Tower Of London Task Research Articles

Planning ability impairments in probable Alzheimer's disease patients: Evidence from the Tower of London test.

Alzheimer's disease (AD) is associated with progressive impairment of higher-level cognitive abilities. Previous research suggests that early impairment of executive functions occurs during the course of the disease, but few studies have specifically investigated planning ability in an AD population.ObjectiveThe purpose of the current study was to examine whether AD patients retain the ability to plan ahead, by analyzing specificities of their behavior in successfully achieving a pre-established goal.MethodsTwenty-one AD patients and thirty-three elderly controls underwent a problem-solving assessment using the Tower of London (TOL) test.ResultsAD patients were less accurate and less efficient than controls. AD patients also committed more mistakes. This indicates a decline in working memory and inhibitory deficits, resulting in impulsive and inappropriate behaviors.ConclusionThese results are in agreement with previous studies, showing executive function problems in patients with AD. Specifically, this study demonstrates the presence of planning ability deficits in AD, considering both qualitative and quantitative approaches. The wide range of analysis presented in this study can aid clinicians in identifying the nature of the poor performance of AD patients during a planning task.

Differences in cognitive deficits in individuals with subthreshold syndromes with and without family history of bipolar disorder

Little is known about the development of cognitive deficits prior to the official onset of bipolar disorder (BP). The aim of this study was to investigate neurocognitive performance in two early stages of BP. This high-risk design study recruited a group of offspring of parents with BP (n = 58), aged 8–28 years. Based on the subthreshold syndromes, the “unaffected” offspring were further divided into high-risk (HR) and ultra-high-risk (UHR) stages. For comparison, a group of individuals with subthreshold symptoms but without family history of psychiatric disorder (n = 17) and 48 healthy controls (HCs) were included. The MATRICS Consensus Cognitive Battery (MCCB) and Tower of London task were applied to assess neuropsychological performance. The HR offspring performed significantly poorer on verbal learning and memory when compared with HCs, indicating that the deficits may serve as neurocognitive endophenotypes for BP. Deficits in working memory, visual-spatial memory, and cognitive planning were observed in the UHR offspring when compared with HCs, suggestive of risk of developing BP. The deficits observed in the UHR offspring were absent in the individuals with subthreshold symptoms without psychiatric family history. Our data suggest that cognitive deficits become apparent prior to the official onset of BP, with specific deficits observable in different early stages. These results nonetheless are based on small sample size and a cross-sectional design. Given this and the heterogeneity of bipolar disorders, these findings should be interpreted cautiously and require replication.

Active Workstations Do Not Impair Executive Function in Young and Middle-Age Adults.

This study aimed to examine the effects of self-selected low-intensity walking on an active workstation on executive functions (EF) in young and middle-age adults. Using a within-subjects design, 32 young (20.6 ± 2.0 yr) and 26 middle-age (45.6 ± 11.8 yr) adults performed low-intensity treadmill walking and seated control conditions in randomized order on separate days, while completing an EF test battery. EF was assessed using modified versions of the Stroop (inhibition), Sternberg (working memory), Wisconsin Card Sorting (cognitive flexibility), and Tower of London (global EF) cognitive tasks. Behavioral performance outcomes were assessed using composite task z-scores and traditional measures of reaction time and accuracy. Average HR and step count were also measured throughout. The expected task difficulty effects were found for reaction time and accuracy. No significant main effects or interactions as a function of treadmill walking were found for tasks assessing global EF and the three individual EF domains. Accuracy on the Tower of London task was slightly impaired during slow treadmill walking for both age-groups. Middle-age adults displayed longer planning times for more difficult conditions of the Tower of London during walking compared with sitting. A 50-min session of low-intensity treadmill walking on an active workstation resulted in accruing approximately 4500 steps. These findings suggest that executive function performance remains relatively unaffected while walking on an active workstation, further supporting the use of treadmill workstations as an effective approach to increase physical activity and reduce sedentary time in the workplace.

The Tower of London (ToL) in Italy: standardization of the ToL test in an Italian population.

Deficit in planning and problem-solving, affecting a wide range of neuropsychological patients, has been widely investigated using the Tower of London (ToL) test, as developed by Shallice (Philos Trans R Soc Lond Ser B Biol Sci 298:199-209, 1). The ToL taps on several executive functions (EF), such as planning, time for planning or rule breaks, which may be usefully indexed by different ToL measurements. However, in its original version, the different aspects involved in ToL are not evaluated in a specific way.Here, we report the standardization of the ToL, on 896 individuals aged 15-86years, taking in account individual factors (i.e. gender, age, years of education) which may affect performances on ToL. We computed several indexes on the ToL including score, planning and execution times, perseverations, rule breaks and self-monitoring. We found that these indexes were affected by individual factors such as gender, age and education. Present results not only provide extensive normative data according to gender, as well as different age and education ranges, but also represent a very useful instrument for a more fine-grained diagnosis of EF deficits in a wide range of neuropsychological patients, including traumatic brain injury and brain-damaged patients, as well as Alzheimer's disease and Parkinson's disease patients.

Executive functioning, response inhibition and attentional process impairments in impulsive children

Impulsivity is a multidimensional concept that incorporates failure of response inhibition, rapid processing of information, novelty seeking, and inability to delay gratification. Aggressive, suicidal and violent behaviors have been shown to be associated with impulsivity and difficulty in inhibiting responses. As explorers of executive function (EF) and impulsivity research areas believe this two are generally considered conceptually distinct, and suggest that they may be antipodes (i.e., widely separated on a common continuum, upon which they are related), We selected subjects with high (n = 25) and low (n = 25) levels of impulsivity among 537 students of ages 8 to 10 years-old, who were measured by Conners Teacher Rating impulsivity Scale. Using computerized versions, response inhibition was examined by their performance in a Go/No Go task, general performance in executive functions (EF) was measured by tower of London Test and continuous performance test (CPT) was used to assess their attentional processes. Using independent t- test and ANOVA, the results revealed that overall performance of executive functions in impulsive children in all three areas were remarkably damaged: they had impaired performance regarding Go/No Go task results; also have consumed more time and committed more errors and a worse general performance; and had more errors and weaker performance in attentional processes. The results of this study along with similar results would be effective in achieving a brighter image of impulsive children's cognitive problems in order to provide efficient treatments focused on improving their executive functions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assessment of Executive Functions in Methamphetamine-addicted Individuals: Emphasis on Duration of Addiction and Abstinence.

Introduction:Several studies have conducted on impairments of executive functions in individuals with methamphetamine addiction; however, only a few have investigated the relationship between executive functions and duration of addiction or abstinence. This study was designed to assess the executive functions in methamphetamine-addicted individuals in relation to the duration of addiction or abstinence.Methods:A total of 161 subjects aged between 20 and 45 years were categorized into three subgroups: currently abusing (n=41), abstinent (n=60), and control healthy individuals (n=60). A battery of standardized executive function tasks, including Stroop test, Wisconsin Card Sorting test, and Tower of London task, were administered. Data were analyzed using Pearson correlation coefficient, analysis of variance, and post hoc Bonferroni test with SPSS16.0.Results:Methamphetamine-addicted and abstinent subjects performed worse than the controls. Methamphetamine-abstinent subjects performed better than the currently methamphetamine abusers in most executive functions. Duration of addiction and abstinence were correlated with executive dysfunctions.Conclusion:This study revealed that although executive functions may be improved by protracted abstinence, executive dysfunctions are not completely relieved, and specific attention to planning and implementation of intervention programs are necessary.

Neurocognitive functions in inpatient suicide attempters and non-attempters: A comparison

IntroductionAccording to many studies, suicide attempters, compared to healthy general population, exhibit some neurocognitive deficits, which are considered promising endophenotype of suicidal behavior disorder. A similar pattern of impairment is widespread in individuals affected by psychiatric disorders.ObjectivesTo compare neurocognitive functions of hospitalized suicide attempters (A) with those of an inpatient group without history of suicidal behavior (NA), likewise affected by psychiatric disorders.AimsThe purpose of the study is to evaluate if neurocognitive impairment is associated to suicidal behaviors, regardless of underlying psychiatric diagnosis.MethodsThe whole sample is composed of 70 adult psychiatric inpatients (34 males, 36 females), divided into two groups (A and NA) of 35 patients with diagnosis of Psychotic, affective and personality disorders. Neurocognitive functions were assessed using Tower of London Test (TOL), Modified Wisconsin Card Sorting Test (MCST), Stroop Test (ST) and Attentional Matrices (AM). Differences between A and NA groups were analyzed using U-test of Mann–Whitney and cross tabulations, taking into account the three diagnostic areas.ResultsStatistically significant differences were found between A and NA with regard to the ability of categorization (MCST), planning, problem solving and inhibition of automatic response (TOL), which proved to be more preserved in A individuals. No significant differences were found on selective attention tasks (ST and AM).ConclusionsThese preliminary findings show statistically significant differences on executive functions between suicide attempters and psychiatric non-attempter individuals. Further research on larger samples is needed to investigate these associations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Relationship between executive function and depressive symptoms during the tower of London test in patients with major depressive disorder

Objective To investigate the relationship between executive function and depressive symptoms in patients with major depressive disorder(MDD) under the Tower of London Test (TOL). Methods Thirty depression patients and thirty age-, gender-, education-matched normal controls participated in the study. All subjects received the Tower of London Test. The severity of depressive and anxiety symptoms were assessed by Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale(HAMA) and Beck Depression Rating Scale(BDI). Results (1)The numbers of correct response and total response of the TOL in MDD(9.1±5.1, 12.1±5.3) were significantly lower than those of the control group(13.8±5.0, 17.3±3.9)(P<0.05). The response time of the TOL test in patients with MDD((10.4±2.8)s) was significantly longer than that of the control group((8.5±2.2)s)(P<0.05). (2)The scores of HAMD , BDI and HAMA were negatively correlated with numbers of total response(r=-0.403, -0.544, -0.495, ) in patients with MDD (all P<0.05). Conclusion The executive function of patients with MDD is impaired and negatively correlated with depressive and anxiety symptoms under the Tower of London Test. Key words: Depression; Tower of London test; Executive function

Executive functioning in a racially diverse sample of children who are overweight and at risk for eating disorders

Difficulties with executive functioning may underlie both overweight and loss of control (LOC) eating behavior across the age spectrum, but there is a relative paucity of research in children with both conditions. This study aimed to characterize general executive functioning among children with overweight and LOC eating as compared to their overweight and normal-weight peers. Participants were 75 racially diverse children (58.7% female; 81.3% African-American), aged 9-12y (M age = 10.5 ± 1.1), of whom 26 were overweight/obese and endorsed LOC eating (OW-LOC), 34 were overweight controls (OW-CON), and 15 were normal-weight controls (NW-CON). All children completed interview-based measures of eating pathology, and behavioral measures of executive functioning. Parents reported on behavioral facets of children's executive functioning. Groups were compared across parent-report measures and behavioral tasks using analyses of covariance (ANCOVAs) and multivariate analyses of covariance (MANCOVAs) which adjusted for general intellectual functioning. Significant group differences were revealed on a behavioral measure of planning, the Tower of London task [F (5,65) = 3.52; p = 0.007], and a behavioral measure of working memory, the List Sorting task [F (2,71) = 6.45; p = 0.003]. Post-hoc tests revealed that OW-LOC and OW-CON performed worse than NW-CON on the Tower of London, with relative decrements in accuracy rather than performance time. Further, OW-LOC performed worse than both OW-CON and NW-CON on the List Sorting task. Overweight with or without concomitant LOC eating in children may characterize a unique pattern of executive dysfunction. Interventions for eating- and weight-related problems in youth should address underlying deficits in planning and working memory.

Oral 5-Hydroxytryptophan (5-HTP) Does not Affect Grooved Pegboard Test Performance

Abstract: There is limited knowledge of the neurocognitive effects of the serotonin precursor 5-hydroxytryptophan (5-HTP), which is sold over-the-counter as a nutritional supplement. Animal studies have demonstrated that exogenous 5-HTP promotes the production of ectopic serotonin in dopaminergic neurons—an effect that may reduce dopamine output in these cells. Behavioral studies in humans have demonstrated specific 5-HTP induced cognitive deficits on the Iowa Gambling Task and the Tower of London task that are likely the result of reduced forebrain dopamine. However, it remains unclear if 5-HTP induced performance decrements observed on the Tower of London task were the result of a motor or cognitive impairment. The objective of this double-blind, placebo-controlled study was to clarify this point by determining if oral administration of 150 mg of 5-HTP disrupts fine motor control, as measured by the Grooved Pegboard Test. Seventy five university undergraduates received either a placebo or 5-HTP and completed the Grooved Pegboard Test. The groups did not differ in the amount of time needed to complete the place (p = 0.67) and remove (p = 0.48) components of the Grooved Pegboard Test. Therefore, 5-HTP induced reductions in performance on the Tower of London task appear to be cognitive in nature, and are unlikely to be the result of fine motor impairment (as measured by the Grooved Pegboard Test). These results also provide important safety information for 5-HTP by demonstrating that a 150 mg oral dose does not generally alter fine motor function.

Exhaustive Exercise Alters Thinking Times in a Tower of London Task in a Time-Dependent Manner.

Purpose: In contrast to other aspects of executive functions, acute exercise-induced alterations in planning are poorly investigated. While only few studies report improved planning performances after exercise, even less is known about their time course after exhaustive exercise.Methods: One hundred and nineteen healthy adults performed the Tower of London (ToL) task at baseline, followed by a graded exercise test (GXT). Participants were subsequently randomized into one of four groups (immediately, 30, 60, and 90 min after the GXT) to repeat the ToL. Main outcomes of the ToL were planning (number of tasks completed in the minimum number of moves), solutions (correct responses independent of the given number of moves) as well as thinking times (time between presentation of each problem and first action) for tasks with varying difficulty (four-, five,- and six-move problems). Blood lactate levels were analyzed as a potential mediator.Results: No effect of exercise on planning could be detected. In contrast to complex problem conditions, median thinking times deteriorated significantly in the immediately after GXT tested group in less challenging problem conditions (four-move problems: p = 0.001, F = 5.933, df = 3; five-move problems: p = 0.005, F = 4.548, df = 3). Decreased lactate elimination rates were associated with impaired median thinking times across all groups ΔMTT4-6 (p = 0.001, r = −0.309), ΔMTT4 (p < 0.001, r = −0.367), and ΔMTT5 (p = 0.001, r = −0.290).Conclusion: These results suggest that planning does not improve within 90 min after exhaustive exercise. In line with previous research, revealing a negative impact of exhaustive exercise on memory and attention, our study extends this knowledge of exercise-induced alterations in cognitive functioning as thinking times as subcomponents of planning are negatively affected immediately after exercise. This is further associated with peripheral lactate levels.

Comparison between Conventional Statistic Approach and Modelling Based on Artificial Neural Network in Differentiating Fronto-Temporal Dementia from Alzheimer's Disease with the Tower of London Test

Comparison between Conventional Statistic Approach and Modelling Based on Artificial Neural Network in Differentiating Fronto-Temporal Dementia from Alzheimer's Disease with the Tower of London Test

Predictive value of premorbid IQ, negative symptoms, and age for cognitive and social functions in Japanese patients with schizophrenia: A study using the Japanese version of the Brief Assessment of Cognition in Schizophrenia.

Enduring cognitive impairment in patients with schizophrenia represents a global health burden. The Japanese-language version of the Brief Assessment of Cognition in Schizophrenia (BACS) and the Japanese Adult Reading Test were administered to 288 patients with chronic schizophrenia and 308 unrelated healthy control subjects. The Japanese version of self-reported Social Functioning Scale (SFS) was administered to a subpopulation of 157 patients with schizophrenia. In patients with schizophrenia, premorbid IQ and age were significantly related to most of the BACS subdomains, composite score, and intra-individual variability of BACS subdomains, whereas negative symptoms were significantly related to all BACS indices. Dosages of the first-generation antipsychotics had a significant negative impact on Tower of London task and intra-individual variability of BACS subdomains. The relationship of symbol coding with age was significantly lower in patients than in healthy control subjects. Multiple regression analysis revealed that negative symptoms were significantly negatively related to the total SFS scale, whereas better performance of token motor task was associated with higher total SFS. The present study revealed the role of premorbid IQ, age, and negative symptoms in predicting cognitive performance, and the significant correlation of negative symptoms and token motor task with social function in patients with schizophrenia.

The Influence of Age and Gender on Executive Functions of the Brain in an Iranian Sample of Healthy Adults

Objective : Executive functions refer to a group of higher-order cognitive processes responsible for self-regulated and targeted behaviors. This study aimed to investigate the effects of age and gender on executive functions focusing on three distinct areas of attentional control, planning and set-shifting among18-80 year-old healthy subjects. Materials and Methods: This cross-sectional study enrolled a total of 200 healthy adults (100 women and 100 men) 18-80 years of age living in Tehran. Sampling was done through a random stratified cluster procedure with regard to the inclusion and exclusion criteria. Each area of the executive functions was evaluated using Stroop test for attentional control, Tower of London (ToL) test for planning and problem-solving and Wisconsin test for set-shifting. The correlation between age and components of executive functions was evaluated through Pearson correlation test. Moreover, the differences between age groups were examined by ANOVA while the correlation between gender and components of the executive functions was examined by t -test. Results : Age was significantly correlated with all subscales of Stroop test except time-interference, with the total number of errors and the overall result from ToL and all subscales of Wisconsin (P<0.001), R=0.49). There were no gender effect on executive functions except for the total time ( t =-2.09, p =0.037) and the number of errors (t=-9.2, p=0.004) in ToL test which was significantly higher in women than men. Conclusion : The executive functions including attentional control, planning and set-shifting was shown to be decreased by age. Problem-solving and planning were better in men than women.

Role of working memory, inhibition, and fluid intelligence in the performance of the Tower of London task

ABSTRACTWe investigated the relationship between verbal and visuo-spatial measures of working memory, inhibition, fluid intelligence and the performance on the Tower of London (ToL) task in a large sample of 830 healthy participants aged between 18 and 71 years. We found that fluid intelligence and visuo-spatial working memory accounted for a significant variance in the ToL task, while performances on verbal working memory and on the Stroop Test were not predictive for performance on the ToL. The present results confirm that fluid intelligence has a fundamental role on planning tests, but also show that visuo-spatial working memory plays a crucial role in ToL performance.

A Meta-analysis on the neural basis of planning: Activation likelihood estimation of functional brain imaging results in the Tower of London task.

The ability to mentally design and evaluate series of future actions has often been studied in terms of planning abilities, commonly using well-structured laboratory tasks like the Tower of London (ToL). Despite a wealth of studies, findings on the specific localization of planning processes within prefrontal cortex (PFC) and on the hemispheric lateralization are equivocal. Here, we address this issue by integrating evidence from two different sources of data: First, we provide a systematic overview of the existing lesion data on planning in the ToL (10 studies, 211 patients) which does not indicate any evidence for a general lateralization of planning processes in (pre)frontal cortex. Second, we report a quantitative meta-analysis with activation likelihood estimation based on 31 functional neuroimaging datasets on the ToL. Separate meta-analyses of the activation patterns reported for Overall Planning (537 participants) and for Planning Complexity (182 participants) congruently show bilateral contributions of mid-dorsolateral PFC, frontal eye fields, supplementary motor area, precuneus, caudate, anterior insula, and inferior parietal cortex in addition to a left-lateralized involvement of rostrolateral PFC. In contrast to previous attributions of planning-related brain activity to the entire dorsolateral prefrontal cortex (dlPFC) and either its left or right homolog derived from single studies on the ToL, the present meta-analyses stress the pivotal role specifically of the mid-dorsolateral part of PFC (mid-dlPFC), presumably corresponding to Brodmann Areas 46 and 9/46, and strongly argue for a bilateral rather than lateralized involvement of the dlPFC in planning in the ToL. Hum Brain Mapp 38:396-413, 2017. © 2016 Wiley Periodicals, Inc.

Behaviour planning and problem solving deficiencies in children with symptoms of attention deficit hyperactivity disorder from the Balobedu culture, Limpopo province, South Africa

Objective: To compare planning behaviour (frontal lobe functioning) in children with and without symptoms of attention deficit hyperactivity disorder (ADHD).Method: A total of 90 children (45 with symptoms of ADHD and 45 matched controls without ADHD symptoms) of both genders, who were medication naïve, from the Balobedu culture (Limpopo province, South Africa), aged 7–13 years, participated in the study. The performance of the two groups was compared on a test of planning and problem solving, the Tower of London (ToL) task. The results were analysed as a function of gender and ADHD subtype. The Finger Tapping test (testing fine motor skills) was used as a control test to verify that the expected differences were not due to poor motor skills.Results: The children with ADHD symptoms scored significantly lower than the non-ADHD comparison group which indicated deficiency in frontal lobe functioning (p = 0.00). The difference in performance was not due to poor motor control (p = 0.70).Conclusion: Children with ADHD symptoms show deficits in behavioural planning which indicates impairment of functions of the frontal areas supplied by the mesocortical dopamine branch. More so than others, the ADHD Inattentive and Combined subtypes showed poor performance in the Tower of London task, indicating poor organisational and planning skills in these groups. The results also did show that the difference was not due to problems with motor control and that the ToL task is a culture-fair instrument for testing planning behaviour.

Sensitivity and specificity of executive function tests for Alzheimer’s disease

ABSTRACTDecline in executive function (EF) occurs early in Alzheimer’s disease (AD) and can interfere with daily functioning. Unfortunately, little is known about the relative ability of traditional EF tests to detect these cognitive changes. Given that timely diagnosis and intervention are essential to improving functional outcome in this population, our aim was to identify the specific EF measures that best differentiated mild dementia from normal aging. Thirty-one patients with mild AD and 31 controls were administered 7 EF tests. Findings indicated significant between-group differences on all measures except Wisconsin Card Sorting Test. The remaining 6 tests displayed fair to good accuracy discriminating between AD cases and controls. Only category fluency and Tower of London test remained in the final regression model that yielded the highest AUC of 0.90, which was not statistically different from that of either test alone. Overall, most of the tests employed were valid for assessing mild EF disturbances. Specifically, the two measures can be used in isolation for quick screening or in combination to facilitate a more in-depth evaluation of EF performance. This study contributes to clinical field by testifying to the validity of various EF tests to identify AD-related compromises in this cognitive domain.

Impact of co-morbid attention-deficit and hyperactivity disorder on cognitive function in male children with Tourette syndrome: A controlled study

Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD) are co-morbid neurodevelopmental conditions affecting more commonly male patients. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study. Participants included four matched groups of unmedicated children (age range 6–15 years): TS (n=13), TS+ADHD (n=8), ADHD (n=39), healthy controls (n=66). Following clinical assessment, each participant completed a battery of tests from the Wechsler Intelligence Scale for Children-III, the Italian Battery for ADHD, the Tower of London test, the Corsi test, and the Digit Span test. All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. The TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group, particularly in the tests assessing planning ability, inhibitory function, working memory and visual attention, but not auditory attention. Problems in executive functions are more common in patients with neurodevelopmental disorders than controls. Deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms than core TS symptoms.

Association of Type D personality with cognitive functioning in individuals with and without cardiovascular disease - The Gutenberg Health Study.

Distressed ('Type D') personality is associated with adverse health outcomes in patients with cardiovascular disease (CVD). While personality traits from the Five-Factor Model are related to cognitive functioning, neither Type D personality nor its underlying traits negative affectivity (NA) and social inhibition (SI) have been investigated regarding cognition. We therefore compared the predictive value of Type D classification and its subcomponents NA and SI on planning performance in individuals with and without CVD. Type D personality traits (DS14) were determined in a population-based sample of 4026 participants (including 549 with CVD) aged 40-80years from the Gutenberg Health Study (GHS) and related to planning performance as assessed with the Tower of London task. Current depression and anxiety were controlled as state variables. Type D personality status was negatively associated with planning performance in the CVD patient group only (p<0.001) but had no impact in the non-CVD group (p=0.40). In the overall sample, NA was negatively and SI positively associated with planning performance. No differential effect on planning between groups was found for depression and anxiety. While the subcomponents NA and SI in the population-based sample confirm and extend previous research on personality traits and cognition, Type D personality classification in combination with CVD emerged as a risk factor for decreased cognitive functioning, independent of depression and anxiety. These findings implicate the need to early focus on individual differences in cognitive functioning in patients with CVD.