Executive and Attentional Functions in Chronic Pain: Does Performance Decrease with Increasing Task Load?

According to the American Heart Association (AHA), primitive dilated cardiomyopathy (PDCM) is a "progressive dilation of the left or both ventricles and a depressed contractility in the absence of abnormal load conditions". It evolves in progressive heart-failure. The term "cardiogenic dementia" expresses the intimate connection between heart diseases and cognitive functions. The association between PDCM and the neuropsychological functions is unclear: the main pathophysiological hypotheses are cerebral hypoperfusion and cardiogenic emboli. The aim of this study is to evaluate the impact that the PDCM has on neuropsychological decline and to detect early echocardiographic markers of cognitive impairment. We enrolled 235 patients: 168 suffering from PDCM as sample group and 67 suffering from hypertensive dilated cardiomyopathy (HTCM) as control group. They underwent a cardiology examination and a neuropsychological assessment. A p<0.05 was considered significant. The two groups showed no differences in risk factors, demographic and cardiovascular parameters (except for dimensions of aortic root, left atrium and ventricle which appeared greater in PDCM and left ventricle ejection fraction that appeared lower in PDCM). Among administered neuropsychological tests, only the Stroop Test (which explores executive and attentive functions) appeared significantly lower in PDCM (p = 0.029). Moreover left ventricle end-diastolic diameter was inversely related to the Stroop Test Score (r= -0.32). PDCM doesn't appear to be at the basis of a generalized cognitive and neuropsychological decline. Only the executive functions seem impaired in PDCM. Left ventricle dilation seems to be associated to attentive and executive functions decline.

CEREBRAL OXYGENATION/PERFUSION, CARDIAC HEMODYNAMICS DURING EXERCISE AND COGNITIVE FUNCTIONS IN OBESE PATIENTS

Impaired attention is one of the most common, debilitating, and persistent consequences of traumatic brain injury (TBI), which impacts overall cognitive and executive functions in these patients. Previous neuroimaging studies, trying to understand the neural mechanism underlying attention impairment post TBI, have highlighted the role of prefrontal white matter tracts in attentional functioning in mild TBI (mTBI). Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training program that targets executive control functions in participants by applying mindfulness-based attention regulation and goal management strategies. GOALS training has been demonstrated to improve attention and executive functioning in patients with chronic TBI. However, its impact on microstructural integrity of attention-associated prefrontal white matter tracts is still unclear. Here, using diffusion magnetic resonance imaging in a pilot randomized controlled trial, we investigated the effect of GOALS training on prefrontal white matter microstructure in 19 U.S. military veterans with chronic mTBI, compared with a matched control group of 14 veterans with chronic mTBI who received standard of care brain health education. We also tested for an association between microstructural white matter changes and sustained attention ability in these patients pre- and post-GOALS training. Our results show significantly better white matter microstructural integrity in left and right anterior corona radiata (ACR) in the GOALS group compared with the control group post-training. Moreover, we found a significant correlation between sustained attention ability of GOALS training participants and white matter integrity of their right ACR pre- and post-training. Finally, our findings indicated that the improved white matter integrity of the ACR in GOALS training participants was the result of increased neurite density and decreased fiber orientation dispersion within this tract.

BackgroundChronic pain affects one in five older adults and is linked to increased risk for Alzheimer’s disease (AD) dementia. Few studies have investigated associations between chronic pain and AD biomarkers, especially chronic pain at moderate‐to‐severe levels considered clinically significant.MethodWe included 2487 participants without baseline dementia from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). At baseline, participants were categorized by absence/presence of moderate‐to‐severe chronic pain, defined as persistent/recurring pain with onset >3 months prior. For sensitivity analyses, we categorized people based on the absence/presence of chronic pain at mild levels. Cognitive outcomes included the Clinical Dementia Rating Scale Sum of Boxes (CDR‐SB), episodic memory, and executive function (minimal n = 1328, mean follow‐up‐years=1.49, SD=2.78). AD biomarkers included cerebrospinal fluid levels of Aβ42, total tau, and phosphorylated tau (minimal n = 1057, mean follow‐up‐years=.53, SD=1.24); and structural MRI (AD structural brain signature, hippocampal volume, entorhinal cortical thickness, and whole brain volume, minimal n = 2136, mean follow‐up‐years=1.11, SD=2.28). Mixed‐effects models assessed differences in baseline levels and change in each outcome between pain groups, and mediation analyses explored Aβ and neurodegeneration pathways. Covariates included baseline age, sex, APOE ε4 status, depressive symptoms, and opioid use (intracranial volume for structural MRI outcomes).ResultModerate‐to‐severe chronic pain relative to mild or none was associated with accelerated decline in global cognition (increase in CDR‐SB: b=.05), memory, executive function (b=‐.04), and whole brain volume (b=‐.02), and faster accumulation of Aβ pathology (CSF Aβ42 decline: b=‐.07, all p’s < .05). It was not associated with neurodegeneration in AD brain signature regions, hippocampal volume, or entorhinal cortex (all ps>.05). Accumulation of Aβ pathology (absolute b’s range=.03 to .05) and whole brain volume loss (absolute b’s range=.001‐.002) mediated associations of moderate‐to‐severe chronic pain with cognitive decline, with Aβ also mediating moderate‐to‐severe chronic pain’s association with brain volume loss (b=‐.01, all ps<.05). Mild chronic pain relative to none did not significantly relate to cognitive or biomarker outcomes (all ps>.05).ConclusionModerate‐to‐severe chronic pain contributes to accelerated cognitive decline and general neurodegeneration, primarily via Aβ. These findings highlight the need to consider moderate‐to‐severe chronic pain, rather than just presence/absence of chronic pain in AD risk assessments and interventions.

Attention allows us to focus and process information from our environment, and executive function enables us to plan, work, and manage our daily lives. As individuals become older, both of these cognitive abilities decline. It is essential for the elderly to perform more cognitive exercises. Previous studies have shown that arithmetic calculations require attention span and that playing video games requires executive function. Therefore, we developed a serious game involving mental arithmetic calculations specifically for improving attention span and executive functions. Our objective was to analyze the effectiveness of the game and the efficacy of the game’s mechanic factors affecting attention span and executive function in the elderly. Forty elderly volunteers who are over 60 years of age were invited to join an eight-week cognitive training program through an elderly social welfare center. Four assessment tests were used in pre-test and post-test before and after the training period. D-CAT and SAT are used for screening attention span; TMT-A and TMT-B are used for screening executive function. They were instructed to play the game for at least 15 min per day, 5 days per week, for a total of 8 weeks. There were three independent variables (difficulty, pressure, and competition) with two parameters that could be selected. A paired-sample t-test showed the effective results by comparing the pre-test scores and post-test scores of the cognitive training. There were significant improvements in attention span and executive functions. The mixed repeated-measure ANOVA and MANCOVA results showed that two game mechanic factors (difficulty and pressure) had a significant effect and an interaction effect, but the other factor (competition) had a non-significant effect. In conclusion, the game showed a significant enhancement in both attention span and executive functions after training, and the difficulty factor and the pressure factor were shown to have an effect, but the competition factor was shown to have no effect.

Event Abstract Back to Event Effect of etilic alcohol (EA) on driving abilities Umberto Bivona1*, J. Rigon1, M. Matteis1, G. Onder2, S. Catani1, M.P Ciurli1 and R. Formisano1 1 Santa Lucia Foundation, Italy 2 Catholic University, Italy Objectives: To verify that Italian law limits for driving (EA blood level less than 0.5 grams per liter) are accurate to prevent risk behaviours while driving, due to lack of attention, executive functions and imprudence. Methods: Thirty-two healthy volunteers (M=16, F=16; mean age: 30.9 years, SD = 8.3; Educational Level: 16.5 years, SD = 2.2) were submitted to both a neuropsychological battery of tests assessing attention and executive functions, and to a questionnaire evaluating the strategic level of the driving process and subject’s imprudence. The assessment was performed before and after having taken enough alcohol to reach at least a blood EA level of 0.5 grams per liter. Results: The study, performed using standardized tools and uniform conditions of alcohol assumption, revealed that verbal fluency and all the attentive functions (tonic and phasic alertness, selective, divided and sustained attention) in our subjects worsened at blood EA level of 0.5 g/l. Even if in both selective and divided attention the presence of alcohol in the blood didn’t compromise the accuracy in selecting the target stimuli, we found a significance increasing of RT (p<0.05) that might indicate the negative influence of the alcoholic substance on these attentive components as a whole. No significant differences were found at the Driving Strategic Competency Questionnaire performance after alcohol assumption, probably due to unimpaired intellectual driving strategic competence. The gender seems to be irrelevant to determine any decline of the examined variables. In order to evaluate the possible effect of EA even at blood level lower than 0.5g/l, a statistical analysis was conducted comparing performances obtained respectively at upper and lower blood EA levels than the median value (0.52 g/l). Even at low EA rate, subjects had a significant decrease of both semantic verbal fluency and alertness and divided attention performance. Conclusions: These data, even if obtained in a small sample, showed a negative effect of EA (at the Italian law limit) on some neuropsychological variables, commonly involved in driving performance. Moreover, a negative effect of the EA on some attentive and executive functions has been found even at EA levels lower than 0.5 g/l. This study suggests the utility to reconsider the cut-off of 0.5 grams per liter provided by the Italian law, with respect to the driver and public safety. Conference: 10th International Conference on Cognitive Neuroscience, Bodrum, Turkey, 1 Sep - 5 Sep, 2008. Presentation Type: Poster Presentation Topic: Attention Citation: Bivona U, Rigon J, Matteis M, Onder G, Catani S, Ciurli M and Formisano R (2008). Effect of etilic alcohol (EA) on driving abilities. Conference Abstract: 10th International Conference on Cognitive Neuroscience. doi: 10.3389/conf.neuro.09.2009.01.097 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Dec 2008; Published Online: 02 Dec 2008. * Correspondence: Umberto Bivona, Santa Lucia Foundation, Rome, Italy, u.bivona@hsantalucia.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Umberto Bivona J. Rigon M. Matteis G. Onder S. Catani M.P Ciurli R. Formisano Google Umberto Bivona J. Rigon M. Matteis G. Onder S. Catani M.P Ciurli R. Formisano Google Scholar Umberto Bivona J. Rigon M. Matteis G. Onder S. Catani M.P Ciurli R. Formisano PubMed Umberto Bivona J. Rigon M. Matteis G. Onder S. Catani M.P Ciurli R. Formisano Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

The relations between cognition and the independent living skill of shopping in people with schizophrenia

Despite recent attention to the increased risk of cognitive impairment in older adults with essential tremor (ET), there are only limited data on the trajectories of cognitive change in ET or the demographic and motor predictors of such change. This study included 148 cognitively normal individuals with ET (mean age = 76.7 ± 9.7 years) at baseline and had at least one follow-up evaluation (mean years of observation = 5.2 ± 1.6). Generalized Estimating Equations examined rates of change in six composite cognitive outcomes as a function of time, as well as demographic (age, sex, and education) and motor predictors (tremor severity, age of tremor onset, presence of rest tremor, cranial tremor, intention tremor, tandem gait) of rates of change. Demographics, medication use, and mood symptoms at baseline were covariates for all models. Participants evidenced a decline in global cognition, executive function, and attention (p range = <0.001-0.044) over time. Older age predicted faster decline in all cognitive outcomes except attention (p range =<0.001-0.025). Tremor severity predicted faster decline in executive function (p = 0.011). Rest tremor predicted faster decline in executive function and attention (p = 0.033, 0.017). Tandem gait missteps predicted faster decline in memory and visuospatial ability (p = 0.026, 0.028). Results point to a dissociation in the predictive value of different motor features for specific aspects of cognitive decline. These results shed light on the earliest manifestations of cognitive impairment in older adults with ET and implicate different pathways by which heterogeneous cognitive changes emerge.

BackgroundInhibitory control and attention processing atypicalities are implicated in various diseases, including autism spectrum disorders (ASD). These cognitive functions can be tested by using visually guided saccade-based paradigms in children, adolescents and adults to determine the time course of such disorders.MethodsIn this study, using Gap, Step, Overlap and Antisaccade tasks, we analyzed the oculomotor behavior of 82 children, teenagers and adults with high functioning ASD and their peer typically developing (TD) controls in a two-year follow-up study under the auspices of the InFoR-Autism project. Analysis of correlations between oculomotors task measurements and diagnostic assessment of attentional (ADHD-RS and ADHD comorbidity indices) and executive functioning (BRIEF scales) were conducted in order to evaluate their relationship with the oculomotor performance of participants with ASD.ResultsAs indicated by the presence of a Gap and Overlap effects in all age groups, the oculomotor performances of ASD participants showed a preserved capability in overt attention switching. In contrast, the difference in performances of ASD participants in the Antisaccade task, compared to their TD peers, indicated an atypical development of inhibition and executive functions. From correlation analysis between our oculomotor data and ADHD comorbidity index, and scores of attention and executive function difficulties, our findings support the hypothesis that a specific dysfunction of inhibition skills occurs in ASD participants that is independent of the presence of ADHD comorbidity.LimitationsThese include the relatively small sample size of the ASD group over the study’s two-year period, the absence of an ADHD-only control group and the evaluation of a TD control group solely at the study’s inception.ConclusionsChildren and teenagers with ASD have greater difficulty in attention switching and inhibiting prepotent stimuli. Adults with ASD can overcome these difficulties, but, similar to teenagers and children with ASD, they make more erroneous and anticipatory saccades and display a greater trial-to-trial variability in all oculomotor tasks compared to their peers. Our results are indicative of a developmental delay in the maturation of executive and attentional functioning in ASD and of a specific impairment in inhibitory control.

295 Cognition in adult patients with cystic fibrosis (CF) with and without cystic fibrosis related diabetes (CFRD)

Background: Type 2 diabetes mellitus a common endocrine disorder is on constant rise in the world. Diabetes mellitus is associated with premature mortality and several complications such as neuropathy, nephropathy and cardiovascular diseases. It can lead to decrease in psychomotor speed, executive functions, verbal memory, processing speed, complex motor functioning, working memory, visual retention and attention. These consequences have been attributed to glycemic control and duration of disease. Objective: 1) To correlate duration of disease with attention, executive function and visual reaction time in type 2 diabetes patients. 2) To correlate HbA1c with attention, executive function and visual reaction time in type 2 diabetes patients. Materials and Method: 60 uncomplicated Type 2 diabetes mellitus patients of either sex, aged 40-60 years were recruited from Diabetic Clinic Victoria Hospital, Bangalore. Ethical clearance & informed consent taken. After detailed examination & history taking, 2ml of fasting blood sample were taken for estimation of HbA1c. The cognitive tests include Digit vigilance test for attention, Stroop test for executive functions and visual reaction time using Human Benchmark software. Correlation was found using Pearson correlation, p value<0.05 taken as statistically significant. Results: The Attention and executive function scores and visual reaction time are positively correlated with both duration of disease and HbA1c. Significant correlation is found with attention and Visual Reaction time with p value<0.05. Conclusion: With progressive increase in the duration of disease and HbA1c levels there is decline in Attention and executive function & increase in Visual reaction time.

Abstract. The cognitive reserve hypothesis postulates that lifelong cognitive stimulation establishes a buffer that is instrumental in maintaining cognitive health. To examine this conceptual proposition in detail, we applied a novel, more general conceptual view that included recent models of vulnerability and examined whether the longitudinal association between hepatobiliary diseases and later decline in executive functioning across 6 years varied by cognitive reserve. For this purpose, we investigated longitudinal data from 897 older individuals ( M = 74.33 years) tested using the Trail Making Test (TMT) in two waves 6 years apart. Individuals reported information on key commonly used indicators of lifelong cognitive reserve build-up (i.e., education, work, and participation in leisure activity) and hepatobiliary diseases. The results revealed a significant interaction of hepatobiliary diseases with participation in leisure activity on latent change in executive functioning. Specifically, only in individuals with little (but not greater) participation in leisure activity did hepatobiliary diseases significantly predict a steeper decline in executive functioning over 6 years (i.e., increases in TMT finishing time). In conclusion, the unfavorable aftereffects of hepatobiliary diseases on a later decline in executive functioning seem to be mitigated in individuals who have built up greater cognitive reserve via participation in leisure activity during their life.

Sickle cell disease (SCD) is a genetic hematological disorder with complications including pain crises, chronic anemia, infections, organ damage, and stroke. The frontal lobes are highly susceptible to stroke in youth with SCD, and subsequently, executive functioning skills are often compromised. Additionally, children with SCD often have atypical adaptive demands, particularly medical-self care activities. Impairments in executive functioning may help explain difficulties with independent self-management and transition to adult hood. In an interactional model described by Tarazi and colleagues (2007), the role of increased medical self-care demands and executive dysfunction in the development of self-care independence in children with chronic illness is considered. The current study aimed to investigate the relationship between executive functioning and adaptive functioning in youth with SCD by identifying which variables are most important in self-management and independence. It also aimed to validate the KIS-SCD as a measure of independence in medical-self care activities. Twenty-seven participants, ages 12-18 completed neuropsychological testing (general intelligence, attention, processing speed, memory, and executive functioning) and a measure of disease knowledge. Caregivers completed questionnaires assessing adherence, executive functioning, adaptive functioning, and medical self-care independence. Participants displayed borderline executive functioning skills despite parent reports of executive functioning within normal limits. Parent reports of executive functioning (BRIEF) were significantly correlated with adaptive functioning (ABAS-II; r = -.67, p &lt; .01) and medical self-care independence (KIS-SCD; r = -.65, p &lt; .01. Differences were found between those with low and high demands on response monitoring (t(24) = 2.32, p = .029) and inhibition/flexibility (t(24) = 2.07, p = .049). Results from hierarchical linear regression analyses revealed significantly greater predictive value of parent reports of executive functioning than other cognitive and medical variables for general adaptive functioning. Cognitive skills (i.e., sustained attention, memory) held the strongest predictive values for medical self-care independence. No variables were significantly predictive of adherence to SCD clinic appointments. Findings suggest that performance-based measures of executive functioning may be more sensitive that parent report measures in identifying executive functioning impairments in SCD. Executive functioning may explain variance in general adaptive functioning, particularly as it relates to parent reports, suggesting that parent reports and performance-based measures assess separate constructs of executive functioning. Cognitive functioning may be more related to disease-specific demands than global adaptive functioning. Continued research is recommended to further investigate the interaction between executive functioning and medical demand levels. Implications for these findings in the context of disease management and transition planning are discussed.

Optimising medication adherence is one of the essential factors in reversing the tide of a TB-HIV syndemic in sub-Saharan Africa, especially South Africa. Impairment in key neurocognitive domains may impair patients' ability to maintain adherence to treatment, but the level of cognition and its relationship to HIV status has not been examined in individuals with drug-resistant TB. We therefore investigated performance on several key neurocognitive domains in relationship to HIV status in a multidrug-resistant tuberculosis patients (MDR-TB) sample. We enrolled microbiologically confirmed MDR-TB inpatients at a TB-specialist referral hospital in KwaZulu-Natal province, South Africa. We collected cross-sectional data on sociodemographic, clinical and neurocognitive function (e.g. attention, memory, executive functioning, language fluency, visual-spatial, eye-hand coordination). For the primary analysis, we excluded participants with major depressive episode/substance use disorder (MDE/SUD). We fitted adjusted Poisson regression models to explore the association between HIV and neurocognitive function. We enrolled 200 people with MDR-TB; 33 had MDE/SUD, and data of 167 were analysed (151 HIV+, 16 HIV-). The mean age of participants was 34.2years; the majority were female (83%), and 53% had not completed secondary school. There was evidence of impaired neurocognitive functioning across all domains in both HIV+/- study participants. Based on the regression analyses, individuals with co-infection (MDR-TB/HIV+), as well as those who had longer duration of hospital stays experienced significantly lower cognitive performance in several domains. Poor cognitive performance was significantly related to older age and lower educational attainment. The presence of major depression or substance use disorders did not influence the significance of the findings. Adults with MDR-TB have significant neurocognitive impairment, especially if HIV positive. An integrated approach is necessary in the management of MDR-TB as cognitive health influences the ability to adhere to chronic treatment, clinical outcomes and functionality.

ObjectivesNewly diagnosed focal epilepsy (NDfE) is rarely studied, particularly using advanced neuroimaging techniques. Many patients with NDfE experience cognitive impairments, particularly with respect to memory, sustained attention, mental flexibility, and executive functioning. Cognitive impairments have been related to alterations in resting‐state functional brain networks in patients with neurological disorders. In the present study, we investigated whether patients with NDfE had altered connectivity in large‐scale functional networks using resting‐state functional MRI.MethodsWe recruited 27 adults with NDfE and 36 age‐ and sex‐matched healthy controls. Resting‐state functional MRI was analyzed using the Functional Connectivity Toolbox (CONN). We investigate reproducibly determined large‐scale functional networks, including the default mode, salience, fronto‐parietal attention, sensorimotor, and language networks using a seed‐based approach. Network comparisons between patients and controls were thresholded using a FDR cluster‐level correction approach.ResultsWe found no significant differences in functional connectivity between seeds within the default mode, salience, sensorimotor, and language networks and other regions of the brain between patients and controls. However, patients with NDfE had significantly reduced connectivity between intraparietal seeds within the fronto‐parietal attention network and predominantly frontal and temporal cortical regions relative to controls; this finding was demonstrated including and excluding the patients with brain lesions. No common alteration in brain structure was observed in patients using voxel‐based morphometry. Findings were not influenced by treatment outcome at 1 year.ConclusionsPatients with focal epilepsy have brain functional connectivity alterations at diagnosis. Functional brain abnormalities are not necessarily a consequence of the chronicity of epilepsy and are present when seizures first emerge.