Reaction Time Standard Error Research Articles

Nitrogen dioxide exposure, attentional function, and working memory in children from 4 to 8 years: Periods of susceptibility from pregnancy to childhood

BackgroundAir pollution exposure during pregnancy and childhood has been linked to executive function impairment in children, however, very few studies have assessed these two exposure periods jointly to identify susceptible periods of exposure. We sought to identify potential periods of susceptibility of nitrogen dioxide (NO2) exposure from conception to childhood on attentional function and working memory in school-aged children. MethodsWithin the Spanish INMA Project, we estimated residential daily NO2 exposures during pregnancy and up to 6 years of childhood using land use regression models (n = 1,703). We assessed attentional function at 4–6 years and 6–8 years, using the Conners Kiddie Continuous Performance Test and the Attention Network Test, respectively, and working memory at 6–8 years, using the N-back task. We used distributed lag non-linear models to assess the periods of susceptibility of each outcome, adjusting for potential confounders and correcting for multiple testing. We also stratified all models by sex. ResultsHigher exposure to NO2 between 1.3 and 1.6 years of age was associated with higher hit reaction time standard error (HRT-SE) (0.14 ms (95 % CI 0.05; 0.22) per 10 μg/m3 increase in NO2) and between 1.5 and 2.2 years of age with more omission errors (1.02 (95 % CI 1.01; 1.03) of the attentional function test at 4–6 years. Higher exposure to NO2 between 0.3 and 2.2 years was associated with higher HRT-SE (10.61 ms (95 % CI 3.46; 17.75) at 6–8 years only in boys. We found no associations between exposure to NO2 and working memory at 6–8 years. ConclusionOur findings suggest that NO2 exposure during the first two years of life is associated with poorer attentional function in children from 4 to 8 years of age, especially in boys. These findings highlight the importance of exploring long-term effects of traffic-related air pollution exposure in older age groups.

Long‐term nicotine treatment of mild cognitive impairment (The MIND Study): Baseline characteristics and study progress

AbstractBackgroundCognitive decline in AD/MCI is related to loss of cholinergic neurons. However, inhibition of acetylcholine degradation has not slowed progression. Treatment directly targeting nicotinic cholinergic receptors may be more helpful. We have shown proof of concept in a 6‐month multicenter trial that transdermal nicotine provides significant improvement in attention, episodic memory, and global ratings of functioning with minimal side effects in MCI. A larger and longer (2‐year) trial is underway to determine the persistence of improvement and attenuation of cognitive decline.MethodMCI participants were randomized 1:1 to either transdermal nicotine, beginning at 3.5 mg/day, increasing to 21 mg/day or matching placebo by 5 weeks. Participants were assessed at 0, 3, 6, 12, 18, and 24 months, with a subset undergoing MRI scans at 0, 12, and 24 months, and CSF collection at 0 and 24 months. Primary cognitive outcomes included reaction time standard error change‐from‐baseline (Connors CPT) for attention and delayed word recall (Cogstate) for memory. Primary clinical outcome is the CGIC. Secondary clinical measures include behavioral/functional scales and the CDR‐SOB. An MRI substudy is examining possible neural mechanisms.ResultTo date, 663 participants were screened and 309 were randomized including 133 females (43%) and 176 males (57%). Mean age was 73.7±7.1, education 16±2.8 years. Mean MMSE was 27.4±1.8 and CDR Global was 0.5. Randomization of ethnoracial underrepresented populations (URPs) was 9.4% (Black/African‐American 4%, Asian 2%, Hispanic/Latinx 3%). Treatment/Study discontinuations were higher than expected at 29% due in part to pandemic‐related disruptions. There are 87 completers thus far. Baseline MRI scans are 59 and LPs are 37. Safety results show that treatment has been generally well tolerated with no SAEs definitively or probably tied to study participation or investigational product thus far.ConclusionIf the hypotheses are validated, this will support a novel, broadly available, and inexpensive repurposed intervention for MCI and would encourage early treatment to improve symptoms, attenuate progression of cognitive impairment, and lead to combined trials with agents that interact with Aβ, tau or other mechanisms. Low URP recruitment and higher dropout rate remain challenging and will be specifically addressed in recruitment/enrollment/retention efforts moving forward.

Correlation Analysis of Attention and Intelligence of Preterm Infants at Preschool Age: A Premature Cohort Study

Developmental delay in neurocognitive function has been reported in premature children. This cohort study prospectively followed preterm infants following birth, and herein we present the four-year longitudinal follow-up data of cognitive development at preschool age and analyze correlated factors. Term and preterm children received regular clinical evaluations and development assessments after birth, and at age 4 ± 1 years, they received the Wechsler-preschool and primary scale of intelligence, Fourth Edition (WPPSI-IV), excluding those with full-scale intelligence quotient < 70. A total of 150 participants received Conners Kiddie Continuous Performance Test (K-CPT), while 129 participants received ophthalmic evaluation. We adopted Chi-square test, ANOVA, and post hoc analysis to compare group differences. Correlations with K-CPT and WPPSI-IV were analyzed using Pearson's correlation. Group 1 consisted of 25 full-term children, group 2 had 94 preterm children with birth-weight of ≥ 1500 g, and group 3 had 159 preterm children with birth-weight of < 1500 g. Group 1 was the healthiest group and had the best performance in attention and intelligence, while group 3 had the worst physical condition and cognitive performance. The correlation analysis revealed that perinatal factors, including gestational age, birth weight, Apgar scores, and physical conditions, significantly correlated with WPPSI-IV and K-CPT variables. Gender significantly correlated with object assembly of WPSSI-IV and clinical index of K-CPT. Among vision-related variables, best corrected visual acuity correlated most with K-CPT, including clinical index, Omission, and hit reaction time standard error of K-CPT, as well as significantly correlated with information and bug search of WPPSI-IV. Preterm children at preschool age still had poorer cognitive performance than full-term children, especially those with birth BW less than 1500 g. Gender and vision are correlated with cognitive deficits. Continuous monitoring with comprehensive assessments is recommended.

Impact of Mobile Phone Screen Exposure on Adolescents' Cognitive Health.

There is existing evidence on how excessive screen exposure can be detrimental to cognitive health, and in recent years there has been an increase in the usage of mobile phones by adolescents. We aimed to examine the association between mobile phone screen exposure and cognitive function among a young healthy population. We carried out a cross-sectional study conducted in 632 adolescents (13.89 ± 0.52 years old). Exposure data were collected through self-reported questionnaires, and cognitive outcomes were assessed by different computer-based neuropsychological tests. Compared to students in the lowest tertile (<9 min/day) of mobile phone screen exposure (MPSE), those in the medium tertile (9–20 min/day) showed significantly higher hit reaction time standard error (HRT-SE, higher inattentiveness) = (14.9 ms, 95% CI = 0.6; 29.3), as did as those in the highest tertile (>20 min/day) = (11.1 ms, 95% CI = 2.8; 25.0). When adjusting for confounders, the association held for the medium-MPSE tertile (17.6 ms, 95% CI = 3.4; 31.7). When further adjusting for intermediate factors, an increase in inattentiveness scores was also observed in both groups, with higher HRT-SE values for participants in the medium (15.8 ms, 95% CI = 1.4; 30.3) and highest MPSE tertiles (14.97 ms, 95% CI = 0.9; 29.1). There were no significant associations with fluid intelligence or working memory scores. Overall, our study shows that healthy teenagers reporting higher screen exposure may be affected in their attention performance. However, more studies are needed to determine the causality of these associations and to better shape the screen exposure recommended guidelines for brain health during adolescence.

Red blood cell omega-3 fatty acids and attention scores in healthy adolescents

Omega-3 fatty acids are critical for brain function. Adolescence is increasingly believed to entail brain vulnerability to dietary intake. In contrast to the abundant research on the omega-3 docosahexaenoic acid (DHA) in cognition, research on DHA and attention in healthy adolescents is scarce. In addition, the role of alpha-linolenic acid (ALA), the vegetable omega-3 fatty acid, is unexplored. We examined associations between DHA and ALA and attention function among a healthy young population. In this cross-sectional study conducted in 372 adolescents (13.8 ± 0.9 years-old), we determined the red blood cell proportions of DHA and ALA by gas chromatography (objective biomarkers of their long-term dietary intake) and measured attention scores through the Attention Network Test. We constructed multivariable linear regression models to analyze associations, controlling for known confounders. Compared to participants at the lowest DHA tertile (reference), those at the highest DHA tertile showed significantly lower hit reaction time-standard error (higher attentiveness) (28.13 ms, 95% confidence interval [CI] = – 52.30; – 3.97), lower hit reaction time ( – 38.30 ms, 95% CI = – 73.28; – 3.33) and lower executive conflict response ( – 5.77 ms, 95% CI = – 11.44; – 0.09). In contrast, higher values were observed in those at the top tertile of ALA in hit reaction time compared to the lowest one (46.14 ms, 95% CI = 9.90; 82.34). However, a beneficial association was observed for ALA, with decreasing impulsivity index across tertiles. Overall, our results suggest that DHA (reflecting its dietary intake) is associated with attention performance in typically developing adolescents. The role of dietary ALA in attention is less clear, although higher blood levels of ALA appear to result in lower impulsivity. Future intervention studies are needed to determine the causality of these associations and to better shape dietary recommendations for brain health during the adolescence period.

Exposure to road traffic noise and cognitive development in schoolchildren in Barcelona, Spain: A population-based cohort study.

BackgroundRoad traffic noise is a prevalent and known health hazard. However, little is known yet about its effect on children’s cognition. We aimed to study the association between exposure to road traffic noise and the development of working memory and attention in primary school children, considering school-outdoor and school-indoor annual average noise levels and noise fluctuation characteristics, as well as home-outdoor noise exposure.Methods and findingsWe followed up a population-based sample of 2,680 children aged 7 to 10 years from 38 schools in Barcelona (Catalonia, Spain) between January 2012 to March 2013. Children underwent computerised cognitive tests 4 times (n = 10,112), for working memory (2-back task, detectability), complex working memory (3-back task, detectability), and inattentiveness (Attention Network Task, hit reaction time standard error, in milliseconds). Road traffic noise was measured indoors and outdoors at schools, at the start of the school year, using standard protocols to obtain A-weighted equivalent sound pressure levels, i.e., annual average levels scaled to human hearing, for the daytime (daytime LAeq, in dB). We also derived fluctuation indicators out of the measurements (noise intermittency ratio, %; and number of noise events) and obtained individual estimated indoor noise levels (LAeq) correcting for classroom orientation and classroom change between years. Home-outdoor noise exposure at home (Lden, i.e., EU indicator for the 24-hour annual average levels) was estimated using Barcelona’s noise map for year 2012, according to the European Noise Directive (2002). We used linear mixed models to evaluate the association between exposure to noise and cognitive development adjusting for age, sex, maternal education, socioeconomical vulnerability index at home, indoor or outdoor traffic-related air pollution (TRAP) for corresponding school models or outdoor nitrogen dioxide (NO2) for home models. Child and school were included as nested random effects.The median age (percentile 25, percentile 75) of children in visit 1 was 8.5 (7.8; 9.3) years, 49.9% were girls, and 50% of the schools were public. School-outdoor exposure to road traffic noise was associated with a slower development in working memory (2-back and 3-back) and greater inattentiveness over 1 year in children, both for the average noise level (e.g., ‒4.83 points [95% CI: ‒7.21, ‒2.45], p-value < 0.001, in 2-back detectability per 5 dB in street levels) and noise fluctuation (e.g., ‒4.38 [‒7.08, ‒1.67], p-value = 0.002, per 50 noise events at street level). Individual exposure to the road traffic average noise level in classrooms was only associated with inattentiveness (2.49 ms [0, 4.81], p-value = 0.050, per 5 dB), whereas indoor noise fluctuation was consistently associated with all outcomes. Home-outdoor noise exposure was not associated with the outcomes. Study limitations include a potential lack of generalizability (58% of mothers with university degree in our study versus 50% in the region) and the lack of past noise exposure assessment.ConclusionsWe observed that exposure to road traffic noise at school, but not at home, was associated with slower development of working memory, complex working memory, and attention in schoolchildren over 1 year. Associations with noise fluctuation indicators were more evident than with average noise levels in classrooms.

Cognitive and Emotional Determinants of Automatic Perspective Taking in Healthy Adults.

Previous studies using the dot-perspective task postulated that people automatically take into account others' perspective even when it prevents them from achieving their own goals. This human ability may be of key importance for the ascription of mental states and social interactions. The cognitive and emotional determinants of automatic perspective taking (APT) is still matter of debate. To address this issue, we examined the performance in the Samson et al. APT task in 91 healthy adults who underwent a detailed neuropsychological testing including assessment of their general intelligence (Wechsler Adult Intelligence Scale, WAIS), attention and impulsivity (Conners' Continuous Performance Test-II, CPT-II), alexithymia (Toronto Alexithymia Scale, TAS), and measures of affective empathy and explicit theory of mind (Geneva Social Cognition Scale, GeSoCS, and mini-Social cognition and Emotional Assessment, mini-SEA). Univariate and multiple linear regression models (adjusted for age, gender, and education) were used to explore the association between mean reaction times (respectively, mean number of errors) in the APT task, and the CPT-II parameters, WAIS global score (as well as subscale scores), TAS, and GeSoCS and mini-SEA scores. Only the CPT-II parameters were significantly associated with the mean reaction times. Increased omissions, commissions, and detectability as well as hit reaction time standard error in CPT-II were all related to worse performances both in Self and Other conditions. The mean number of errors was negatively associated with the GeSoCS score. Among the variables studied, only CPT-II parameters had a significant impact on egocentric and altercentric interference. Neither global intelligence nor alexithymia have an effect on dot-perspective task performance. The present findings suggest that people with lower attentional resources and increased impulsivity display worse performances in the APT task and are less responsive to both egocentric and altercentric interference.

Omega-3 Fatty Acid Intake during Pregnancy and Child Neuropsychological Development: A Multi-Centre Population-Based Birth Cohort Study in Spain.

Background: There are few studies that look at the intake of all types of omega-3 polyunsaturated fatty acids (n-3 PUFAs) during the different stages of pregnancy along with a long-term neuropsychological follow-up of the child. This study aims to explore the association between maternal n-3 PUFA intake during two periods of pregnancy and the child’s neuropsychological scores at different ages. Methods: Prospective data were obtained for 2644 pregnant women recruited between 2004 and 2008 in population-based birth cohorts in Spain. Maternal n-3 PUFA intake during the first and third trimester of pregnancy was estimated using validated food frequency questionnaires. Child neuropsychological functions were assessed using Bayley Scales of Infant Development version one (BSID) at 1 year old, the McCarthy Scale of Children’s Abilities (MSCA) at 4 years old, and the Attention Network Test (ANT) at 7 years old. Data were analysed using multivariate linear regression models and adjusted for potential covariates, such as maternal social class, education, cohort location, alcohol consumption, smoking, breastfeeding duration, and energy intake. Results: Compared to participants in the lowest quartile (<1.262 g/day) of n-3 PUFA consumption during the first trimester, those in the highest quartile (>1.657 g/day) had a 2.26 points (95% confidence interval (CI): 0.41, 4.11) higher MSCA general cognitive score, a 2.48 points (95% CI: 0.53, 4.43) higher MSCA verbal score, and a 2.06 points (95% CI: 0.166, 3.95) higher MSCA executive function score, and a 11.52 milliseconds (95% CI: −22.95, −0.09) lower ANT hit reaction time standard error. In the third pregnancy trimester, the associations were weaker. Conclusions: Positive associations between n-3 PUFA intake during early pregnancy and child neuropsychological functions at 4 and 7 years of age were found, and further clinical research is needed to confirm these findings.

Identifying Factors Influencing Attention in Adolescents with a Co-Created Questionnaire: A Citizen Science Approach with Secondary Students in Barcelona, Spain.

Studies on factors that can influence attention in healthy adolescents are recent and focus on recurrent topics. Students’ contribution to public health research often revolves around collecting data but rarely around creating data collection instruments. The ATENC!Ó project reunited secondary students and scientists to create a questionnaire including factors that students thought could affect their attention. We conducted a cross-sectional study to assess whether the factors included in this questionnaire had an effect on attention in adolescents. A total of 1667 students (13–16 years old) from 28 schools in Barcelona performed a validated attention test and answered the questionnaire. The response speed consistency (attentiveness), expressed as hit reaction time standard error (HRT-SE, in ms), was used as the primary outcome. Analyses were conducted using conditional linear regression with school as strata, adjusted for sociodemographic characteristics and further stratified by gender and maternal social class. Some factors showed a negative influence on attention, including taking medication and not reading regularly. We found a significant 14.3% (95% confidence interval: 3.4%, 25.3%) higher median of HRT-SE (increase inattentiveness) among students who reported not having a good relationship with classmates. Students’ input into research is relevant for advancing the knowledge production in public health.

Short-term effect of air pollution on attention function in adolescents (ATENC!Ó): A randomized controlled trial in high schools in Barcelona, Spain.

The recent evidence of the short-term impact of air pollution on youth cognitive functions is based primarily on observational studies. We conducted a randomized controlled trial to assess whether purifying the air of the classrooms produced short-term changes in attention processes of adolescents. We recruited a total of 2,123 adolescents (13-16years old) in 33 high schools in Barcelona metropolitan area (Spain). In each school, adolescents from each class were randomly split into two equal-sized groups and assigned to two different classrooms. A set of two air cleaner devices with the same appearance (one recirculating and filtrating the air and the other only recirculating the air) was used. Each one of the devices was placed at random at one of the two classrooms. Students were masked to intervention allocation and had to complete several computerized activities for 1.5h, including an attention test (Flanker task) to be performed at baseline and at the end of the intervention. The response speed consistency, expressed as hit reaction time standard error (HRT-SE, in ms), was measured as the primary outcome. Analyses were conducted using conditional linear regressions with classroom as strata, adjusted for variables that may differ from one class to another such as temperature, humidity and carbon dioxide concentration. Average levels of PM2.5 and black carbon throughout the 1.5h of experiment were 89% and 87%, respectively, lower in the classrooms with air cleaner than in the control classrooms. No differences were found in the median of HRT-SE between classrooms with cleaned air and normal air (percent change: 1.37%, 95% confidence interval: -2.81%, 5.56%). Sensitivity analyses with secondary attention outcomes resulted in similar findings. Cleaning the air of a classroom to reduce exposure to air pollutants for 1.5h did not have an impact on the attention function of adolescents. Still, in light of previous evidence suggesting an association between air pollution and attention, further experimental studies should explore other short-term timescales of exposure and age ranges.

Effect of Air Pollution on the Cognitive Function of Adolescents (ATENC!Ó): An Experimental Study in High Schools in Barcelona, Spain

Background: The recent evidence of the short-term impact of air pollution on youth cognitive functions is based primarily on observational studies. We conducted an experimental study to assess whether air pollution in high schools can affect the adolescents' attention processes.Methods: A total of 2124 adolescents (14-15 years old) were recruited in 33 high schools in Barcelona province (Spain). In each school, adolescents were randomly split into two equal-sized groups. For each school, each group was assigned to a different classroom. One classroom had an internal air purifier (recirculation and filtration) and the other had the same device but without the filter (only recirculation). Students were masked to intervention allocation and were asked to complete several computerized activities for two hours, including an attention test (Flanker task) to perform at baseline and after the intervention. We measured the response speed consistency, expressed as hit reaction time standard error (HRT-SE), as our primary outcome. Analyses were conducted using conditional linear regressions with classroom as strata, adjusted for variables that may differ from one class to another such as temperature, humidity and carbon dioxide concentration.Results: Average levels of PM2.5 and black carbon for the two hours of experiment were 89% and 87% lower in the classrooms with purified air than in the control classrooms. We found a non-significant 1.84% (95% confidence interval -2.27%, 6.12%) difference in the median of HRT-SE between classrooms with purified or normal air. Sensitivity analyses and results with secondary outcomes resulted in similar findings.Conclusions: Cleaning the air of a classroom to reduce exposure to air pollutants for a duration of two hours did not have an impact on the attention of high-school students. Experimental studies with longer duration of the intervention could shed more light on the potential association between air pollution and adolescents’ cognitive function.

Add-on memantine may improve cognitive functions and attenuate inflammation in middle- to old-aged bipolar II disorder patients

ObjectivesChronic inflammation and neuroprogression underlie bipolar disorder (BP) and associated cognitive deficits. Memantine (MM) exerts neuroprotective effects by reducing neuroinflammation. Therefore, we investigated whether add-on low-dose MM (5 mg/day) in BP-II patients may improve cognition and inflammation. MethodsWe combined two 12-week randomized, double-blind, placebo-controlled studies (NCT 01188148 and NCT 03039842) for analysis. Each participant was allocated to the MM or placebo group. Symptom severity, neuropsychological tests, and the cytokine plasma levels [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-8 (IL-8), transforming growth factor-β1 (TGF-β1), and brain-derived neurotrophic factor (BDNF)] were evaluated at baseline and endpoint. A subgroup analysis of middle- to old-aged BP-II patients was also performed. ResultsWe recruited 155 BP-II patients (23 of which were middle- to old-aged) for the MM group and 170 patients (20 of which were middle- to old-aged) for the placebo group. Add-on MM did not result in significant improvements in cognitive functions in all BP-II patients, but a group difference in TNF-α levels was found in the MM group (P=0.04). Specifically, in middle- to old-aged BP-II patients, there was a significant time and group interaction effect on omission T-scores, hit reaction time T-scores, and hit reaction time standard error T-scores on continuous performance tests (CPTs) in the MM group (P=0.007, 0.02, and 0.01, respectively), and a decrease in plasma TNF-α levels (P=0.04). LimitationsThe sample size of middle- to old-aged BP-II patients were limited. ConclusionAdd-on MM may attenuate inflammation in BP-II and improve cognition in middle- to old-aged BP-II patients.

Using Mobile Electroencephalography and Actigraphy to Diagnose Attention-Deficit/Hyperactivity Disorder: Case-Control Comparison Study.

BackgroundChildren with attention-deficit/hyperactivity disorder (ADHD), a neurobehavioral disorder, display behaviors of inattention, hyperactivity, or impulsivity, which can affect their ability to learn and establish proper family and social relationships. Various tools are currently used by child and adolescent psychiatric clinics to diagnose, evaluate, and collect information and data. The tools allow professional physicians to assess if patients need further treatment, following a thorough and careful clinical diagnosis process.ObjectiveWe aim to determine potential indicators extracted from a mobile electroencephalography (EEG) device (Mindset; NeuroSky) and an actigraph (MotionWatch 8; CamNtech) and to validate them for diagnosis of ADHD. The 3 indicators are (1) attention, measured by the EEG; (2) meditation, measured by the EEG; and (3) activity, measured by the actigraph.MethodsA total of 63 participants were recruited. The case group comprised 40 boys and 9 girls, while the control group comprised 5 boys and 9 girls. The groups were age matched. The test was divided into 3 stages—pretest, in-test, and posttest—with a testing duration of 20 minutes each. We used correlation analysis, repeated measures analysis of variance, and regression analysis to investigate which indicators can be used for ADHD diagnosis.ResultsWith the EEG indicators, the analysis results show a significant correlation of attention with both hit reaction time (RT) interstimulus interval (ISI) change (r=–0.368; P=.003) and hit standard error (SE) ISI change (r=–0.336; P=.007). This indicates that the higher the attention of the participants, the smaller both the hit RT change and the hit SE ISI change. With the actigraph indicator, confidence index (r=0.352; P=.005), omissions (r=0.322; P=.01), hit RT SE (r=0.393; P=.001), and variability (r=0.351; P=.005) were significant. This indicates that the higher the activity amounts, the higher the impulsive behavior of the participants and the more target omissions in the continuous performance test (CPT). The results show that the participants with ADHD present a significant difference in activity amounts (P<0.001). The actigraph outperforms the EEG in screening ADHD.ConclusionsWhen the participants with ADHD are stimulated under restricted conditions, they will present different amounts of activity than in unrestricted conditions due to participants’ inability to exercise control over their concentration. This finding could be a new electronic physiological biomarker of ADHD. An actigraph can be used to detect the amount of activity exhibited and to help physicians diagnose the disorder in order to develop more objective, rapid auxiliary diagnostic tools.

Maternal seafood consumption during pregnancy and child attention outcomes: a cohort study with gene effect modification by PUFA-related genes.

There is a need to test the fetal programming theoretical framework in nutritional epidemiology. We evaluated whether maternal seafood intake during pregnancy was associated with 8-year-old attention outcomes after adjusting for previous child seafood intake and cognitive function. We also explored effect modification by several single nucleotide polymorphisms (SNPs) related with polyunsaturated fatty acid (PUFA) metabolism. Our final analyses included 1644 mother-child pairs from the prospective INMA (INfancia y Medio Ambiente) cohort study (Spain, recruitment between 2003 and 2008). We used food frequency questionnaires to assess prenatal and postnatal seafood consumption of the mother-child pairs. We evaluated attention function of the children through the computer-based Attention Network Test (ANT) and we used the number of omission errors and the hit reaction time standard error (HRT-SE). Parents reported child attention deficit hyperactivity disorder (ADHD) symptoms using the Revised Conners' Parent Rating Scale Short Form (CPRS-R: S). We measured seven candidate SNPs in a subsample of 845 children. We estimated associations using regression models, adjusting for family characteristics, child seafood intake and cognitive functions at early ages, and to explore SNP effect modifications. Higher total seafood intake during early pregnancy was associated with a reduction of child ANT omission errors, 5th quintile (median = 854 g/week) vs 1st quintile (median = 195 g/week), incidence risk ratio (IRR) 0.76; 95% CI = 0.61, 0.94. Similar results were observed after adjusting the models for child seafood intake and previous cognitive status. Lean, large and small fatty fish showed similar results, and generally similar but less robust associations were observed with the other attention outcomes. Shellfish and canned tuna showed weaker associations. The association patterns were weaker in late pregnancy and null in child seafood consumption. Child rs1260326 (glucokinase regulator, GCKR) and child/maternal rs2281591 (fatty acid elongase 2, ELOVL2) polymorphisms showed nominal P-value for interactions <0.10 between total seafood intake and ANT outcomes. After adjusting for previous child cognitive functions and child seafood intake, high pregnancy consumption (total, lean, small and large fatty fish) was independently associated with improvements of some 8-year-old attention outcomes. Genetic effect modification analyses suggest PUFA intake from seafood as a potential biological mechanism of such association.

Maternal nut intake in pregnancy and child neuropsychological development up to 8years old: a population-based cohort study in Spain.

There is scientific evidence on the protective effects of nut intake against cognitive decline in the elderly; however, this effect has been less explored in child neurodevelopment and no studies have explored the potential longitudinal association with nut intake during pregnancy. We aimed to analyze the association of maternal nut intake during pregnancy with child neuropsychological outcomes. We included 2208 mother-child pairs from a population-based birth cohort in four regions of Spain. The follow up settings were during pregnancy (first and third trimesters), birth, 1.5, 5 and 8years. Neuropsychological examinations were based on Bayley Scales of Infant Development (1.5years), McCarthy scales of Children's Abilities (5year), Attention Network Test (ANT, 8year) and N-Back test (8year). Nut intake in pregnancy was reported through a validated food frequency questionnaire during the first and the third trimester. Multivariable regressions analyzed associations after controlling for priori selected confounders notably maternal education, social class, body mass index, energy intake, fish intake, omega-3 supplements, alcohol consumption and smoking habits during pregnancy. Children within the highest tertile of maternal nut consumption during first pregnancy trimester (> 32g/week) had a decrease of 13.82ms [95% confidence interval (CI) - 23.40, - 4.23] in the ANT-hit reaction time standard error, compared to the first tertile (median 0g/w). A similar protective association pattern was observed with the other cognitive scores at the different child ages. After correcting for multiple testing using Bonferroni familywise error rate (FWER), Hochberg FWER and Simes false discovery rate, ANT-hit reaction time standard error remained significant. Final model estimates by inverse probability weighting did not change results. Third pregnancy trimester nut intake showed weaker associations. These data indicate that nut intake during early pregnancy is associated with long-term child neuropsychological development. Future cohort studies and randomized clinical trials are needed to confirm this association pattern in order to further extend nutrition guidelines among pregnant women.

Effect of mindfulness yoga programme MiYoga on attention, behaviour, and physical outcomes in cerebral palsy: a randomized controlled trial.

To investigate the efficacy of an embodied mindfulness-based movement programme (MiYoga), targeting attention in children with cerebral palsy (CP). Total number of participants 42, with 24 boys (57.1%) and 18 girls (42.9%); mean age 9y 1mo, SD 3y; Gross Motor Function Classification System levels I=22, II=12, III=8) and their parents were randomized to either MiYoga (n=21) or waitlist comparison (n=21) groups. The primary outcome was attention postintervention measured by the Conners' Continuous Performance Test, Second Edition (CCPT). Secondary outcomes included parent and child mindfulness, child quality of life, parental well-being, child executive function, child behaviour, child physical measures, and the parent-child relationship. Children in the MiYoga group demonstrated significantly better attention postintervention than the waitlist comparison group, with lower inattention scores on the hit reaction time standard error (F1,33 =4.59, p=0.04, partial eta-squared [ηp2]=0.13) variable and fewer perseveration errors (F1,33 =4.60, p=0.04, ηp2=0.13) on the CCPT. Intention-to-treat analysis also revealed that sustained attention in the MiYoga group was significantly better than in the waitlist comparison group postintervention (F1,37 =5.97, p=0.02, ηp2=0.14). Parents in the MiYoga group demonstrated significantly decreased mindfulness (Mindfulness Attention Awareness Scale; F1,33 =10.130, p=0.003, ηp2=0.246). MiYoga offers a lifestyle intervention that improves attention in children with CP. MiYoga can be considered as an additional option to standard rehabilitation to enhance attention for children with CP. MiYoga, an embodied mindfulness-based movement programme, can enhance attention (more attentive and consistent performance) in children with cerebral palsy. MiYoga had no significant effect on physical functioning.

The relevance of attention deficit hyperactivity disorder in self-limited childhood epilepsy with centrotemporal spikes

In this study, we aimed to evaluate the attentional and executive functions in patients with benign childhood epilepsy with centrotemporal spikes (BCECTS) with and without attention-deficit hyperactivity disorder (ADHD) compared with controls and compared with patients with ADHD without epilepsy. We evaluated 12 patients with BCECTS and ADHD (66.7% boys; mean age of 9.67years); 11 children with non-ADHD BCECTS (63.6% boys; mean age of 11.91years); 20 healthy children (75% boys; mean age of 10.15years); and 20 subjects with ADHD without epilepsy (60% boys; mean age of 10.9years). We used a comprehensive battery of neuropsychological tests to evaluate attentional and executive functions in their broad domains. Patients with BCECTS and ADHD had worse performance in Conners' Continuous Performance Test II (reaction time standard error [p=0.008], variability [p=0.033], perseverations [p=0.044] and in reaction time interstimuli interval [p=0.016]). Patients with ADHD showed worse performance in Trail Making Test B errors [p=0.012]. In conclusion, patients with BCECTS and ADHD had worse executive and attentional performance compared with controls than non-ADHD patients with BCECTS. Regardless of the presence of epilepsy, ADHD also negatively impacted executive and attentional functions but in different executive subdomains compared with patients with epilepsy.

The Association between Lifelong Greenspace Exposure and 3-Dimensional Brain Magnetic Resonance Imaging in Barcelona Schoolchildren

Background:Proponents of the biophilia hypothesis believe that contact with nature, including green spaces, has a crucial role in brain development in children. Currently, however, we are not aware of evidence linking such exposure with potential effects on brain structure.Objective:We determined whether lifelong exposure to residential surrounding greenness is associated with regional differences in brain volume based on 3-dimensional magnetic resonance imaging (3D MRI) among children attending primary school.Methods:We performed a series of analyses using data from a subcohort of 253 Barcelona schoolchildren from the Brain Development and Air Pollution Ultrafine Particles in School Children (BREATHE) project. We averaged satellite-based normalized difference vegetation index (NDVI) across buffers around all residential addresses since birth to estimate each participant’s lifelong exposure to residential surrounding greenness, and we used high-resolution 3D MRIs of brain anatomy to identify regional differences in voxel-wise brain volume associated with greenness exposure. In addition, we performed a supporting substudy to identify regional differences in brain volume associated with measures of working memory (d′ from computerized n-back tests) and inattentiveness (hit reaction time standard error from the Attentional Network Task instrument) that were repeated four times over one year. We also performed a second supporting substudy to determine whether peak voxel tissue volumes in brain regions associated with residential greenness predicted cognitive function test scores.Results:Lifelong exposure to greenness was positively associated with gray matter volume in the left and right prefrontal cortex and in the left premotor cortex and with white matter volume in the right prefrontal region, in the left premotor region, and in both cerebellar hemispheres. Some of these regions partly overlapped with regions associated with cognitive test scores (prefrontal cortex and cerebellar and premotor white matter), and peak volumes in these regions predicted better working memory and reduced inattentiveness.Conclusion:Our findings from a study population of urban schoolchildren in Barcelona require confirmation, but they suggest that being raised in greener neighborhoods may have beneficial effects on brain development and cognitive function. https://doi.org/10.1289/EHP1876

Impact of commuting exposure to traffic-related air pollution on cognitive development in children walking to school

A few studies have found associations between the exposure to traffic-related air pollution at school and/or home and cognitive development. The impact on cognitive development of the exposure to air pollutants during commuting has not been explored. We aimed to assess the role of the exposure to traffic-related air pollutants during walking commute to school on cognitive development of children. We performed a longitudinal study of children (n = 1,234, aged 7–10 y) from 39 schools in Barcelona (Catalonia, Spain) who commuted by foot to school. Children were tested four times during a 12-month follow-up to characterize their developmental trajectories of working memory (d’ of the three-back numbers test) and inattentiveness (hit reaction time standard error of the Attention Network Test). Average particulate matter ≤2.5 μm (PM2.5), Black Carbon (BC) and NO2 concentrations were estimated using Land Use Regression for the shortest walking route to school. Differences in cognitive growth were evaluated by linear mixed effects models with age-by-pollutant interaction terms. Exposure to PM2.5 and BC from the commutes by foot was associated with a reduction in the growth of working memory (an interquartile range increase in PM2.5 and BC concentrations decreased the annual growth of working memory by 5.4 (95% CI [-10.2, -0.6]) and 4.6 (95% CI [-9.0, -0.1]) points, respectively). The findings for NO2 were not conclusive and none of the pollutants were associated with inattentiveness. Efforts should be made to implement pedestrian school pathways through low traffic streets in order to increase security and minimize children's exposure to air pollutants.

Lifelong Residential Exposure to Green Space and Attention: A Population-based Prospective Study.

Background:Natural environments, including green spaces, may have beneficial impacts on brain development. However, longitudinal evidence of an association between long-term exposure to green spaces and cognitive development (including attention) in children is limited.Objectives:We evaluated the association between lifelong residential exposure to green space and attention during preschool and early primary school years.Methods:This longitudinal study was based on data from two well-established population-based birth cohorts in Spain. We assessed lifelong exposure to residential surrounding greenness and tree cover as the average of satellite-based normalized difference vegetation index and vegetation continuous fields, respectively, surrounding the child’s residential addresses at birth, 4–5 y, and 7 y. Attention was characterized using two computer-based tests: Conners’ Kiddie Continuous Performance Test (K-CPT) at 4–5 y () and Attentional Network Task (ANT) at 7 y (). We used adjusted mixed effects models with cohort random effects to estimate associations between exposure to greenness and attention at ages 4–5 and 7 y.Results:Higher lifelong residential surrounding greenness was associated with fewer K-CPT omission errors and lower K-CPT hit reaction time-standard error (HRT-SE) at 4–5 y and lower ANT HRT-SE at 7 y, consistent with better attention. This exposure was not associated with K-CPT commission errors or with ANT omission or commission errors. Associations with residential surrounding tree cover also were close to the null, or were negative (for ANT HRT-SE) but not statistically significant.Conclusion:Exposure to residential surrounding greenness was associated with better scores on tests of attention at 4–5 y and 7 y of age in our longitudinal cohort. https://doi.org/10.1289/EHP694