish elective and emergency caesareans, (b) adequately adjust for confounding variables and (c) have valid outcome measures of cognition.

Associations of Maternal Stress, Prenatal Exposure to Per- and Polyfluoroalkyl Substances (PFAS), and Demographic Risk Factors with Birth Outcomes and Offspring Neurodevelopment: An Overview of the ECHO.CA.IL Prospective Birth Cohorts.

Background. Infants whose mothers experience greater psychosocial stress and environmental chemical exposures during pregnancy may face greater rates of preterm birth, lower birth weight, and impaired neurodevelopment. Methods. ECHO.CA.IL is composed of two cohorts, Chemicals in Our Bodies (CIOB; n = 822 pregnant women and n = 286 infants) and Illinois Kids Development Study (IKIDS; n = 565 mother-infant pairs), which recruit pregnant women from San Francisco, CA and Urbana-Champaign, IL, respectively. We examined associations between demographic characteristics and gestational age, birth weight z-scores, and cognition at 7.5 months across these two cohorts using linear models. We also examined differences in biomarkers of exposure to per- and polyfluoroalkyl substances (PFAS), measured in second-trimester serum, and psychosocial stressors by cohort and participant demographics. Results. To date, these cohorts have recruited over 1300 pregnant women combined. IKIDS has mothers who are majority white (80%), whereas CIOB mothers are racially and ethnically diverse (38% white, 34% Hispanic, 17% Asian/Pacific Islander). Compared to CIOB, median levels of PFOS, a specific PFAS congener, are higher in IKIDS (2.45 ng/mL versus 1.94 ng/mL), while psychosocial stressors are higher among CIOB. Across both cohorts, women who were non-white and single had lower birth weight z-scores relative to white women and married women, respectively. Demographic characteristics are not associated with cognitive outcomes at 7.5 months. Conclusions. This profile of the ECHO.CA.IL cohort found that mothers and their infants who vary in terms of socioeconomic status, race/ethnicity, and geographic location are similar in many of our measures of exposures and cognitive outcomes. Similar to past work, we found that non-white and single women had lower birth weight infants than white and married women. We also found differences in levels of PFOS and psychosocial stressors based on geographic location.

Patient-Reported Cognitive Outcomes Following Cardiac Surgery: A Descriptive Review.

A descriptive review was conducted to evaluate the evidence of cognitive patient-reported outcome measures (PROMs) following cardiac surgery. The search of electronic databases resulted in 400 unique manuscripts. Nine studies met the criteria to be part of the final review. Results of the review suggest that there are few validated PROMs that assess cognitive function in the cardiac surgical population. Furthermore, PROMs have not been used to assess overall cognitive function following cardiac surgery within the past decade. However, one domain of cognitive function—memory—was described, with up to half of patients reporting a decline postoperatively. Perceived changes in cognitive function may impact health-related quality of life and a patient’s overall view of the success of their surgery. Early identification of cognitive changes measured with PROMs may encourage earlier intervention and improve patient-centered care. In clinical practice, nurses may be in the best position to administer PROMs preoperatively and postoperatively.

The Effects of Cognitive Training Program for Older Adults: A Brief Preliminary Report

As one ages, some degree of cognitive decline is expected. Despite this, declines in cognitive abilities and the possibility of dementia is a common concern among older adults. In response to these concerns, a variety of cognitive training programs has been developed that aim to improve or maintain cognitive functioning. Prior literature has shown mixed or limited findings on cognitive changes after implementation of cognitive training. This study evaluated the effectiveness of a cognitive training program designed for older adults with no to minimal cognitive decline. The current study included 17 participants who engaged in two one-hour cognitive training sessions each week for 12 weeks. Each session required participants to complete activities that targeted the following cognitive domains: attention, visual and verbal memory, visual spatial skills, processing speed and executive functioning, and language. These cognitive domains, along with depression and memory self-efficacy, were assessed prior to and immediately after completion of the program. Small to large effect sizes on the majority of cognitive outcome measures were observed following participation in the program. Small reductions in depressive symptoms were also found. These findings provide preliminary support for the use of a comprehensive cognitive training program for cognitively-intact older adults.

Effects of participation in excellence programmes on cognitive and non-cognitive skills among higher education students in the Netherlands

ABSTRACT Most existing studies on excellence programmes focus primarily on the characteristics of students and/or programmes. However, little is known about the effects of participation in excellence programmes on cognitive and non-cognitive outcome measures. This study uses longitudinal data on over 1,000 students from five higher education institutions in the Netherlands to examine the added value of the excellence programmes relative to the regular education programmes. This study contributes to the current literature on the effects of participation in excellence programmes in three ways: the use of a representative control group; investigating multiple cognitive and non-cognitive outcome measures; and longitudinal assessments over a period of two years with pre- and post-test measurements (i.e. at the start and the end of the excellence programme). Our findings suggest that students who participated in excellence programmes have developed positively on both cognitive and non-cognitive skills, but that their development was not substantially different compared to students who did not participate in excellence programmes. The results underline that the students who participated in excellence programmes already performed better on most cognitive and non-cognitive skill measures at the start of the programme compared to students who did not participate in excellence programmes.

Cognitive and clinical outcome measures for Alzheimer's disease prevention trials in adults with Down syndrome

AbstractBackgroundAdults with Down syndrome (DS) are at ultra‐high risk for developing Alzheimer’s disease (AD) due to APP gene triplication on chromosome 21. There is interest in conducting trials of treatment that can delay or prevent onset of disease in at‐risk individuals with DS. Reliable outcome measures are required to demonstrate clinical benefit of treatment in a population with premorbid cognitive impairments that affect their performance on cognitive outcome measures. We aimed to identify the most efficient clinical and cognitive outcomes for prevention trials of AD in DS.MethodsAnalysis of cognitive data based on different test batteries from several recent longitudinal cohort studies of AD in DS in Europe and the US (n &gt;300 with 2 years of follow‐up data), using staging and E‐Max models and other statistical methods.ResultsThe age range within which cognitive decline can be first reliably observed in DS adults who do not yet have dementia is around age 45; this varies by outcome measure, with memory, attention, orientation and some verbal tasks being the most feasible and reliable tests for prevention trials. We will report effect sizes for these outcome measures to inform trial design.ConclusionsTrials of treatment to prevent or delay AD in DS individuals using cognitive measures as primary outcomes are feasible if targeted at individuals within age ranges where decline can be first observed, but effect sizes (and sample sizes) vary by outcome measures selected.

Neurofilament light and cognitive performance: Associations with amyloid and vascular pathologies in individuals with mild cognitive impairment

AbstractBackgroundNeurodegenerative, amyloid and vascular pathologies have all been associated with cognitive performance, but their interrelationship remains uncertain. We investigated the associations between cerebrospinal fluid (CSF) neurofilament light (NfL), a biomarker for neurodegeneration, with four different cognitive measures in individuals with mild cognitive impairment (MCI) with and without biomarker evidence of amyloid and vascular pathologies.MethodWe included 314 individuals with MCI from the EMIF‐AD Multimodal Biomarker Discovery study based on availability of data on CSF markers, MRI markers and cognitive data. CSF amyloid‐β42/40 ratio was used to determine amyloid status (A‐/A+). Vascular status (V‐/V+) was based on the presence of at least one abnormal vascular MRI marker (Fazekas≧2, lacunes&gt;0, microbleeds&gt;0). Linear mixed models, with center as random factor, were used to test associations between NfL and four pooled cognitive outcome measures (memory z‐score, language z‐score, executive functioning z‐score and an attention z‐score) and the interaction with amyloid and vascular status.ResultOn average individuals were 69.2 (SD 7.6) years old and 51% were female. Seventyseven (25%) were classified as A‐V‐, 49 (16%) as A‐V+, 103 as A+V‐ (33%) and 85 (27%) as A+V+. The A+V+ group had significantly higher levels of NfL compared to the A‐V‐ group (p=0.026). There were no other differences between the groups on NfL levels. We found that NfL levels were associated with lower memory (β=‐0.019, p=0.037) and language (β=‐0.022, p=0.019) scores, but not with attention or executive functioning scores. In addition, the associations between NfL levels and memory scores were driven by the individuals with vascular pathology (A‐V+ p=0.007, A+V+ p=0.044) and the association with language scores was driven by the A‐V+ group (p=0.040). Figure 1 shows the relationship between cognitive outcome measures and NfL levels in the AV groups.ConclusionHigher NfL levels were associated with lower memory and language scores, in particular in patients with vascular pathology. NfL was not associated with attention and executive functioning scores and it was not associated with cognitive performance in patients with isolated amyloid pathology. These results could indicate that high NfL levels in prodromal Alzheimer’s disease may be proxy for underlying vascular pathology.

Developing feedback methods for caregivers of persons with cognitive impairment using a home‐based sensing and computing system

AbstractBackgroundConventional methods assessing activities related to caregiving rely on self‐report with caregivers providing estimations of time and resources directed to these activities, which vary over time and can be difficult to reliably estimate retrospectively. Home‐based assessment platforms using sensors to collect objective information on daily activities represent a novel method to evaluate caregivers.MethodThis pilot study is an observational trial using the Collaborative Aging Research Using Technology (CART) sensor platform to assess cognitive and functional outcome measures. The study is enrolling individuals with cognitive impairment living with a caregiver. All participants’ complete questionnaires on functional status and behavioral symptoms, and undergo cognitive testing at baseline. These conventional measures are compared to the sensor‐based outcome measures. Caregivers complete an additional survey on burden level, the Zarit Burden Inventory (ZBI‐12). Additionally, focus group sessions will be held including caregivers enrolled in the pilot study and caregivers of individuals with cognitive impairment in the community.ResultData is currently being collected on daily functional activities in caregivers. Enrollment is ongoing for participant homes installing the sensor system. Three caregivers are enrolled, with an average age of 61.7 years (± 5.0), and 14 (± 3.4) years of education. Baseline mean ZBI‐12 scores were 15 (±4.6). Data has been collected for 9672 hours in total for the 3 participants. Caregivers slept on average 8.8 (±2.3) hrs/night and took 3868 (± 592) steps per day. Sensor data will be compared to ZBI‐12 scores to identify those activities correlated with higher levels of burden. Information from the focus group sessions will be used to guide development of a feedback system to inform caregivers of their activities related to time and effort spent in caregiving.ConclusionA home‐based sensing and computing system could provide objective information on activity and effort related to caregiving activities. The design of the feedback system is being developed using input from end‐users. The information provided by this system could help to inform caregivers of changes in their level of caregiving activities associated with higher levels of stress and more promptly identify whether they should seek increased external or community support.

Optimizing the unsupervised assessment of cognition in web‐based registries of individuals at risk for Alzheimer’s disease: Results from the Healthy Brain Project

AbstractBackgroundWeb‐based platforms are used increasingly to assess cognitive function in unsupervised settings. However, methods for ensuring the validity of cognitive data arising from unsupervised assessments are limited. We applied Human Computer Interaction (HCI) concepts of acceptability and usability to examine the validity of unsupervised cognitive testing in middle‐aged adults enrolled in the Healthy Brain Project (HBP).MethodA total of 1594 middle‐aged adults (mean age 56 years, SD 6.60 years) completed unsupervised assessments using a self‐administered version of the Cogstate Brief Battery (CBB) via our online platform, healthybrainproject.org.au. HCI acceptability was defined by the nature and amount of missing data, and HCI usability as (a) errors made during test performance, and (b) the time taken to read test instructions and complete the tests (learnability). We also explored whether cognitive performance varied across different testing environments (e.g., home/work alone, home/work with others around, public space).ResultOverall, we observed high acceptability (98% complete data) and high usability (95% met criteria for low error rates and high learnability). Test validity was confirmed by observation of expected inverse relationships between performance and increasing test difficulty and age. When accounting for the effects of age, no general influence of testing environment was found for any of the cognitive outcome measures in this study. Testing environment also had no significant effect on the proportion of individuals who satisfied our pre‐specified acceptability and usability criteria.ConclusionWith HCI acceptability and usability criteria considered, the data collected in this study retains similar psychometric characteristics to those collected from supervised testing of the same tests. The HCI definitions of acceptability and usability show great promise for use as real time algorithms for the collection of valid indices of cognition in unsupervised settings. This is of particular salience when considering the development of registries of individuals at risk for Alzheimer’s disease.

Evaluating pre‐screening tools for older Latino recruitment into preclinical Alzheimer’s disease studies

AbstractBackgroundRecruitment for preclinical Alzheimer’s disease clinical trials and observational studies in the Latino population continues to increase as researchers aim to diversify their samples. The Telephone Interview for Cognitive Status modified version (TICS‐m) is a pre‐screening tool that has shown to have high diagnostic validity for identification of dementia in mostly Caucasian samples. The TICS‐m cut‐off currently used for screening out cognitive impairment in older individuals is ≥26. We aimed to 1) determine whether currently used TICS‐m cut‐offs are appropriate for pre‐screening clinically normal older Latinos, and 2) assess the relationships among the TICS‐m score and outcome measures typically used in clinical trials, such as Mini Mental State Exam (MMSE), Logical Memory Delayed Recall, and Clinical Dementia Rating (CDR).MethodsTwenty‐nine older Latino adults (mean age= 68.7, mean education=15.6, and mean TICS‐m= 33.4/40) from the Harvard Aging Brain Study (HABS) were included in this study. Participants completed the pre‐screening TICS‐m over the phone, followed by an in‐clinic screening neuropsychological battery, which included the MMSE, Logical Memory Delayed Recall, and CDR, administered in Spanish. Linear regression models controlling for age, sex, and education were used to assess the relationships between TICS‐m score and performance on the neuropsychological measures.ResultsTICS‐m scores were positively correlated with years of education (r=0.54, p=0.002). No significant associations were observed among TICS‐m scores and other cognitive measures, after adjusting by age, sex, and education (MMSE: r=0.04, p=0.82; Logical Memory Delayed: r=0.10, p=0.62; and CDR sum of boxes: r=‐0.03, p=0.86).ConclusionPreliminary results suggest that in this sample of largely cognitively normal Latino adults, TICS‐m score is not associated with performance in other cognitive outcome measures typically used in clinical and observational trials for preclinical Alzheimer’s disease. These findings also suggest that the TICS‐m may not accurately reflect actual cognitive function in older Latino participants. However, we do not know if we are inadvertently screen‐failing participants using TICS‐m as a pre‐screening tool. Further research is needed to assess whether this pre‐screening tool is adequate in the pre‐screening process for preclinical Alzheimer’s disease in older Latino adults.

Optimal age and outcome measures for Alzheimer's disease prevention trials in people with Down syndrome.

People with Down syndrome (DS) typically develop Alzheimer's disease (AD) neuropathology before age 40, but a lack of outcome measures and longitudinal data have impeded their inclusion in randomized controlled trials (RCTs). Cohort study. Event-based and dose-response Emax models were fitted to longitudinal cognitive data, to stage AD and determine the earliest ages of decline. Results informed sample size estimations for hypothetical RCTs of disease-modifying treatments that reduced decline by 35% or 75%. Seventy-five percent of participants progressed or remained stable in the AD staging model; effect sizes varied by age group and tests. Varied treatment effects could be detected with 50-200 people per arm when using sensitive cognitive outcome measures and targeting recruitment to ages 36 to 45 years. Efficient RCTs of AD preventative treatments can be conducted in the DS population using sensitive outcome measures to monitor early decline. Dose-response models could help tailor future RCTs.

Cognitive and Psychosocial Outcomes of Self-Guided Executive Function Training and Low-Intensity Aerobic Exercise in Healthy Older Adults.

ObjectivesPrior work has demonstrated that executive function training or physical exercise can improve older adults’ cognition. The current study takes an exploratory approach to compare the feasibility and efficacy of online executive function training and low-intensity aerobic exercise for improving cognitive and psychosocial functioning in healthy older adults.MethodFollowing a standard pretest-training-posttest protocol, 40 older adults (aged 65 and above) were randomly assigned to an executive function or a physical training group. A battery of cognitive and psychosocial outcome measures were administered before and after training. During the 10 weeks of self-guided training at home (25–30 min/day, 4 days/week), the executive function training group practiced a set of adaptive online executive function tasks designed by Lumos Labs, whereas the physical training group completed an adaptive Digital Video Disc (DVD)-based low-intensity aerobic exercise program.ResultsTraining transfer effects were limited. Relative to low-intensity aerobic exercise, executive function training yielded cognitive improvement on the 64-card Wisconsin Card Sorting Task (WCST-64), a general executive function measure. Depression and stress levels dropped following both training programs, but this could be driven by decreased stress or excitement in performing the tasks over time.DiscussionThe results revealed limited cognitive benefits of the online executive function training program, specifically to a near transfer test of general executive control. Importantly, the current study supports the feasibility of home-based self-guided executive function and low-intensity physical training with healthy older adults.

Is Neurodevelopment Related to Exercise Capacity in Single Ventricle Patients Who Have Undergone Fontan Palliation?

Survivors of palliative surgery for single ventricle heart disease (SVHD) are at risk of poor neurodevelopmental outcomes and reduced exercise capacity. In healthy populations, reduced exercise capacity is related to decreased cognition suggesting a possible relationship between exercise capacity and neurodevelopment. Using cardiopulmonary exercise testing (CPET) and neuropsychological testing (NPT) as indicators of exercise capacity and neurodevelopment, respectively, we hypothesized that in SVHD, higher CPET measures are related to better NPT performance. Patients were retrospectively identified. CPET variables included VO2max, anaerobic threshold, peak heart rate, ventilatory efficiency, and respiratory exchange ratio. NPT instruments were divided into domains measuring attention, executive functioning, adaptive functioning, and emotional functioning. Linear regression was used to test for associations between CPET and NPT. 23 subjects with SVHD met inclusion criteria. On both CPET and NPT, the cohort scored worse than healthy, age-matched subjects. Higher VO2max and anaerobic threshold were associated with better parent-rated overall adaptive functioning (p = 0.01 and p = 0.02, respectively). Higher peak heart rate was related to better sustained visual attention (p = 0.01). In SVHD, CPET measures indicating better exercise capacity were positively associated with a subset of scores on NPT. Larger, multisite studies implementing cardiorespiratory fitness intervention and incorporating cognitive outcome measures will be needed to better characterize the relationship between neurodevelopment and functional capacity in this population. Results may assist in providing anticipatory guidance and optimizing post-Fontan developmental trajectories.

Multicentre longitudinal study of fluid and neuroimaging BIOmarkers of AXonal injury after traumatic brain injury: the BIO-AX-TBI study protocol

Introduction and aimsTraumatic brain injury (TBI) often results in persistent disability, due particularly to cognitive impairments. Outcomes remain difficult to predict but appear to relate to axonal injury. Several new...

The Urban Built Environment, Walking and Mental Health Outcomes Among Older Adults: A Pilot Study

The benefits of walking in older age include improved cognitive health (e.g., mental alertness, improved memory functioning) and a reduced risk of stress, depression and dementia. However, research capturing the benefits of walking among older people in real-time as they navigate their world is currently very limited. This study explores cognitive health and well-being outcomes in older people as they walk in their local neighborhood environment. Residents from an independent living facility for older people (mean age 65, n = 11) walked from their home in two dichotomous settings, selected on the basis of significantly different infrastructure, varying levels of noise, traffic and percentage of green space. Employing a repeated-measures, cross over design, participants were randomly allocated to one of two groups, and walked on different days in an urban busy “gray” district (a busy, built up commercial street) vs. an urban quiet “green” district (a quiet residential area with front gardens and street trees). Our study captured real-time air quality and noise data using hand-held Airbeam sensors and physiologic health data using a smart watch to capture heart rate variability (a biomarker of stress). Cognitive health outcome measures were a pre- and post-walk short cognitive reaction time (SRT) test and memory recall of the route walked (captured via a drawn mental map). Emotional well-being outcomes were a pre- and post-walk mood scale capturing perceived stress, happiness and arousal levels. Findings showed significant positive health benefits from walking in the urban green district on emotional well-being (happiness levels) and stress physiology (p < 0.05), accompanied by faster cognitive reaction times post-walk, albeit not statistically significant in this small sample. Cognitive recall of the route varied between urban gray and urban green conditions, as participants were more likely to rely on natural features to define their routes when present. The environmental and physiologic data sets were converged to show a significant effect of ambient noise and urban conditions on stress activation as measured by heart rate variability. Findings are discussed in relation to the complexity of combining real-time environmental and physiologic data and the implications for follow-on studies. Overall, our study demonstrates the viability of using older people as citizen scientists in the capture of environmental and physiologic stress data and establishes a new protocol for exploring relationships between the built environment and cognitive health in older people.