The influence of planning and response inhibition on cognitive functioning of Non-Psychotic unipolar depressed suicide attempters

Depression is one of the main risk factors for suicide. However, little is known about the intricate relationships among depressive symptomatology in unipolar depression, suicide risk, and the characteristics of executive dysfunction in depressed patients. We compared 20 non-psychotic unipolar depressed suicide attempters to 20 matching depressed non-attempters and to 20 healthy controls to further investigate the possible differences in neuropsychological performance. Depressed subjects were controlled for current suicidal ideation, and their neuropsychological profile was assessed using a range of measures of executive functioning, attention, verbal memory, processing speed, and psychomotor speed. Depressed groups were outperformed by healthy controls. Depressed attempters presented more cognitive impairment than depressed non-attempters on a simple Go/No-go response inhibition task and performed better than non-attempters on the Tower of London planning task. Depressed attempters were clearly distinguished by a deficit in response inhibition (Go/No-go commission errors). The normative planning performance (Tower of London extra moves) of the suicide attempters was unexpected, and this unanticipated finding calls for further research. Normative planning may indicate an increased risk of suicidal behavior.info:eu-repo/semantics/publishedVersio

Value and efficacy of transcranial direct current stimulation in the rehabilitation of neurocognitive disorders: A critical review since 2000.

open3siNon-invasive brain stimulation techniques, including transcranial direct current stimulation (t-DCS) have been used in the rehabilitation of cognitive function in a spectrum of neurological disorders. The present review outlines methodological communalities and differences of t-DCS procedures in neurocognitive rehabilitation. We consider the efficacy of tDCS for the management of specific cognitive deficits in four main neurological disorders by providing a critical analysis of recent studies that have used t-DCS to improve cognition in patients with Parkinson’s Disease, Alzheimer’s Disease, Hemi-spatial Neglect and Aphasia. The evidence from this innovative approach to cognitive rehabilitation suggests that tDCS can influence cognition. However, the results show a high variability between studies both on the methodological approach adopted and the cognitive functions aspects. The review also focuses both on methodological issues such as technical aspects of the stimulation ( electrodes position and dimension; current intensity; duration of protocol) and on the inclusion of appropriate assessment tools for cognition. A further aspect considered is the best timing to administer tDCS: before, during after cognitive rehabilitation. We conclude that more studies with shared methodology are needed to have a better understanding of the efficacy of tDCS as a new tool for rehabilitation of cognitive disorders in a range of neurological disordersopenCappon, D; Jahanshahi, M; Bisiacchi, PCappon, Davide; Jahanshahi, M; Bisiacchi, Patrizi

Executive function in first-episode schizophrenia

BACKGROUND: We tested the hypothesis that schizophrenia is primarily a frontostriatal disorder by examining executive function in first-episode patients. Previous studies have shown either equal decrements in many cognitive domains or specific deficits in memory. Such studies have grouped test results or have used few executive measures, thus, possibly losing information. We, therefore, measured a range of executive ability with tests known to be sensitive to frontal lobe function. METHODS: Thirty first-episode schizophrenic patients and 30 normal volunteers, matched for age and NART IQ, were tested on computerized test of planning, spatial working memory and attentional set shifting from the Cambridge Automated Neuropsychological Test Battery. Computerized and traditional tests of memory were also administered for comparison. RESULTS: Patients were worse on all tests but the profile was non-uniform. A componential analysis indicated that the patients were characterized by a poor ability to think ahead and organize responses but an intact ability to switch attention and inhibit prepotent responses. Patients also demonstrated poor memory, especially for free recall of a story and associate learning of unrelated word pairs. CONCLUSIONS: In contradistinction to previous studies, schizophrenic patients do have profound executive impairments at the beginning of the illness. However, these concern planning and strategy use rather than attentional set shifting, which is generally unimpaired. Previous findings in more chronic patients, of severe attentional set shifting impairment, suggest that executive cognitive deficits are progressive during the course of schizophrenia. The finding of severe mnemonic impairment at first episode suggests that cognitive deficits are not restricted to one cognitive domain

Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD+ODD/CD?

Item does not contain fulltextThis study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3)~whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99~children ages 6–12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).17 p

Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets.

Limited access to Cognitive Training (CT) for people with schizophrenia (SZ) prevents widespread adoption of this intervention. Delivering CT remotely via tablets may increase accessibility, improve scheduling flexibility, and diminish patient burden.In this reanalysis of data from a larger trial of CT, we compared two samples of individuals with SZ who chose to complete 40 h of CT either on desktop computers in the laboratory (N = 33) or remotely via iPads (N = 41). We examined attrition rates and adherence to training, and investigated whether remote iPad-based CT and in-person desktop-based CT induced significantly different improvements in cognitive and real-world functioning.The attrition rate was 36.6%. On average, participants completed 3.06 h of CT per week. There were no significant between-group differences in attrition and adherence to CT requirements. Participants who completed iPad-based CT were significantly younger and had lower symptoms at baseline compared to participants who completed CT on the lab desktops. Controlling for age and symptom severity, rANCOVA showed that iPad-based and desktop-based CT similarly and significantly improved verbal learning and problem solving. Main effects of time, at trend level significance, were evident in global cognition, verbal memory, quality of life, and social functioning. All group by time interactions were non-significant except for verbal memory, where iPad users showed greater gains. Within-group effect sizes for changes in outcomes were in the small range.Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples

Reducing fall risk with combined motor and cognitive training in elderly fallers

Background. Falling is a major clinical problem in elderly people, demanding effective solutions. At present, the only effective intervention is motor training of balance and strength. Executive function-based training (EFt) might be effective at preventing falls according to evidence showing a relationship between executive functions and gait abnormalities. The aim was to assess the effectiveness of a motor and a cognitive treatment developed within the EU co-funded project I-DONT-FALL. Methods. In a sample of 481 elderly people at risk of falls recruited in this multicenter randomised controlled trial, the effectiveness of a motor treatment (pure motor or mixed with EFt) of 24 one-hour sessions delivered through an i-Walker with a non-motor treatment (pure EFt or control condition) was evaluated. Similarly, a 24 one-hour session cognitive treatment (pure EFt or mixed with motor training), delivered through a touch-screen computer was compared with a non-cognitive treatment (pure motor or control condition). Results. Motor treatment, particularly when mixed with EFt, reduced significantly fear of falling (F(1,478) = 6.786, p = 0.009) although to a limited extent (ES -0.25) restricted to the period after intervention. Conclusions. This study suggests the effectiveness of motor treatment empowered by EFt in reducing fear of falling.Peer ReviewedPostprint (published version

Less-structured time in children's daily lives predicts self-directed executive functioning.

Executive functions (EFs) in childhood predict important life outcomes. Thus, there is great interest in attempts to improve EFs early in life. Many interventions are led by trained adults, including structured training activities in the lab, and less-structured activities implemented in schools. Such programs have yielded gains in children's externally-driven executive functioning, where they are instructed on what goal-directed actions to carry out and when. However, it is less clear how children's experiences relate to their development of self-directed executive functioning, where they must determine on their own what goal-directed actions to carry out and when. We hypothesized that time spent in less-structured activities would give children opportunities to practice self-directed executive functioning, and lead to benefits. To investigate this possibility, we collected information from parents about their 6-7 year-old children's daily, annual, and typical schedules. We categorized children's activities as "structured" or "less-structured" based on categorization schemes from prior studies on child leisure time use. We assessed children's self-directed executive functioning using a well-established verbal fluency task, in which children generate members of a category and can decide on their own when to switch from one subcategory to another. The more time that children spent in less-structured activities, the better their self-directed executive functioning. The opposite was true of structured activities, which predicted poorer self-directed executive functioning. These relationships were robust (holding across increasingly strict classifications of structured and less-structured time) and specific (time use did not predict externally-driven executive functioning). We discuss implications, caveats, and ways in which potential interpretations can be distinguished in future work, to advance an understanding of this fundamental aspect of growing up

Neurocognitive impairment is associated with lower health literacy among persons living with HIV infection.

This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply health-related information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of well-validated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection

The Role of Neurocognitive Tests in the Assessment of Adult Attention-Deficit/Hyperactivity Disorder

Despite widespread recognition that attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder, optimal methods of diagnosis among adults remain elusive. Substantial overlap between ADHD symptoms and cognitive symptoms of other mental health conditions, such as depression and anxiety, and concerns about validity in symptom reporting have made the use of neuropsychological tests in ADHD diagnostic assessment appealing. However, past work exploring the potential diagnostic utility of neuropsychological tests among adults has often relied on a relatively small subset of tests, has failed to include symptom and performance validity measures, and often does not include comparison groups of participants with commonly comorbid disorders, such as depression. The current study examined the utility of an extensive neuropsychological measure battery for diagnosing ADHD among adults. Two hundred forty-six participants (109 ADHD, 52 depressed, 85 nondisordered controls) completed a multistage screening and assessment process, which included a clinical interview, self, and informant report on behavior rating scales, performance and symptom validity measures, and an extensive neuropsychological testing battery. Results indicated that measures of working memory, sustained attention, response speed, and variability best discriminated ADHD and non-ADHD participants. While single test measures provided performed poorly in identifying ADHD participants, analyses revealed that a combined approach using self and informant symptom ratings, positive family history of ADHD, and a reaction time (RT) variability measure correctly classified 87% of cases. Findings suggest that neuropsychological test measures used in conjunction with other clinical assessments may enhance prediction of adult ADHD diagnoses