Wisconsin Card Sorting Test Perseverative Errors Research Articles

Testing associations between assessments of cognitive flexibility and eating disorder symptoms in adolescent bulimia nervosa.

Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents. Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT). Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT. The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes. Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN.

Impact of subjective sleep quality on objective measures of neurocognitive dysfunction in patients with major depressive disorder

Background: Sleep disturbances are prevalent in major depressive disorder (MDD). MDD and sleep disturbances are both linked to cognitive impairments. Studies exploring the mechanisms and impact of sleep disturbances on neurocognitive functioning in depressed patients are lacking and proper assessment and therapeutic interventions for sleep disturbances are not part of clinical management of MDD. Aim: We investigated the association between subjective sleep quality and neurocognitive dysfunction in patients with MDD. Materials and Methods: Patients with moderate MDD episode were matched and assigned to two groups with poor and good sleep quality. We used Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. To measure frontotemporally mediated cognitive functioning, following tests were administered: Wisconsin Card Sorting Test (WCST) and degraded continuous performance test (CPT-DS). Two-tailed independent samples t tests or Mann–Whitney U tests and Pearson’s correlation coefficient were performed for the statistical analysis of sleep latency, sleep duration, overall sleep quality, CPT d’ value, WCST correct answers, errors, and perseverative errors. Results: Participants with MDD and poor sleep quality performed worse on cognitive tests compared to patients with MDD and good sleep quality. Scores of subjective sleep on PSQI positively correlated with WCST errors (r (60) =0.8883 P = .001) and negatively correlated with WCST correct answers (r (60) = -.869 P = .001) and measures of CPT-DS d’ value (r (60) = -.9355 P = .001). Conclusions: Poor sleep quality, notably sleep duration and sleep latency, worsens the neurocognitive impairments of MDD patients. As these impairments are found to be associated with treatment outcomes, sleep disturbances should be additionally assessed and treated in MDD episode.

Measuring cognitive flexibility in anorexia nervosa: Wisconsin Card Sorting Test versus cued task-switching

PurposeThe Wisconsin Card Sorting Test (WCST) is the most common measure of cognitive flexibility in anorexia nervosa (AN), but task-switching paradigms are beginning to be utilized. The current study directly compared performance on a cued task-switching measure and the WCST to evaluate their association in participants with a lifetime diagnosis of AN, and to assess which measure is more strongly associated with clinical symptoms.MethodsForty-five women with a lifetime diagnosis of AN completed the WCST, cued color-shape task-switching paradigm, Anti-saccade Keyboard Task, Running Memory Span, Eating Disorder Examination Questionnaire, Depression Anxiety Stress Scales short form and Eating Disorder Flexibility Index.ResultsThere was no evidence of a significant association between WCST perseverative errors and cued task-switching switch costs. Results suggest lower working memory capacity is a determinant of higher perseverative error rate. When controlling for mood variables, neither cognitive flexibility measure was a significant independent predictor of symptom severity.ConclusionsResults provide support for previous suggestions that WCST perseverative errors could occur due to difficulties with working memory, sensitivity to feedback, and issues with concept formation. Cued task-switching paradigms may provide a useful measure of cognitive flexibility for future eating disorders research by reducing task-specific confounds.Level of evidenceLevel III Case–control analytic study.

Are Signals Regulating Energy Homeostasis Related to Neuropsychological and Clinical Features of Gambling Disorder? A Case-Control Study.

Gambling disorder (GD) is a modestly prevalent and severe condition for which neurobiology is not yet fully understood. Although alterations in signals involved in energy homeostasis have been studied in substance use disorders, they have yet to be examined in detail in GD. The aims of the present study were to compare different endocrine and neuropsychological factors between individuals with GD and healthy controls (HC) and to explore endocrine interactions with neuropsychological and clinical variables. A case−control design was performed in 297 individuals with GD and 41 individuals without (healthy controls; HCs), assessed through a semi-structured clinical interview and a psychometric battery. For the evaluation of endocrine and anthropometric variables, 38 HCs were added to the 41 HCs initially evaluated. Individuals with GD presented higher fasting plasma ghrelin (p < 0.001) and lower LEAP2 and adiponectin concentrations (p < 0.001) than HCs, after adjusting for body mass index (BMI). The GD group reported higher cognitive impairment regarding cognitive flexibility and decision-making strategies, a worse psychological state, higher impulsivity levels, and a more dysfunctional personality profile. Despite failing to find significant associations between endocrine factors and either neuropsychological or clinical aspects in the GD group, some impaired cognitive dimensions (i.e., WAIS Vocabulary test and WCST Perseverative errors) and lower LEAP2 concentrations statistically predicted GD presence. The findings from the present study suggest that distinctive neuropsychological and endocrine dysfunctions may operate in individuals with GD and predict GD presence. Further exploration of endophenotypic vulnerability pathways in GD appear warranted, especially with respect to etiological and therapeutic potentials.

Discrete Roles for Impulsivity and Compulsivity in Gambling Disorder.

Background and Objective: Complex associations between gambling disorder (GD) and impulsivity have been identified. However, little is known regarding how compulsivity associates with different impulsivity domains in GD. In this study, we examined associations between self-reported and behavioral measures of impulsivity–assessed through the Barratt Impulsiveness Scale (BIS-11) and the Experiential Discounting Task (EDT), respectively- and compulsivity-measured using the Padua Inventory and the Wisconsin Card Sorting Test (WCST), respectively-, in an adult sample with GD (N = 132, 94 men and 38 women, ages ranging from 18 to 69 years). GD severity was assessed using the South Oaks Gambling Screen.Methods: Structural Equation Modeling was used to examine relationships between impulsivity and compulsivity measures, age, and GD severity.Results: BIS-11 non-planning and BIS-11 total scores positively correlated with GD severity. The standardized coefficients for the SEM showed direct positive contributions of BIS-11 non-planning, Padua and EDT scores to GD severity. Only participants' ages directly contributed to WCST perseverative errors, and no direct or indirect effects were found with respect to GD severity.Conclusion: The findings suggest that specific aspects of impulsivity and compulsivity contribute to GD severity. Interventions specifically targeting domains that are most relevant to GD severity may improve treatment outcomes.

Cerebellar GABA Levels and Cognitive Interference in Parkinson's disease and Healthy Comparators.

The neuroanatomical and molecular substrates for cognitive impairment in Parkinson Disease (PD) are far from clear. Evidence suggests a non-dopaminergic basis, and a crucial role for cerebellum in cognitive control in PD. We investigated whether a PD cognitive marker (response inhibition) was differently controlled by g-amino butyric acid (GABA) and/or by glutamate-glutamine (Glx) levels in the cerebellum of idiopathic PD patients, and healthy comparators (HC). Magnetic resonance spectroscopy of GABA/Glx (MEGA-PRESS acquisition sequence) was performed at 3 Tesla, and response inhibition assessed by the Stroop Word-Color Test (SWCT) and the Wisconsin Card Sorting Test (WCST). Linear correlations between cerebellar GABA/Glx levels, SWCT time/error interference effects and WCST perseverative errors were performed to test differences between correlation coefficients in PD and HC. Results showed that higher levels of mean cerebellar GABA were associated to SWCT increased time and error interference effects in PD, and the contrary in HC. Such effect dissociated by hemisphere, while correlation coefficients differences were significant in both right and left cerebellum. We conclude that MRS measured levels of cerebellar GABA are related in PD patients with decreased efficiency in filtering task-irrelevant information. This is crucial for developing pharmacological treatments for PD to potentially preserve cognitive functioning.

Normative scores of the Wisconsin Card Sorting Test in a sample of the adult Portuguese population

Objectives The Wisconsin Card Sorting Test (WCST) is a neuropsychological instrument that is widely used for assessment of executive functioning in both clinical and research settings. The aim of this study was to provide the normative scores for the WCST in a sample of Portuguese healthy adults. Methods The data was collected from archival data in a total sample of 359 individuals, 149 men (41.5%, Mage = 38.3; SD = 20.3) and 210 women (58.5%, Mage = 52.2; SD = 19.4). Descriptive statistics were calculated to describe mean scores, standard-deviation and percentiles of the WCST indexes by gender, age and education. ANOVAs were used to explore the differences between these scores in sociodemographic variables. The normative scores were adjusted for age and educational level. Results Significant statistical differences in mean scores were found in several WCST indexes, such as, total errors, perseverations, perseverative errors and conceptual level responses regarding age and education. Percentiles for WCST indexes were stratified by age group and educational level. Conclusions Age and education are important factors explaining performance on the WCST. This is the first study focused on the development of WCST normative scores for the adult Portuguese population, which can be applied in clinical, educational and research contexts.

Effects of Diabetic Ketoacidosis on Executive Function in Children With Type 1 Diabetes: Evidence From Wisconsin Card Sorting Test Performance

Diabetic ketoacidosis (DKA) in patients with type 1 diabetes mellitus (T1DM) is known to affect memory function, but little is known about its impact on executive function. This study aimed to determine whether a history of DKA was associated with changes in executive function in children with T1DM. The sample consisted of 99 patients with T1DM with histories of DKA, 82 patients with T1DM without DKA, and 100 healthy controls aged 7 to 18 years. Neuropsychological function and emotion assessments were performed in all participants. The Wisconsin Card Sorting Test (WCST) was used to assess executive function. Compared with healthy controls, the DKA group (but not the non-DKA group) had a significantly lower mean intelligence quotient (IQ; p = .006, Cohen d = 0.528) and a significantly higher rate of WCST perseverative errors (p = .006, Cohen d = 0.475). In the DKA group, the age at DKA onset was significantly associated with the IQ (p = .001) and the number of completed WCST categories (p = .046). Higher hemoglobin A1c levels were associated significantly with lower IQ (p < .001), increased rate of WCST perseverative errors (p = .015), and completion of fewer WCST categories (p = .027). DKA has implications for executive function in children with T1DM. These findings emphasize the importance of DKA prevention in patients with known T1DM, especially younger children with newly diagnosed T1DM.

Effects of abstinence of alcohol on neurocognitive functioning in patients with alcohol dependence syndrome.

Alcohol dependence causes impairment of neurocognitive functions. Abstinence for some time leads to improvement in neurocognitive functions. This study was conducted with the aim to observe the effects of abstinence on neurocognition. The current study was an observational, single group with longitudinal design exploring the effect of abstinence on neuropsychological functioning and further exploring correlation of clinical factors with neuropsychological functioning in patients with Alcohol Dependence Syndrome (ADS). Sixty consecutive male patients of ADS meeting inclusion and exclusion criteria were inducted. Neurocognitive tests were applied at baseline, one month and three months of abstinence. All neurocognitive functions showed significant improvement at three-time intervals (p < 0.05) except for visuomotor function, for which improvement was statistically insignificant (p > 0.05) at one month. The difference for scores on verbal fluency, working memory, set-shifting (WCST total trials and perseverative errors) and visuomotor function from 0 to 3 months was significant (p < 0.05). There was significant interaction (p < 0.05) between duration of regular but non-dependent use, total duration of use, duration of dependence, average intake per day, last intake and time period with verbal fluency, working memory, set -shifting (for WCST total trials, total errors, perseverative errors and non-perseverative errors) and visuomotor function. The study showed improvement in neurocognitive functions with abstinence over three months, suggesting the need to address these cognitive deficits in the early part of abstinence. Also, correlates for drinking history were identified which may help in the future for the prevention and management of cognitive deficits in ADS patients.

Neurocognitive and clinical correlates of insight in schizophrenia.

Background:Schizophrenia is a heterogeneous disorder characterized by various symptom dimensions and neurocognitive deficits. Impairment of insight is a core clinical symptom of the disorder. There has been an increasing focus on neurocognition and insight in schizophrenia; although, many studies fail to control for premorbid cognitive status.Materials and Methods:Schizophrenia patients (n = 60) selected for adequate background education were recruited from outpatient services of a tertiary care hospital and community care homes in Southern India. These patients were comprehensively assessed using a neurocognitive battery. Clinical assessments were done using the Positive and Negative Syndrome Scale (PANSS) and Schedule for the Assessment of Insight-expanded version (SAI-E). Partial correlation was performed to examine the relationship of insight with clinical and neurocognitive measures. Statistical significance was set at P = 0.004 (Bonferroni correction for 12 tests of association). Linear regression analysis was performed to examine the predictors of insight.Results:The mean PANSS positive, negative, general psychopathology, and total scores were 14.2 ± 4.9, 17.4 ± 5.0, 34.3 ± 6.8, and 65.8 ± 13.9, respectively. Mean insight score (SAI-E) was 8.5 ± 2.9. In partial correlation done after controlling for IQ, significant negative correlations were observed between insight score and the Wisconsin Card Sorting Test (WCST) total errors (P = 0.001), WCST perseverative errors (P < 0.001). Insight scores had negative correlations with PANSS negative (P < 0.002) and total scores (P < 0.002). WCST perseverative errors were the primary predictor of insight in the regression analysis.Conclusion:Insight has a strong relationship with executive functioning in schizophrenia. This could indicate shared neurobiological substrates for insight and executive functioning.

Faulty Executive Attention and Memory Interactions in Schizophrenia: Prefrontal Gray Matter Volume and Neuropsychological Impairment.

We hypothesized that neuropsychological disturbance in schizophrenia (SZ) may reflect faulty interactions of executive attention and episodic memory, emanating, in part, from reduced prefrontal cortex (PFC) gray matter volume. Participants with SZ (n = 84) and age-matched (n = 77) controls completed both the Wisconsin Card Sorting Test (WCST) and the Wechsler Memory Scale-Third Edition (WMS-III), used, respectively, as measures of executive attention and episodic memory. A subset of SZ (n = 27) and control (n = 17) groups also had available 3-T magnetic resonance imaging (MRI) studies of the PFC. For SZ, but not control groups, neuropsychological results indicated that executive attention interacted significantly with episodic memory, with failures of executive attention, as reflected by increased WCST perseverative errors, directly linked to poor performance on the WMS-III measure of delayed visual recall of action scenes. MRI results indicated reduced left PFC gray matter volume for SZ group, which in turn correlated significantly with their deficits in visual memory but not in executive attention. Results showed that 61% of the variance in neuropsychological performance in the SZ group was attributed to gray matter volume of left inferior prefrontal gyrus gray matter volume. PFC-mediated failure of executive attention-episodic memory interactions may represent an important mechanism in neuropsychological disturbance in SZ.

Reduced Plasma Orexin-A Concentrations are Associated with Cognitive Deficits in Anorexia Nervosa

Orexins/hypocretins are neuropeptides implicated in numerous processes, including food intake and cognition. The role of these peptides in the psychopathology of anorexia nervosa (AN) remains poorly understood. The aim of the current study was to evaluate the associations between plasma orexin-A (OXA) concentrations and neuropsychological functioning in adult women with AN, and a matched control group. Fasting plasma OXA concentrations were taken in 51 females with AN and in 51 matched healthy controls. Set-shifting was assessed using the Wisconsin Card Sorting Test (WCST), whereas decision making was measured using the Iowa Gambling Task (IGT). The AN group exhibited lower plasma OXA levels than the HC group. Lower mean scores were obtained on the IGT in AN patients. WCST perseverative errors were significantly higher in the AN group compared to HC. In both the AN and HC group, OXA levels were negatively correlated with WCST non-perseverative errors. Reduced plasma OXA concentrations were found to be associated with set-shifting impairments in AN. Taking into consideration the function of orexins in promoting arousal and cognitive flexibility, future studies should explore whether orexin partly underpins the cognitive impairments found in AN.

Early Diffusion Imaging Biomarkers of Prefrontal Lobe White Matter Microstructural Damage are Associated with Executive Dysfunction Following Radiation Therapy in Patients with Primary Brain Tumors: A Prospective, Longitudinal Study

White matter in the prefrontal area, namely the anterior cingulate (AC), is critical to executive functioning (EF): a cognitive domain important for occupational status and quality of life in patients with brain tumors. Using advanced imaging and serial cognitive testing, we evaluated the longitudinal effects of radiation therapy (RT) on prefrontal white matter microstructure and executive function (EF) in a prospective, longitudinal trial of patients with primary brain tumors. Twenty-two patients with primary brain tumors were treated with brain RT on trial (median dose 54Gy, range 50.4-60Gy; 64% gliomas). Half the cohort was female and median age was 48 years. Diffusion tensor imaging to measure superficial white matter microstructure was obtained prior to RT, and at 3-months and 6-months post-RT. Diffusion metrics included: fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). The AC white matter was divided into the rostral AC (RAC) and caudal AC (CAC) given differential roles in cognitive processing. Cognitive EF testing included: Wisconsin Card Sorting Test perseverative errors (WCST-PE), Delis-Kaplan Executive Function System (D-KEFS) Letter Fluency (LF) and Category Switching Accuracy (CSA). Reliable change indexes (RCIs) were calculated to determine significant baseline to 6-month changes in EF accounting for practice effects. Regression analyses were used to examine the relationship between early changes in white matter microstructure and later changes in EF, controlling for age and gender. From pre-RT to 3 months post-RT, FA decreased in the right CAC [t (19) = 2.38, p = .029], whereas MD increased in both the right [t (19) = -2.43, p = .026] and left [t (19) = -2.24, p = .038] CAC, reflecting white matter damage. Increases in MD were driven by increased RD in the right [t (19) = -2.84, p = .01] and left [t (19) = -2.42, p = .028] CAC, with no significant changes in AD during this time period. Group means revealed that the patients were largely intact in executive functioning at baseline, with a minimal number of patients impaired. At 6-month follow-up, there was a significant decline in performance on the WCST-PE at the group level [t (20) = -3.19, p = .005]. Decreases in FA (r = -.57, p = .034) and increases in MD (r = .56, p = .035) and RD (r = .70, p = .005) of the left CAC at 3 months were associated with 6-month decreases in D-KEFS-CSA performance. In addition, early increase in MD of the right CAC was associated with poorer performance on the WCST-PE (r = .56, p = .035) at 6 months. Superficial white matter underlying the AC in the prefrontal area may be particularly vulnerable to radiation effects in brain tumor patients. Early microstructural damage in this area represents an important imaging biomarker for EF decline, and dose reduction in this region may represent a possibility for cognitive preservation.

Anticholinergic discontinuation and cognitive functions in patients with schizophrenia: a pharmacist-physician collaboration in the outpatient department.

IntroductionCognitive impairment is a core feature and shows the highest impact on functional outcome in patients with schizophrenia. There have been no previous studies investigating the role of the pharmacist in a multidisciplinary team on cognitive outcomes in patients with schizophrenia.PurposeWe evaluated the impact of pharmacist intervention on cognitive outcomes in patients with schizophrenia by focusing on anticholinergic discontinuation.Patients and methodsA prospective, open-label, randomized, controlled study was conducted. Patients with schizophrenia were randomly assigned to either the pharmacist intervention or usual care groups. In the pharmacist intervention group, the pharmacist identified drug-related problems (DRPs) and provided a pharmacotherapy suggestion, while there was no intervention in the usual care group. The primary outcome was mean change from baseline of executive function by using Wisconsin Card Sorting Test (WCST) perseverative errors within the pharmacist intervention group at week 12.ResultsA total of 30 patients completed the study (13 in the pharmacist intervention group and 17 in the usual care group). WCST perseverative errors at the end of the study within the pharmacist intervention group improved significantly from baseline (P=0.003). DRPs at week 12 were reduced by 85.19% and 9.76% in the pharmacist intervention and usual care groups, respectively. The most common intervention was the discontinuation of anticholinergics in patients without extrapyramidal side effects.ConclusionAdded-on pharmacist intervention in a multidisciplinary team could help to improve cognitive functions in patients with schizophrenia by reducing DRPs and optimizing the drug therapy regimen, especially for anticholinergic discontinuation.

A Three-Factor Structure of Cognitive Functioning Among Unimpaired Carriers and Non-Carriers of Autosomal-Dominant Alzheimer's Disease.

There is a need to find cognitive markers that can help identify individuals at risk for Alzheimer's disease (AD), and that can be used to reliably measure cognitive decline. We tested whether a theoretically driven three-factor structure would characterize cognitive functioning in individuals who are genetically-determined to develop AD due to a mutation in Presenilin-1 (PSEN1) gene. We also examined whether these factors could distinguish cognitively unimpaired PSEN1 mutation carriers from age-matched non-carrier family members. 1,395 cognitively unimpaired members of a Colombian kindred with the PSEN1 E280A mutation were included in the study. A confirmatory factor analysis examined the fit of the three-factor model comprising episodic memory (MMSE memory recall, CERAD-COL Word list recall, and Constructional praxis recall), executive function (Phonemic fluency and WCST perseverative errors), and psychomotor processing speed (TMT-A and WAIS-III Digit Symbol). The three-factor model provided an excellent fit for all participants (p = 0.24; RMSEA = 0.01). Further, the episodic memory (p = 0.0004, d = 0.25) and executive functioning (p = 0.001, d = 0.18) factors distinguished cognitively unimpaired carriers from non-carriers. The episodic memory factor provided the earliest indication of preclinical cognitive decline at 35 years of age, nine years before individuals' estimated age of clinical onset. The three theoretically derived cognitive factors provide a reliable measure of cognition and may be useful for the early detection of AD, as well as for measuring disease progression. However, longitudinal studies are needed to confirm that these factors can be used to track the progression of cognitive decline in preclinical AD.

Trait impulsivity and cognitive domains involving impulsivity and compulsivity as predictors of gambling disorder treatment response

Background and aimsGambling disorder (GD) is a highly heterogeneous condition with high rates of chronicity, relapses and treatment dropout. The aim of this study was to longitudinally explore the associations between trait impulsivity, impulsivity-compulsivity related cognitive domains, and treatment outcome in an outpatient sample of adult patients with GD. Methods144 adult male participants diagnosed with GD undergoing cognitive-behavioural treatment (CBT) at a specialized outpatient service completed a series of neuropsychological tests to assess executive functioning (including cognitive flexibility, inhibition control and decision making) and psychometric questionnaires. ResultsTrait impulsivity predicted low compliance [UPPS-P negative urgency (B = 0.113; p = 0.019)] and relapse [UPPS-P negative urgency (B = 0.140; p = 0.015)] at 5 weeks of treatment and dropout at the end of treatment [(UPPS-P sensation seeking B = 0.056; p = 0.045)]. Cognitive flexibility performance predicted: dropout rates at the end of treatment [WCST perseverative errors (B = 0.043; p = 0.042)]; dropout [WCST categories completed (B = −1.827; p = 0.020)] and low compliance or relapses at follow-up [WCST perseverative errors (B = 0.128; p = 0.020)]; and time to first relapse [WCST failure to maintain set (B = −0.374; p = 0.048)] and time to dropout [WCST perseverative errors (B = 0.0198; p = 0.019)]. ConclusionsOur findings indicate impulsivity-compulsivity levels may influence response to GD treatment (i.e.: low compliance and dropout or relapse rates) thus representing a potential target for improving treatment outcomes.

The relationship between executive functioning and weight loss and maintenance in children and parents participating in family-based treatment for childhood obesity

We examined the relationship between executive function and weight loss among children (8–12 years) and parents enrolled in a behavioral weight-loss program. 150 overweight/obese children and their parents participated in a 6-month family-based weight-loss intervention and completed baseline (month 0), post-treatment (month 6) and 18-month follow-up assessments (month 24), which included Digit Span (DS), Stop Signal Task (SST), and Wisconsin Card Sorting Test (WCST). Anthropometrics were additionally measured at mid-treatment (month 3) and 6-month follow-up (month 12). Children with more baseline WCST perseverative errors regained more weight (p = .002) at 18-month follow-up. Change in child BMIz was not associated with change in child executive function (p > .05) or parent executive function (p > .05). Among parents, baseline measure of DS-backward (p < .001) and post-treatment changes in WCST perseverative errors (p < .001) were associated with post-treatment changes in parent BMI. SST was not related to parent or child weight loss. Thus, children's baseline set-shifting was associated with weight regain during follow-up whereas changes in parent set-shifting was associated with changes in parent weight. Future research is needed to examine the relationship between executive function and weight loss and how this translates to intervention success for both overweight/obese children and participating parents.

Correlations between Gray-White Matter Contrast in Prefrontal Lobe Regions and Cognitive Set-Shifting in Healthy Adults

Humans have a unique capacity for higher-order cognition such as planning and multitasking. These abilities are collectively referred to as “executive functions.” This study investigates cognitive set-shifting, a type of executive function that involves shifting from one task to another. Advances in neuroimaging have allowed for the structural integrity of specific frontal lobe&#x0D; subregions to be probed with greater resolution. One measure of brain structural integrity is the intensity contrast between cortical gray and white matter (GWC), with greater contrast indicating better development. This study tested whether GWC in 8 subregions of the Prefrontal Cortex (PFC) was associated with set-shifting abilities in 61 healthy controls. Set-shifting abilities&#x0D; were measured using two neuropsychology tests: Trail Making Test B (TMT-B) and Wisconsin Card Sorting Test-Perseverative Errors (WCST-PE), with a third test, the Boston Naming Test (BNT), used to determine the discriminant validity of set-shifting findings. Cognitive set-shifting was significantly correlated with GWC in the left ventrolateral PFC (Broca’s area), the left and right middle frontal gyri (dorsolateral PFC), and the left and right superior frontal gyri. These findings indicate that&#x0D; successful set-shifting relies on the structural integrity of ventrolateral and dorsolateral PFC but not the basal orbitofrontal regions.

Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis.

Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.

Neurocognitive profile among Omani who have sustained traumatic brain injury with post-concussion syndrome

BackgroundNeurocognitive disorders, previously not featured in the psychiatric nomenclature such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), have now been included in the latest, fifth edition of the DSM. There is a dearth of studies on neurocognitive disorders among non-western population.AimsThe aim of this study is to compare neuropsychological functioning measured by tests of executive function and cognition among patients marked by apathy and impulsivity following a traumatic brain injury in a non-Western population, Oman.MethodsComparing the performance of various neurocognitive indices including negativistic features and disinhibition, which were identified using the symptom checklists Apathy Evaluation Scale and Disinhibited Evaluation Scale. Comparative neurocognitive measures included tapping verbal reasoning ability (Raven's Standard Progressive Matrices), working memory (Digit Span–Digit Forward–Digit Backward); Buschke Reminding Test, planning/goal-directed (Controlled Oral Word Association Test–verbal fluency, Tower of London(–planning time–number solved), (Wisconsin Card Sorting Test–perseverative errors, and–number of categories solved), and affective ranges (Hospital Anxiety and Depression Scale).ResultAnalysis showed that those participants who scored highly at Apathy Evaluation Scale and Disinhibited Evaluation Scale did not differ on indices measuring working memory/attention and affective ranges except for one measure: Digit span-Digit Forward. In the measures operationalized here to tap planning/goal-directed behaviour, the two cohorts differ on all indices except for Tower of London-Number Solved.ConclusionThis study lays ground for further scrutiny in delineating the different characteristics of what previously labelled as frontal dysexecutive phenotype. It indicates that apathetic and disinhibited temperaments marked with specific neuropsychological performance.Disclosure of interestThe author has not supplied his/her declaration of competing interest.