Trail Test Research Articles

B - 124 Neuropsychological Evaluation of Chinese Speaking Patients with Parkinson’s Disease for Deep Brain Stimulation Surgery

Abstract Objective Neuropsychological evaluation is a critical part of standardized workup of candidates with Parkinson’s disease (PD) for deep brain stimulation (DBS), identifying patients with cognitive dysfunction (Okun et al., 2006). Existing literature has primarily involved native English speakers with dementia and mild cognitive impairment (MCI), informing treatment planning (Troster et al., 2018). This case series aims to address the gap for Chinese-speaking patients, by describing Chinese neuropsychological measures and norms sensitive to MCI. Method Six cases of first-generation Chinese immigrants diagnosed with PD considering DBS were included in this study. They identified Chinese as their primary language and English as their second language. Duration of residency in the U.S. ranged from 11 to 44 years. The battery included Chinese version of the MOCA; Chinese WAIS-IV; Boston Naming Test (Cheung et al. 2004); semantic verbal fluency, Auditory Verbal Learning Test, Symbol Digit Modalities Test, and Color Trail Test (Lee and Wang, 2010); and Brief Visuospatial Memory Test, Revised Edition (BVMT-R) or RBANS: Figure Recall. Results Consistent with studies for native English speakers (Foley et al., 2018), cognitive declines were found in attention, memory, and executive function domains. Two of the six cases were diagnosed with MCI, which warrants caution before DBS. Conclusions This case series explores measures for Chinese speakers with PD undergoing evaluation for DBS surgery, highlighting cultural considerations, including Chinese measures and norms. This battery can help to differentiate cognitive impairments before proceeding with DBS. Given the diversity within this population and the scarcity of Chinese tools, more research is urgently needed.

Children’s color trails test: Greek normative data and clinical validity in children with traumatic brain injury and attention deficit - Hyperactivity disorder

The Children’s Color Trail Test (CCTT) is considered a culture fair equivalent of the Trail Making Test for the assessment of cognitive flexibility in pediatric populations, while others emphasize its additional validity as a measure of attention, perceptual tracking, processing speed, susceptibility to interference and inhibition. The need for standardized neuropsychological tests in Greece, especially for the pediatric population is significant. In the present study, considering the relatively good psychometric properties of the CCTT and its wide cross-cultural application, we decided that such a tool would be useful to Greek clinicians and researchers, and therefore developed norms for the Greek child and adolescent population. Additionally, we examined the clinical validity of the test, administering it to two groups of patients (children with Traumatic Brain Injury and Attention Deficit - Hyperactivity Disorder). We administered the test to 417 native healthy Greek children 6-15 years, recruited primarily from Southwestern Greece from several public schools. Linear regression analysis revealed a significant influence of age on completion time in both parts of the CCTT, whereas sex did not influence time to completion. Older children consistently completed the test faster than younger children, whereas girls and boys performed similarly on both conditions. In addition, CCTT differentiated the performance of children who have had a TBI and those diagnosed with ADHD from the performances of their typically developing peers. This study provides much needed performance and clinical utility data for the pediatric population in Greece on a promising neuropsychological tool for use in clinical and research settings.

Validity of the Short Weekly Calendar Planning Activity in patients with Parkinson disease and nonmanifesting LRRK2 and GBA carriers.

Subtle executive dysfunction is common in people newly diagnosed with Parkinson disease (PD), even when general cognitive abilities are intact. This study examined the Short Weekly Calendar Planning Activity (WCPA-10)'s known-group construct validity, comparing persons with PD to healthy controls (HCs) and nonmanifesting carriers of LRRK2 and GBA gene mutations to HCs. Additionally, convergent and ecological validity was examined. The study included 73 participants: 22 with idiopathic PD (iPD) who do not carry any of the founder GBA mutations or LRRK2-G2019S, 29 nonmanifesting carriers of the G2019S-LRRK2 (n = 14) and GBA (n = 15) mutations, and 22 HCs. Known-group validity was determined using the WCPA-10, convergent validity by also using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT), and ecological validity by using the WCPA-10, Schwab and England Activities of Daily Living Scale (SE ADL), and Physical Activity Scale for the Elderly (PASE). Known-group validity of the WCPA-10 was established for the iPD group only; they followed fewer rules (p = 0.020), were slower (p = 0.003) and less efficient (p = 0.001), used more strategies (p = 0.017) on the WCPA-10, and achieved significantly lower CTT scores (p < 0.001) than the HCs. The nonmanifesting carriers and HCs were similar on all cognitive tests. Convergent and ecological validity of the WCPA-10 were partially established, with few correlations between WCPA-10 outcome measures and the MoCA (r = 0.50, r = 0.41), CTT-2 (r = 0.43), SE ADL (r = 0.41), and PASE (r = 0.54, r = 0.46, r = 0.31). This study affirms the known-group validity for most (four) WCPA-10 scores and partially confirms its convergent and ecological validity for PD.

Visuospatial dysfunction predicts dementia-first phenoconversion in isolated REM sleep behaviour disorder

ObjectiveWhile isolated rapid eye movement sleep behaviour disorder (iRBD) is known as a prodrome of α-synucleinopathies, the prediction for its future phenoconversion to parkinsonism-first or dementia-first subtype remains a challenge....

Neurocognitive profile in HIV subjects on INSTI-regimen- one year follow up: Is there room for optimism?

The introduction of antiretroviral therapy (ART) has successfully changed the clinical course of people with HIV, leading to a significant decline in the incidence of HIV-related neurocognitive disorders. Integrase strand transferase inhibitors (INSTI) are recommended and preferred first-line ART for the treatment of HIV-1 infection in ART-naïve subjects. This type of therapy regimen is expected to have higher CNS penetration, which may bring more cognitive stability or even make significant cognitive improvement in people with HIV. The study aimed to follow up on neurocognitive performance in HIV subjects on two types of INSTI therapy regimens at two-time points, one year apart. The study sample consisted of 61 ART naïve male participants, of which 32 were prescribed raltegravir (RAL) and 29 dolutegravir (DTG). There was no significant difference between subsamples according to the main sociodemographic (age, education level) and clinical characteristics (duration of therapy, nadir CD4 cells level, CD4 cells count, CD8 cells, CD4/CD8 ratio). For neurocognitive assessment, six measures were used: general cognitive ability (MoCA test), verbal fluency (total sum score for phonemic and category fluency), verbal working memory (digit span forward), cognitive capacity (digit span backwards), sustained attention (Color Trail Test 1), and divided attention (Color Trail Test 2). In both therapy groups (RAL and DTG), there was no significant decrease in neurocognitive achievement on all used measures over a one-year follow-up in both therapy groups. A statistically significant interactive effect of time and type of therapy was found on the measure of divided attention-DTG group showed slight improvement, whereas RAL group showed slight decrease in performance. During the one-year follow-up of persons on INSTI-based regimen, no significant changes in cognitive achievement were recorded, which suggests that the existing therapy can have a potentially positive effect on the maintenance of neurocognitive achievement.

Bringing the field into the lab: a novel virtual reality outdoor march simulator for evaluating cognitive and physical performance

Soldiers, athletes, and rescue personnel must often maintain cognitive focus while performing intense, prolonged, and physically demanding activities. The simultaneous activation of cognitive and physical functions can disrupt their performance reciprocally. In the current study, we developed and demonstrated the feasibility of a virtual reality (VR)-based experimental protocol that enables rigorous exploration of the effects of prolonged physical and cognitive efforts. A battery of established neurocognitive tests was used to compare novel cognitive tasks to simulated loaded marches. We simulated a 10-km loaded march in our virtual reality environment, with or without integrated cognitive tasks (VR-COG). During three experimental visits, participants were evaluated pre- and post-activity, including the Color Trail Test (CTT), the Synthetic Work Environment (SYNWIN) battery for assessing multitasking, and physical tests (i.e., time to exhaustion). Results show that Strong or moderate correlations (r ≥ 0.58, p ≤ 0.05) were found between VR-COG scores and scores on the cognitive tests. Both the SYNWIN and CTT showed no condition effects but significant time effects, indicating better performance in the post-activity assessment than in the pre-activity assessment. This novel protocol can contribute to our understanding of physical-cognitive interactions, since virtual environments are ideal for studying high performance professional activity in realistic but controlled settings.

Prediction and mediation analysis for treatment responses to combined cognitive and physical training for older adults

Diminished cognitive and physical functions negatively affect the daily functions of individuals. Although combined cognitive and physical training prevents instrumental activities of daily living (IADL) disability in older adults, no predictive model or mediation analysis of IADL after combined training exists. This study aims to employ prediction and mediation analysis to identify the predictors of IADL performance and to elucidate the mediators of the association between baseline global cognition and subsequent IADL performance following combined cognitive and physical training. This study involved 177 participants aged 60 years and older who underwent combined training. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Color Trails Test, Word List, and a dual task; physical function with the Timed Up and Go (TUG) test; daily function with the Lawton IADL Scale. We conducted regression analyses to identify the predictors of IADL performance, and mediation analysis to examine whether DSST and TUG mediate the relationship between MoCA and IADL. The pre-intervention DSST and TUG were significant independent predictors of post-intervention IADL. The association between the pre-intervention MoCA and post-intervention IADL was mediated by pre-intervention DSST and TUG. This study highlighted the importance of measuring and improving processing speed and functional mobility before and during interventions to enhance IADL outcomes.Trial registration: NCT03619577, 23/07/2018; NCT04689776, 29/12/2020.

The Shape Trail Test Is Sensitive in Differentiating Older Adults with Mild Cognitive Impairment: A Culture-neutral Five-minute Test

IntroductionThe Shape Trail Test (STT) was developed based upon the Trail Making Test, as a culture-neutral test for measuring processing speed and mental flexibility. This study aims to evaluate the accuracy and validity of this five-minute test for differentiating individuals with normal cognition (NC), subjective memory impairment (SMI), and mild cognitive impairment (MCI).MethodThe study included 210 participants aged 50–80 years, with 70 participants in each group matched for age, education, and gender.ResultsNo significant difference in STT measures was found between the NC and SMI groups. In contrast, both the NC and SMI groups exhibited significantly better performance (shorter completion time in STT-A and STT-B and fewer STT-B errors) than the MCI group. No significant group differences were found in STT-A errors. Stepwise regression analysis identified three significant predictors for classifying the MCI group from the NC and/or SMI groups, including the STT-B completion time, the STT-A errors, and the interaction between STT-B completion time and STT-B errors. The composite score of these three predictors demonstrated good discriminatory power for classifying the MCI group from the other groups, with area under the curves (AUCs) of 0.76–0.79 (p < 0.001), sensitivities of 78.6%–80%, and specificities of 60%–61.4%. However, none of the STT measures or their interactions were significant predictors for differentiating the SMI group from the NC group. Besides, the STT measures were significantly correlated with age, education, and executive function measures.DiscussionThe STT could be a culture- and language-free, reliable test for assessing executive function and a sensitive test for predicting MCI.

The Effectiveness of Cognitive Rehabilitation Software on the Cognitive Functions of Patients with Non-Amnestic Mild Cognitive Impairment

Background and Aims Mild cognitive impairment (MCI) is one of the cognitive profiles of senility. It is classified into amnestic and nonamnestic MCI depending on the involvement of different cognitive functions. This research aims to design a cognitive rehabilitation software based on the attention process model and investigate its effect on the attention and executive functions of older people with nonamnestic mild cognitive impairment. Methods This quasi-experimental research employed a pretest-posttest and follow-up design. After designing the software program, 30 older people over 60 who were diagnosed with nonamnestic mild cognitive impairment through NUCOG (Neuropsychiatry Unit Cognitive Assessment Tool) screening and a psychiatrist who met the inclusion criteria were randomly assigned to the experimental or control group (each with 15 people). To perform the rehabilitation intervention, a software system was designed based on Mateer and Sohlberg attention process training, whose validity and reliability have been confirmed in Iranian older adults. After the pretest, the experimental group received the rehabilitation intervention with the software, and the control group did not receive anything. Three months after the completion of the sessions, both groups were assessed as the posttest, and the results were compared using an analysis of covariance and the Mann-Whitney U test using SPSS software, version 26. Results The results indicated significant differences between the posttest scores of the experimental and control groups in the mean score of errors in congruent and incongruent selective attention, executive function score, time and error in alternating attention in the colors trail test A form (CTT-A) and time in alternating attention in CTT-B and also time and error in separated attention (P&lt;0.05). However, there were no significant differences between the two groups posttest mean scores in selective attention time, time and error in sustained attention, and error in CTT-B alternating attention (P&gt;0.05). The intervention did not cause any significant improvement in these domains. Also, the results were sustained after 3 months. Conclusion The results confirmed the efficacy of cognitive rehabilitation interventions. The designed cognitive rehabilitation software in this research can cause a significant improvement in attention and executive functions of patients with nonamnestic mild cognitive impairment. It can be used as a clinical intervention.

Testing the bilingual advantage for executive function: insights from hearing children who are native signers

ABSTRACT Bimodal bilingualism involves the use of a sign language and a spoken language, and offers a unique opportunity to explore the cognitive effects of growing up bilingual. The aim of this study was to investigate the relationship between bimodal bilingualism and executive function (EF) in hearing children who are native users of a sign language. We studied three groups of children: bimodal bilinguals (users of a sign language and a spoken language), unimodal bilinguals (users of two spoken languages), and monolinguals, performing three cognitive tasks to measure different components of EF: visuospatial working memory (Odd One Out task), cognitive flexibility (Children’s Colored Trails Test) and conflict resolution (Simon task). All groups of children obtained similar scores on the Odd One Out task and the Children’s Colored Trails Test. Bimodal bilinguals displayed distinct patterns of conflict resolution in comparison to monolingual children: bimodal bilinguals had better overall accuracy and slower overall reaction time in the Simon task. The subsequent analysis did not find a straightforward trade-off between speed and accuracy. These results suggest that bimodal language experience and/or visual-spatial language usage may explain the small bimodal bilingual advantage in the Simon task that we observed in hearing children who are native signers.

Quantitative Analysis of the Influence of Affective Commitment on the Performance of Administrative Staff in Tertiary Institutions, Anambra States

Enhancing the performance of administrative staff necessitated this study. The study quantitatively analyzed the influence of affective commitment on the job performance of administrative staff in tertiary institutions in Anambra State. One research question and one null hypothesis were tested at a 0.05 significant level, guiding the study. The study adopted a descriptive survey research design with a population of 544 administrative staff in tertiary institutions in Anambra state studied without sampling. A 10-10-item questionnaire titled "Influence of Affective Commitment on the Performance of Administrative Staff (IAC-PAS)" was used for data collection. The face and content validity of the instrument were determined by two experts in business education, measurement, and evaluation. Trail testing was used to establish the instrument's reliability, and data were analyzed using Cronbach alpha reliability, which yielded a coefficient value of .81. The researchers, with the help of three research assistants, administered copies of the questionnaire to the respondents. Out of the 544 copies of the questionnaire distributed, 528(97%) copies were correctly filled and returned and used for data analysis. Statistical mean and standard deviation were used to answer the research question and determine the homogeneity of the respondents' ratings, and a t-test was used to test the null hypothesis. Findings revealed that administrative staff agree that affective commitment influences their performance in tertiary institutions in Anambra State. Age did not significantly influence respondents' mean ratings on the influence of affective commitment on the performance of administrative staff in tertiary institutions in Anambra State. Based on the study's findings, the researchers concluded that building a working environment that promotes affective commitment can improve the performance of administrative staff of tertiary institutions in Anambra State to a very high level. Therefore, it was recommended that the management of tertiary institutions in Nigeria provide regular organizational support programs for administrative staff to better develop their personal and career objectives and improve their affective commitment and job performance.

A randomised controlled pilot study of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls.

This pilot study examined the feasibility, acceptability, and effects of a Nintendo Ring Fit Adventure™-based balance and muscle strengthening exercise program in community-dwelling older adults with a history of falls. Older adults who have had at least one fall in the past year were randomly assigned to an experimental (n = 21) or control group (n = 21). The experimental group performed 16 exercise sessions in total, lasting 60 min each, twice a week for 8 weeks, whereas the control group received usual care. Feasibility was evaluated based on the scores of participants in the exercises. Acceptance was evaluated using a customised questionnaire examining participants' self-perceived enjoyment, feasibility and improvements. Clinical outcomes including balance (Mini-BESTest), lower limb muscle strength (Five-Time Sit-to-Stand test), mobility (Timed-Up and Go test), dual-task ability (Timed-Up and Go test-Dual Task), fear of falling (Icon-FES) and executive function (Color Trails Test) were evaluated at baseline and 8 weeks. Thirty-one participants (74%) finished the 8-week assessment. The experimental group significantly improved their scores in six out of eight exercises (all p < .031). The mean scores of the self-perceived enjoyment, feasibility and improvement domains of the acceptability questionnaire were 3.46 ± .53, 3.08 ± .59, and 3.47 ± .57 respectively. A significant improvement in the anticipatory subscore of the Mini-BESTest was found in the experimental group compared to the control group (p = .02; Partial eta squared = .14). The Nintendo Ring Fit Adventure™-based exercise program was feasible, acceptable, and potentially effective in community-dwelling older adults with a history of falls.

Profiles of executive functioning following traumatic brain injury and stroke using the assessment of participation and executive functions: combined cross-sectional and longitudinal designs.

The Assessment of Participation and Executive Functions (A-PEX) evaluates executive functioning through daily participation in complex daily activities. This study examines its ability to discriminate between executive functioning profiles post-traumatic brain injury and post-stroke and its sensitivity to changes. Cross-sectional with a longitudinal component. Adults with post-traumatic brain injury (n = 28) and post-stroke (n = 26) in a rehabilitation facility. Patients were administered the A-PEX, Multiple Errands Test-Hospital version and Color Trail Test at 2 time-points 1 month apart. The Montreal Cognitive Assessment was administered at the first time-point, and Executive Functions Performance Test's Internet-based Bill Payment subtest at the second. The analysis used Mann-Whitney and Wilcoxon signed-rank tests. The stroke group's A-PEX scores were higher than the traumatic brain injury group's at the first time-point (p < 0.05). No differences were found in the other assessments. Within-group differences in both groups were significant in the A-PEX (-3.7 < r < - 2.3, p < 0.05) and Multiple Errands Test-Hospital version (-3.4 < r < -3.3, p < 0.01). The A-PEX may provide valuable information about the uniqueness of executive functioning profiles and patients' progress.

Subjective cognitive complaints and objective cognitive impairment in patients suspected of obstructive sleep apnea who underwent polysomnography.

Obstructive sleep apnea (OSA) is linked to cognitive impairment. We aimed to investigate subjective cognitive complaints (SCCs) and objective cognitive scores and their relation to polysomnography (PSG) parameters in patients suspected of having OSA. A prospective cohort cross-sectional study was conducted at Siriraj Hospital. Patients suspected of OSA who were scheduled for PSG were recruited. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT). The Memory Index Score (MIS) was calculated from the MoCA. Subjective cognitive complaint presence was assessed through direct questioning of patients and by employing the Cognitive Change Index rated by self or informants (CCI-I). Patients with severe dementia were excluded. Among 258 patients (mean age 61.46±7.05years, 51.2% female), the mean MoCA score was 23.89±3.89. Based on PSG results, patients were categorized into groups as follows: those without OSA or with mild OSA (combined total of 20.1%), moderate OSA (28.3%), or severe OSA (51.6%). Cognitive Change Index rated by self and CCI-I scores correlated significantly (r=0.238, p=0.019) but not with the MoCA score or CTT time. Objective cognitive scores were associated with PSG parameters: total sleep time (TST), sleep onset latency, wake after sleep onset, sleep stages, mean O2 saturation, and time spent with SaO2 below 90% (all p<0.05). Subjective cognitive scores were not associated with PSG parameters, except CCI-I with TST. Participants with objective cognitive impairment had lower education, higher body mass index, more comorbidities, and lower SCC percentage (all p<0.05). Patients with moderate to severe OSA had a higher proportion of objective cognitive impairment (64.1%) but a lower incidence of SCC (38.3%) than patients with no OSA or mild OSA. Thirty patients with severe OSA and cognitive impairment received continuous positive airway pressure (CPAP) treatment for a mean of 12.2months. These patients showed MoCA and MIS improvement, but no significant changes were observed in their CTT and Cognitive Change Index scores. Most patients with OSA had objective cognitive impairment, but SCC was less frequent in patients with more severe OSA. Several PSG parameters correlated with cognitive scores but not with subjective cognitive scores. Patients with severe OSA may benefit cognitively from CPAP treatment.

Hybrid surgery can improve neurocognitive function in patients with internal carotid artery occlusion

Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischaemic attack and cerebral infarction. Hybrid surgery (HS) improves cerebral perfusion, but its impact on neurocognitive function has been controversial. Patients with symptomatic chronic ICAO treated by hybrid surgery or medical treatment from 2016 to 2019 were included. We recorded and analysed the clinical characteristics, angiographic data, outcomes and cognitive status. Functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale–Cognitive Subtest (ADAS-cog), verbal fluency, and Colour Trail test Parts 1 and 2, were administered. Significant improvements in the ADAS (before, 7.5 ± 6.2 versus after, 5.2 ± 5.7; P = 0.022), MMSE (before, 25.5 ± 2.8 versus after, 28.1 ± 2.3; P = 0.013), and Colour Trail test Part 1 (before, 118.3 ± 26.5 versus after, 96.2 ± 23.1; P = 0.016) were observed six months after HS. Moreover, the abovementioned postprocedure scales were ameliorated in the HS group. This study found that in patients with multiple symptomatic ICAO and objective ipsilateral ischaemia, successful HS leads to improvement in the scores of three cognitive tests.

Multiple Hypointense Vessels are Associated with Cognitive Impairment in Patients with Single Subcortical Infarction.

We aimed to explore the relationship between multiple hypointense vessels and cognitive function in patients with single subcortical infarction (SSI) and the role of SSI with different etiological mechanisms in the above relationship. Multiple hypointense vessels were measured by the number of deep medullary veins (DMVs), DMVs score, and cortical veins (CVs) score. The Montreal Cognitive Assessment (MoCA), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) were assessed to evaluate cognitive function. SSI was dichotomized as branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI by whole-brain vessel-wall magnetic resonance imaging. We included a total of 103 acute SSI patients. After adjustments were made for related risk factors of cognitive function, the SSI patients with higher DMVs score were more likely to have longer STT-B (P = 0.001) and smaller STT-B-1 min (P = 0.014), and the SSI patients with higher CVs score were more likely to have shorter STT-A (P = 0.049). In subgroup analysis, we found that the negative relationship between DMVs scores and cognitive function and the positive relationship between CVs scores and cognitive function were significantly stronger in BAD patients. We provided valuable insights into the associations between DMVs, CVs, and multi-domain cognitive impairment in SSI patients, which underscored the necessity to further study the dynamic alterations of venules and their specific influence on post-stroke cognitive impairment.

Effects of Cognitive‐motor Rhythmic Training on Executive Functions and Motor Performance in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

AbstractIntroductionIn recent years, prevalence of mild cognitive impairment (MCI) has increased in older adults, exacerbating the potential impact on global health. Cognitive‐motor training is an emerging treatment modality with proven benefits in enhancing both physical and cognitive functions. In recent research findings, training of musical rhythmic skills with auditory‐motor synchronization is beneficial to reactivate the brain’s sensorimotor and perceptual regions as well as to improve cognition. However, there is limited research on combining these modalities.ObjectivesThis pilot study aims to develop a pioneer program on cognitive‐motor rhythmic training (CMRT), and to investigate whether the program would improve the executive functions (EF) and hand functions of patients with MCI.MethodologyThirty patients recruited from the Hong Kong Buddhist Hospital were randomized into two groups: (i) an intervention group receiving a 6‐week training program and (ii) a waitlist control group. The program was designed with reference to the rhythm game “Taiko no Tatsujin”, in which precise timed motor responses were required to hit the circular cues against the target zone. The game was designed with progression of difficulty levels and instant feedback. Classical Cantopop songs that were familiar to Hong Kong older adults were selected. Mental flexibility, inhibitory control, working memory, visuospatial memory, verbal fluency, processing speed and problem‐solving were assessed using domain‐specific cognitive tests, while hand dexterity was measured by the Purdue Pegboard Test. Paired t‐test and ANOVA were used to examine the within group difference and the comparison between groups. The level of significance was set at P&lt;0.05.ResultsThe analysis showed significant Time x Group interaction effects in Color Trail Test (p = 0.001), Color Word Stroop Test (P = 0.002), Digit Span Test (P&lt;0.001), Corsi Block‐Tapping Test (P&lt;0.001), Verbal Fluency Test (P&lt;0.001), Symbol Digit Modalities Test (P = 0.015), Maze Test (P&lt;0.001) and the Purdue Pegboard scores (P&lt;0.001) compared to the control group after training.ConclusionsThe 6‐week CMRT program is effective in improving the executive functions and motor performance in patients with MCI. This innovation can serve as an affordable and quality intervention in early stages of cognitive decline.

Clinical and neurocognitive outcomes in patients with supra-arch vascular disease following transcatheter aortic valve replacement

Abstract Background Symptomatic carotid, vertebral and subclavian artery stenosis are associated with the risk of stroke, but the impact of these supra-arch vascular diseases (SAVD) on clinical and neurocognitive outcomes following transcatheter aortic valve replacement (TAVR) is unclear. Methods Preoperative carotid/vertebral duplex ultrasonography and computed tomography were performed to identify the presence of SAVD. Prospective neurological assessments (Barthel Index), global cognitive tests (Mini-Mental State Examination, MMSE) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. Results Overall, a total of 210 patients were evaluated, and 59 patients (28.1%) had SAVD (carotid stenosis: 37, vertebral stenosis: 23, subclavian stenosis: 6). The patients with SAVD were older (84.0±5.7 vs 79.4±8.2, P=0.0001) and had higher incidence of prior stroke or transient ischemic accident (15.3% vs 5.9%, P=0.031). There was no association between the presence of SAVD and stroke (adjusted hazard ratio (aHR): 1.26; 95% confidence interval (95% CI): 0.217-7.341) or mortality (aHR, 1.38; 95% CI:0.834-2.813). After propensity score matching in patients complete neurocognitive assessment after TAVR, the baseline neurocognitive performance were similar between the patients with (N=44) and without SAVD (N=74). Persistent improvement up to 1 year in Barthel Index, MMSE, Color Trail Test A and B could be observed only in the patients without SAVD, but not in patients with SAVD. Conclusions The presence of SAVD was not associated with an increased risk of post-TAVR stroke or mortality. However, the persistent improvement in neurocognitive assessments after TAVR could only be seen in patients without SAVD.

Impact of Comorbid Oppositional Defiant Disorder on the Clinical and Neuropsychological Characteristics of Korean Children With Attention-Deficit/Hyperactivity Disorder.

The aim of the present study was to investigate the influence of comorbid oppositional defiant disorder (ODD) on clinical features and neuropsychological profiles of children with attention-deficit/hyperactivity disorder (ADHD). We divided the participants into three groups: the ADHD with ODD (ADHD/ODD) (n=36), ADHD without ODD (ADHD/noODD) (n=307), and control groups (n=128). Parents of the participants completed the ADHD Rating Scale, Social Responsiveness Scale (SRS), Korean Personality Rating Scale for Children (K-PRC), and 10-item mania scale from the Parent General Behavior Inventory (P-GBI-10M). Neuropsychological profiles were assessed using the Advanced Test of Attention (ATA), Children's Color Trails Test, and Stroop Color and Word Test. The ADHD/ODD group had more ADHD symptoms and functional impairments in relationships with teachers and peers, and self-esteem than the ADHD/noODD group. The ADHD/ODD group scored higher in Social Communication (p<0.001) and Autistic Mannerisms (p<0.001) subscales of SRS, P-GBI-10M (p<0.001), and Delinquency (p<0.001) and Psychosis (p<0.001) subscales of K-PRC than the ADHD/noODD group. Commission Errors (p<0.001) and Response-Time Variability (p<0.001) in Visual ATA and Commission Errors (p<0.001) in Auditory ATA were significantly higher in the ADHD/ODD group than in the ADHD/noODD group. The present study suggests that patients with ADHD with ODD experience more ADHD symptoms and neuropsychological deficits than those with ADHD without ODD. These results also imply that comorbid ODD is associated with greater social impairment and emotional dysregulation.

Design and Build of an Autonomous Catamaran Urban Cargo Vessel

This study introduces a novel test bed, named the Maverick, which aims to advance the field of autonomous inland waterborne freight transportation and facilitate its eventual implementation. More specifically, the Maverick focuses on operating in small waterways within urban areas, aligning its application scenario with the European project AVATAR. The hull form of the Maverick was selected to be a catamaran, as it offers several advantages, including a large open deck area, high transverse stability, and excellent maneuverability at low speeds. The Maverick is equipped with two 360-degrees-steerable azimuth thrusters, one at the bow and one at the stern. This configuration makes the Maverick over-actuated, and offers more advanced motion control possibilities compared to conventional rudder-propeller actuated vessels. The Maverick is composed out of modular building blocks combined with a flexible interface, which enables it to accommodate diverse control terminals for future developments. Furthermore, to illustrate the feasibility of the Maverick within an urban context, this study also includes results of several trail tests. The interactive communication framework that was successfully employed in the autonomous sailing experiment is introduced. The Maverick offers a versatile platform for testing and developing a wide range of technologies in situation awareness, autonomous sailing, smart waterway logistics, and other interconnected domains. Therefore, this innovative research vessel can pave the way for the development of a new freight transport mode within European urban areas, contributing valuable experiences to the field.