Subjective cognitive complaints and longitudinal changes in memory and brain function.

Objective: Subjective cognitive complaints are often used in the diagnosis of memory and other cognitive impairment. This study examined whether cognitive complaints are associated with longitudinal changes in cognition and cross-sectional differences in regional brain function during memory performance in 98 participants with a mean age of 75. Method: The Cognitive Failures Questionnaire (CFQ) assessed cognitive complaints and mixed effects regression models were used to determine whether mean CFQ scores predicted rates of change in cognitive function over a period of 11.5 years. Results: Higher CFQ scores, reflecting increased subjective complaints, were associated with steeper rates of decline in immediate and delayed recall on the California Verbal Learning Test. Voxel-based regression analysis was used to determine the cross-sectional relationship between CFQ scores and regional cerebral blood flow measured by PET during a resting condition and during verbal and figural memory tasks. Higher levels of cognitive complaints were associated with increased activity in insular, lingual and cerebellar areas during memory tasks. Conclusions: These findings offer some support for the validity of subjective cognitive complaints as markers of age related changes in memory and brain activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working memory performance predicts subjective cognitive complaints in HIV infection.

The authors examined the contribution of working memory performance to subjective cognitive complaints in HIV infection beyond the influence of depressive symptoms. Thirty-six adults with HIV infection were administered neuropsychological (NP) tests of working memory, complex psychomotor efficiency, verbal learning, delayed recall, and questionnaires measuring depressive symptoms and cognitive complaints. Working memory performance, depression scores, and complex psychomotor efficiency were most strongly associated with self-reported cognitive complaints, whereas verbal learning scores and simple psychomotor efficiency showed more modest associations. Regression analyses revealed working memory performance to be the strongest NP predictor of self-reported cognitive complaints, comparable with depression scores in the amount of variance explained. These results suggest that working memory performance may be well suited to reflect how patients function in their everyday environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Effects of Nicotine on Attention and Working Memory in Never-Smokers.

The subjective and physiological effects of nicotine in nicotine-naive individuals are consistent across studies, though the cognitive effects are variable: Positive, negative, or no effects have been reported. Assessing specific cognitive processes (e.g., alerting, orienting, executive function, and phonological and visuospatial working memory) may help reduce this variability. This within-subject study (N = 20) was designed to assess the effect of nicotine gum (0, 2, or 4 mg) on subjective, physiological, and cognitive measures. Dose-dependent increases in dysphoria and heart rate were observed, though nicotine did not influence any aspect of attention or working memory. Future studies should take into account the difference in effect sizes for cognitive versus physiological/subjective measures and maximize power (e.g., increase sample size) accordingly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-related differences in the course of cognitive skill acquisition: The role of regional cortical shrinkage and cognitive resources.

This study examined the impact of age-related differences in regional cerebral volumes and cognitive resources on acquisition of a cognitive skill. Volumes of brain regions were measured on magnetic resonance images of healthy adults (aged 22-80). At the early stage of learning to solve the Tower of Hanoi puzzle, speed and efficiency were associated with age, prefrontal cortex volume, and working memory. A similar pattern of brain-behavior associations was observed with perseveration measured on the Wisconsin Card Sorting Test. None of the examined structural brain variables were important at the later stages of skill acquisition. When hypertensive participants were excluded, the effect of prefrontal shrinkage on executive aspects of performance was no longer significant, but the effect of working memory remained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol intake and cognitive abilities in old age: The Lothian Birth Cohort 1936 study.

Objective: Moderate alcohol consumption has been associated with better cognitive performance in late adulthood, possibly by improving vascular health. Few studies have examined the potentially confounding roles of prior cognitive ability and social class in this relationship. Method: Participants were 922 healthy adults about 70 years old in the Lothian Birth Cohort 1936 study, for whom there are IQ data from age 11. Alcohol consumption was obtained by self-report questionnaire. Cognitive outcome measures included general cognitive ability, speed of information processing, memory, and verbal ability. Results: Moderate to substantial drinking (>2 units/day) was associated with better performance on cognitive tests than low-level drinking (≤2 units/day) or nondrinking in men and women. After adjusting for childhood IQ and adult social class, most of these associations were removed or substantially attenuated. After full adjustment, a small, positive association remained between overall alcohol intake and memory (women and men) and verbal ability (women only). Women's overall alcohol intake was derived almost exclusively from wine. In men, effects differed according to beverage type: wine and sherry–port consumption was associated with better verbal ability, but beer was associated with a poorer verbal ability and spirits intake was associated with better memory. Conclusions: Prior intelligence and socioeconomic status influence both amount and type of alcohol intake and may partly explain the link between alcohol intake and improved cognitive performance at age 70. Alcohol consumption was found to make a small, independent contribution to memory performance and verbal ability, but these findings' clinical significance is uncertain. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive estimation impairment in Alzheimer disease and mild cognitive impairment.

Intact executive functioning is believed to be required for performance on tasks requiring cognitive estimations. This study used a revised version of a cognitive estimations test (CET) to investigate whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) were impaired on the CET compared with normal elderly controls (NECs). Neuropsychological tests were administered to determine the relationship between CET performance and other cognitive domains. AD patients displayed impaired CET performance when compared with NECs but MCI patients did not. Negative correlations between tests of working memory (WM) and semantic memory and the CET were found in NECs and AD patients, indicating that these cognitive domains were important for CET performance. Regression analysis suggests that AD patients were unable to maintain semantic information in WM to perform the task. The authors conclude that AD patients display deficits in working memory, semantic memory, and executive function, which are required for adequate CET performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working-memory-triggered dynamic adjustments in cognitive control.

Dynamic adjustments in cognitive control are well documented in conflict tasks, wherein competition from irrelevant stimulus attributes intensifies selection demands and leads to subsequent performance benefits. The current study investigated whether mnemonic demands, in a working memory (WM) task, can drive similar online control modifications. Demand levels (high vs. low) of WM maintenance (memory load of 2 items vs. 1 item) and delay-spanning distractor interference (confusable vs. not confusable with memoranda) were manipulated using a factorial design during a WM delayed-recognition task. Performance was best subsequent to trials in which both maintenance and distractor interference demands were high, followed by trials with high demand in either of these 2 control domains, and worst following trials with low demand in both domains. These results suggest that dynamic adjustments in cognitive control are not triggered exclusively by conflict-specific contexts but are also triggered by WM demands, revealing a putative mechanism by which this system configures itself for successful task performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The risk of being shot at: Stress, cortisol secretion, and their impact on memory and perceived learning during reality-based practice for armed officers.

A field experiment was organized during a handgun shooting workshop for armed officers (N = 36). In-depth stress analyses involved anticipatory distress, subjective stress, and salivary cortisol reactivity triggered by reality-based handgun shooting practice and, more specifically, by being in an uncontrollable situation with the risk of being shot at. Subsequently, the study examined to what extent exposure to reality-based stress affected working memory performances and self-perceived active learning. As expected, the risk of being shot at caused more anticipatory distress, subjective stress, and increasingly triggered cortisol secretion. Further results showed that, although stress endurance deteriorated working memory performance, participants in the high-realism group simultaneously self-perceivably learned more (i.e., acquired task-relevant skills and competencies). The dual stress effect may result from the professional appreciation of reality-based practice and increased self-efficacy toward hazardous real-life situations. Balancing the intersection between occupational psychology, cognitive psychology, and psychoneuroendocrinology, this study performed stress research in an important and rarely accessible professional setting. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Everyday memory compensation: The impact of cognitive reserve, subjective memory, and stress.

To determine the potential importance of several unexplored covariates of everyday memory compensation, the authors examined relations between responses on the Memory Compensation Questionnaire (a self-report measure of everyday memory compensation) and cognitive reserve (education and verbal IQ), subjective memory, and life stress in 66 older adults (mean age = 70.55 years). Key results indicated that compensation occurred in people (a) whose IQ level was greater than their education level (representing cognitive reserve “discordance”) but not in people whose IQ was commensurate with their education (representing cognitive reserve “concordance”); (b) who had greater perceived memory errors; and (c) who experienced heightened stress. Further, high-stress older adults compensated whether perceived memory errors were low or high, but low-stress older adults compensated only if they perceived high memory errors. Bootstrapped confidence intervals around model betas provided further support for estimate reliability. These results suggest boundary conditions for the concept of cognitive reserve, and highlight the importance of subjective memory and life stress for defining contexts in which compensation may occur. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the cognitive deficits in reading disability and attention-deficit/hyperactivity disorder.

This study used a nonreferred sample of twins to contrast the performance of individuals with reading disability (RD; n?=?93), attention-deficit/hyperactivity disorder (ADHD; n?=?52), RD and ADHD (n?=?48), and neither RD nor ADHD (n?=?121) on measures of phoneme awareness (PA) and executive functioning (EF). Exploratory factor analysis of the EF measures yielded underlying factors of working memory, inhibition, and set shifting. Results revealed that ADHD was associated with inhibition deficits whereas RD was associated with significant deficits on measures of PA and verbal working memory. The RD?+?ADHD group was most impaired on virtually all measures, providing evidence against the phenocopy hypothesis as an explanation for comorbidity between RD and ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors.

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2–4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Ability, Expertise, and Age Differences in Following Air-Traffic Control Instructions.

Differences in cognitive ability and domain-specific expertise may help explain age differences in pilot performance. Pilots heard air-traffic controller messages and then executed them while "flying" in a simulator. Messages varied in length and speech rate. Age was associated with lower accuracy, but the expected Age x Message Difficulty interactions were not obtained. Expertise, as indexed by pilot ratings, was associated with higher accuracy; yet expertise did not reduce age differences in accuracy. The effect of age on communication task accuracy was largely explainable as an age-associated decrease in working memory span, which in turn was explainable as decreases in both speed and interference control. Results are discussed within frameworks of deliberate practice and cognitive mediation of age differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heterogeneity of cognitive trajectories in diverse older persons.

This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Different cognitive profiles for single compared with recurrent fallers without dementia.

Relationships between self-reported retrospective falls and cognitive measures (executive function, reaction time [RT], processing speed, working memory, visual attention) were examined in a population based sample of older adults (n = 658). Two of the choice RT tests involved inhibiting responses to either targets of a specific color or location with hand and foot responses. Potentially confounding demographic variables, medical conditions, and postural sway were controlled for in logistic regression models, excluding participants with possible cognitive impairment. A factor analysis of cognitive measures extracted factors measuring RT, accuracy and inhibition, and visual search. Single fallers did not differ from nonfallers in terms of health, sway or cognitive function, except that they performed worse on accuracy and inhibition. In contrast, recurrent fallers performed worse than nonfallers on all measures. Results suggest that occasional falls in late life may be associated with subtle age-related changes in the prefrontal cortex leading to failures of executive control, whereas recurrent falling may result from more advanced brain ageing that is associated with generalized cognitive decline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response Shifting and Inhibition, but Not Working Memory, Are Impaired After Long-Term Heavy Alcohol Consumption.

Chronic alcohol abuse leads to cognitive deficits. The authors investigated whether a systematic increase of interference in a 2-back working memory paradigm would lead to cognitive deficits in alcoholic participants and compared their performance in such a task with that in an alternate-response task. Twenty-four nonamnesic and nondemented alcohol abuse (AA) patients and 12 patients with Korsakoff's syndrome (KS) were compared with a control group. AA patients were impaired in the alternate-response task but not in working memory interference resolution. KS patients performed worse than the AA patients and the controls in both tasks. The neurotoxic side effects of alcohol therefore lead to a specific deficit in alternating between response rules but not in working memory, independently of whether the working memory task involves interference resolution or not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal deficits to attention, executive, and working memory in subtypes of mild cognitive impairment.

Objective: Mild cognitive impairment (MCI) has emerged as a classification for a prodromal phase of cognitive decline that may precede the emergence of Alzheimer's disease (AD). Recent research suggests that attention, executive, and working memory deficits may appear much earlier in the progression of AD than traditionally conceptualized, and may be more consistently associated with the later development of AD than memory processing deficits. The present study longitudinally tracked attention, executive and working memory functions in subtypes of MCI. Method: In a longitudinal study, 52 amnestic MCI (a-MCI), 29 nonamnestic MCI (na-MCI), and 25 age- and education-matched controls undertook neuropsychological assessment of visual and verbal memory, attentional processing, executive functioning, working memory capacity, and semantic language at 10 month intervals. Results: Analysis by repeated measures ANOVA indicate that the a-MCI and na-MCI groups displayed a decline in simple sustained attention (ηp2 = .054) with a significant decline on a task of divided attention (ηp2 = .053) being evident in the a-MCI group. Stable deficits were found on other measures of attention, working memory and executive function in the a-MCI and na-MCI groups. The a-MCI group displayed stable impairments to visual and verbal memory. Conclusions: The results indicate that a-MCI and na-MCI display a stable pattern of deficits to attention, working memory, and executive function. The decline in simple sustained attention in a-MCI and n-MCI groups and to divided attention in a-MCI may be early indicators of possible transition to dementia from MCI. However, further research is required to determine this. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Impact of age on long-term cognitive function after traumatic brain injury.

Objective: To examine the association of age and time postinjury with cognitive outcome 5–22 years following traumatic brain injury (TBI), in relation to matched uninjured controls. Methods: One hundred twelve participants with mild to very severe TBI, aged 16–81 years at the time of injury, were cognitively assessed on measures of processing speed and attention, verbal and visual memory, executive function, and working memory. Results were compared with those of 112 healthy controls individually matched for current age, gender, education, and estimated IQ. Results: Older injured individuals performed worse than did younger injured individuals across all cognitive domains, after controlling for the performance of controls. In relation to matched controls, long-time survivors performed disproportionately worse than did more recently injured individuals, irrespective of age. Conclusions: After maximum spontaneous recovery from TBI, poorer cognitive functioning appears to be associated with both older age at the time of injury and increased time postinjury. These findings have implications for prognosis, early treatment recommendations, and long-term issues of differential diagnosis and management planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive engagement and cognitive aging: Is openness protective?

The purpose of this study was to examine whether openness to experience is related to longitudinal change in cognitive performance across advancing age. Participants were 857 individuals from the Swedish Adoption/Twin Study of Aging (SATSA). Factors for 5 cognitive domains were created, including verbal ability, spatial ability, memory, processing speed, and a global score, g. Latent growth curve models were used to assess level and longitudinal trajectories of cognitive performance. It was hypothesized that individuals who endorsed higher levels of openness would have higher cognitive test scores and lesser rates of cognitive decline. As predicted, higher openness to experience was associated with significantly higher performance across all cognitive tests for both men and women even after adjusting for education, cardiovascular disease, and activities of daily living. Openness, however, was not predictive of differences in the trajectories of cognitive performance over age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The independent influence of apathy and depression on cognitive functioning in Parkinson's disease.

Objective: The purpose of the present study was to examine the independent influence of symptoms of depression and apathy, two of the most common neuropsychiatric symptoms in Parkinson's disease (PD), on executive functioning and memory in PD patients using measures designed to discriminate between these symptoms. Method: Participants included 68 nondemented, idiopathic PD patients, ages 56–82 years. The Apathy Evaluation Scale—Self-Rating and select items of the Beck Depression Inventory II were used to assess symptoms of apathy and depression, respectively. Cognitive function was assessed using the Wisconsin Card Sorting Test and Hopkins Verbal Learning Test—Revised. Correlations and hierarchical regressions were conducted to investigate the relationships between apathy, depression, and cognitive function. Hierarchical regression analyses were conducted to evaluate the degree of influence of depression and apathy on cognitive function. Results: Results revealed that symptoms of apathy, but not depression, were significantly and negatively associated with executive functioning. Immediate memory was significantly and negatively associated with both apathy and depression. However, apathy accounted for additional variance in memory performance after controlling for depression at a level approaching significance. Conclusions: Apathy is not only associated with cognitive impairment, but also with impaired daily functioning, caregiver burden and distress, medication noncompliance, and increased mortality. Differentiating apathy and depression, understanding their unique effects, and appropriately identifying apathy symptoms in patients have robust implications for the development of neuropsychological models of these effects in PD as well as practical implications in guiding improvements to patient care and enhancing quality of life in patients and caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Residual cognitive dysfunctioning at 6 months following coronary artery bypass graft surgery

Neuropsychological testing is a sensitive method for quantitative assessment of cognitive dysfunctioning following cardiopulmonary bypass (CPB). However, the methodological problems associated with this method, such as learning effects due to repeated testing and the effects of distress on test performance, have often been underestimated. In this study, these confounding effects were controlled for by including the spouses of patients, exposed to the same potential stress effects associated with the operation, as a nonsurgical control group. The experimental group consisted of 63 patients (40-75 years) undergoing elective coronary artery bypass graft (CABG) surgery. A battery of standardized neuropsychological tests was administered to both groups 2 weeks preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical testing of inter-group differences in preoperative to postoperative changes in test performance revealed the following results: (1) For immediate memory and learning, in general test scores showed the same time course for both groups. (2) For recent memory, patients' scores showed a significant deterioration at 1 month after CABG surgery compared with the scores of spouses. This effect had not completely disappeared at 6 months postoperatively. (3) For attention and psychomotor speed as well as verbal fluency, patients' scores had deteriorated significantly at 1 week after surgery, with incomplete recovery at 6 months. These negative cognitive effects were not related to the patients' ages or CPB parameters (duration of CPB, aortic cross-clamp time, mean flow and arterial pressure during CPB and aortic cross-clamping, and minimum nasopharyngeal temperature). No differences in self-ratings of mood over time were found between the patients and spouses. The results indicate that, when adequately controlling for the effects of learning and distress, some cognitive functions are still impaired at 6 months after CABG surgery.