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Objective: In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors ("Confidence in the therapist" and "Confidence in the treatment"), which have been shown to impact outcomes in a clinical context. We also investigated whether these interrelationships varied across treatment orientations (i.e., cognitive or psychodynamic focused). Method: The sample consisted of 631 patients with a primary anxiety or depressive disorder who were admitted to an inpatient program and treated with psychotherapy. The data consisted of weekly measures of cognitive (i.e., "rumination") and affective (i.e., "problems with emotional clarity") change processes as well as scores on Confidence in the therapist and Confidence in the treatment and symptom distress. A multivariate version of the latent curve model with structured residuals was used to investigate the within-patient effects of week-to-week changes in all variables. Results: Initial analyses established that both problems with emotional clarity and rumination predicted symptom distress. Further, we found that higher Confidence in the therapist predicted higher emotional clarity (but not lower rumination) whereas higher Confidence in the treatment predicted lower rumination (but did not affect emotional clarity). Post hoc analyses found that these interrelationships varied across treatment orientation (i.e., cognitive vs. psychodynamic). Discussion: The results indicate that patients' experience of the therapist is associated with emotional change processes, and that patients' experience of the coherence and meaningfulness of treatment, on the other hand, is associated with cognitive change processes. Implications for clinical practice are discussed. What is the public health significance of this article?: This study suggests that emotional and cognitive change processes are associated with different aspects of the therapeutic relationship. Specifically, emotional change seems to be associated with patients' experience of the personal relationship with their therapist, while cognitive change seems to be associated with patients' experience of the treatment as a meaningful remedy for their problems. Different treatment orientations (i.e., psychodynamic and cognitive focused) seem to activate different pathways of change through the therapeutic relationship. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The timing of educational attainment may modify its effects on late‐life cognition, yet most studies evaluate education only at a single time point. METHODS: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study cohort participants (N = 554) reported educational attainment (dichotomized at any college education) at two time points, and we classified them as having low, high, or later‐life high educational attainment. Linear mixed‐effects models estimated associations between educational attainment change groups and domain‐specific cognitive outcomes (z‐standardized). RESULTS: Compared to low educational attainment, high (β= 0.59 SD units; 95% confidence interval [CI]: 0.39, 0.79) and later‐life high educational attainment (β = 0.22; 95% CI: 0.00, 0.44) were associated with higher executive function. Only high educational attainment was associated with higher verbal episodic memory (β = 0.27; 95% CI: 0.06, 0.48). DISCUSSION: Level and timing of educational attainment are both associated with domain‐specific cognition. A single assessment for educational attainment may inadequately characterize protective associations with late‐life cognition. Highlights: Few studies have examined both level and timing of educational attainment on cognition.Marginalized populations are more likely to attain higher education in adulthood.Higher educational attainment in late life is also associated with higher cognition. [ABSTRACT FROM AUTHOR]

BACKGROUND: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long‐term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology. METHODS: The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts. RESULTS: Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium‐spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations. DISCUSSION: The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes. Highlights: Delirium features must be clearly defined, standardized, and operationalized.Large datasets incorporating both clinical and biomarker variables should be analyzed together.Delirium screening should incorporate communication and reasoning. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cardiovascular disease (CVD) is a recognized risk factor for dementia. Here we determined the extent to which an incident CVD event modifies the trajectory of cognitive function and risk of dementia. METHODS: 19,114 adults (65+) without CVD or dementia were followed prospectively over 9 years. Incident CVD (fatal coronary heart disease, nonfatal myocardial infarction [MI], stroke, hospitalization for heart failure) and dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) were adjudicated by experts. RESULTS: Nine hundred twenty‐two participants had incident CVD, and 44 developed dementia after CVD (4.9% vs. 4.4% for participants without CVD). Following a CVD event there was a short‐term drop in processing speed (−1.97, 95% confidence interval [CI]: −2.57 to −1.41), but there was no significant association with longer‐term processing speed. In contrast, faster declines in trajectories of global function (−0.56, 95% CI: −0.76 to −0.36), episodic memory (−0.10, 95% CI: −0.16 to −0.04), and verbal fluency (−0.19, 95% CI: −0.30 to −0.01) were observed. DISCUSSION: Findings highlight the importance of monitoring cognition after a CVD event. [ABSTRACT FROM AUTHOR]

Introduction: Studies suggest bilingualism may delay behavioral manifestations of adverse cognitive aging including Alzheimer's dementia. Methods: Three thousand nine hundred sixty‐three participants (unweighted mean population age ≈56 years) at Hispanic Community Health Study/Study of Latinos baseline (2008–2011) self‐reported their and their parents' birth outside the United States, Spanish as their first language, and used Spanish for baseline and comparable cognitive testing 7 years later (2015–2018). Spanish/English language proficiency and patterns of use were self‐rated from 1 = only Spanish to 4 = English > Spanish. Cognitive testing included test‐specific and global composite score(s) of verbal learning, memory, word fluency, and Digit Symbol Substitution (DSS). Survey linear regression models examined associations between baseline bilingualism scores and cognition. Results: Higher second‐language (English) proficiency and use were associated with higher global cognition, fluency, and DSS at follow‐up and better than predicted change in fluency. Discussion: The bilingual experience was more consistently related to 7‐year level versus change in cognition for Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Objective: Researchers have been interested in the role of negative affect (NA) and positive affect (PA) in cognitive behavioral therapy (CBT) for depression. We examined cognitive change (CC) and these two affect variables across the course of CBT. Method: Patients (N = 125; Mage = 31.7, SD = 13.35; 60% female; 83% Caucasian) participated in 16 weeks of CBT for depression. They completed the Beck Depression Inventory-II (BDI-II) and the Immediate Cognitive Change Scale at each session and a measure of affect before and after each session. Results: NA decreased (rate of change p <.001, d = −1.08) and PA increased (p <.001, d = 0.53) during treatment. CC predicted next-session PA, 0.06, 95% CI [0.01, 0.11], and NA, −0.09, 95% CI [−0.14, −0.04], and was concurrently associated with change in PA, 0.36, 95% CI [0.30, 0.42], and NA, −0.32, 95% CI [−0.42, −0.26], over the course of a session. Presession PA, 0.22, 95% CI [0.17, 0.26], and NA, −0.13, 95% CI [−0.17, −0.08], predicted postsession CC, while pre to postsession change in PA, −0.05, 95% CI [−0.09, −0.002], and NA, 0.06, 95% CI [0.01, 0.11], predicted change in depressive symptoms. Conclusions: Although NA and PA both change in CBT, the changes in PA are more modest. Both NA and PA predict symptom change, consistent with the possibility that increasing PA may be beneficial. CC and affect change are reciprocally related, suggesting that CC may contribute to affect change, while affect may also facilitate CC. What is the public health significance of this article?: Negative affect changes more than positive affect in cognitive behavioral therapy for depression, while both appear to play a critical role in reducing depressive symptoms. Cognitive changes experienced during sessions may result in improvement in positive and negative affect, and this mood improvement facilitates greater cognitive changes. [ABSTRACT FROM AUTHOR]

This study addressed the complex issues surrounding cognitive change in educators. It analyzed qualitative data gathered from an online Experiential Simulation© (ES©). ES© (Brunner, 2002) uses synchronous chats and written reflections to prompt cognitive dissonance around areas of power and identity. Research data was iteratively compared with education, cognitive psychology, and neuroscience literature to build a model of educator cognitive change. The model explains factors required for individual cognitive change and provides leaders with a model to diagnose barriers and remediate them. [ABSTRACT FROM AUTHOR]

Objective: Research suggests that decreases in negative cognitions coincide with symptom improvements over the course of cognitive therapy (CT) of depression, but the role cognitive change (CC) plays in reducing symptoms remains controversial. Method: A total of 126 adults (mean age = 31.7, SD = 13.35; 60% female; 83% Caucasian) participated in CT for depression. Patients completed the Beck Depression Inventory–II and the Immediate Cognitive Change Scale at each session. At intake evaluation, maladaptive personality traits (Personality Inventory for DSM–5, Brief Form) and interpersonal problems (Inventory of Interpersonal Problems, Short Version) were assessed via self-report, and social skills were assessed through patients' evaluation of their performance following a series of behavioral role-plays (standardized interaction task). To rule out between-patient differences as potential confounds, our model disaggregated within- and between-patient components of CC and depression scores. Results: Within-patient CC significantly predicted within-patient change in depressive symptoms. This relation was moderated by patients' evaluations of their social skills and patients' level of interpersonal problems, with CC predicting symptoms more robustly for patients with fewer perceived social skills and for those with greater interpersonal problems. Maladaptive personality traits did not emerge as a moderator. Additional analyses showed the relation of CC and symptom change was particularly strong among those with social anxiety disorder and among those observers rated as having lower social skills. Conclusions: CC in CT sessions appears to foster subsequent depressive symptom reduction, especially among patients with lower levels of self-evaluated social skills and greater interpersonal problems. Cognitive changes experienced during cognitive therapy sessions appear to play a critical role in reducing depressive symptoms, with the importance of cognitive change being stronger among patients with low self-evaluated social skills and patients with high levels of interpersonal problems. [ABSTRACT FROM AUTHOR]

Objective: Although cognitive change has long been posited to drive symptom improvements in cognitive therapy (CT) of depression, whether it does so remains controversial. Methodological challenges have contributed heavily to the lack of resolution on this issue. Using a patient-reported measure of cognitive change, we tested the role of cognitive change in contributing to symptom change in CT. In addition, we tested whether therapists' use of cognitive methods intended to promote cognitive changes predicted these changes. We also tested the specificity of the relation of cognitive methods and cognitive change by examining other psychotherapy process variables. Method: In a sample of 126 patients who participated in CT of depression, patients rated immediate cognitive change (CC-Immediate) at the end of each session and sustained cognitive change (CC-Sustained) at the start of each subsequent session. Observers rated therapist adherence and alliance for the first five sessions. Depressive symptoms were assessed at each session. For all predictors, we disaggregated within- and between-patient effects. Results: Focusing on within-patient predictors, CC-Sustained mediated the relation of CC-Immediate and subsequent symptom change. In addition, both CC-Immediate and CC-Sustained predicted symptom change. Therapist adherence to cognitive methods was the only within-patient variable to predict CC-Immediate. Conclusions: These findings are consistent with the view that cognitive change contributes to symptom reductions in CT, and that therapists' use of cognitive methods contributes to cognitive changes during sessions. [ABSTRACT FROM AUTHOR]

Introduction: Existing studies predominantly consider the association of late‐life lipid levels and subsequent cognitive change. However, midlife rather than late‐life risk factors are often most relevant to cognitive health. Methods: We quantified the association between measured serum lipids in midlife and subsequent 20‐year change in performance on three cognitive tests in 13,997 participants of the Atherosclerosis Risk in Communities study. Results: Elevated total cholesterol, low‐density lipoprotein cholesterol, and triglycerides were associated with greater 20‐year decline on a test of executive function, sustained attention, and processing speed. Higher total cholesterol and triglycerides were also associated with greater 20‐year decline in memory scores and a measure summarizing performance on all three tests. High‐density lipoprotein cholesterol was not associated with cognitive change. Results were materially unchanged in sensitivity analyses addressing informative missingness. Discussion: Elevated total cholesterol, low‐density lipoprotein cholesterol, and triglycerides in midlife were associated with greater 20‐year cognitive decline. Highlights: Elevated midlife lipids were associated with 20‐year decline in executive function.Total cholesterol and triglycerides were associated with overall cognitive decline.Results were similar in sensitivity analyses addressing informative missingness. [ABSTRACT FROM AUTHOR]

Cognitive-behavioral therapy (CBT) is an empirically-supported treatment for hoarding disorder (HD). However, meta-analytic studies suggest that CBT is only modestly effective, and a significant number of individuals with HD remain symptomatic following treatment. To inform the development of more effective and targeted treatments, it will be important to clarify the mechanisms of treatment response in CBT for HD. To this end, the current study examined whether change in maladaptive saving beliefs mediated symptom change in CBT for HD. Sixty-two patients with primary HD completed measures of maladaptive saving cognitions and hoarding severity at pre-, mid-, and post-CBT. Results showed that change in saving cognitions mediated change in all three domains of HD symptoms (i.e., acquiring, difficulty discarding, and excessive clutter), suggesting that cognitive change may be a mechanism of treatment response in CBT. The findings indicate that cognitive change may have an impact on treatment outcomes, and are discussed in terms of cognitive-behavioral theory of HD and potential ways in which to enhance belief change in treatment. [ABSTRACT FROM AUTHOR]

As more individuals are diagnosed with cancer each year, it is becoming increasingly obvious that cancer treatment may impact cognitive function in a subgroup of vulnerable individuals. Age is considered a well-established risk factor for cognitive decline, and researchers have speculated that a cancer diagnosis and its treatment may render older cancer survivors more vulnerable to these age-associated cognitive declines than their healthy counterparts. In other words, age-associated cognitive declines may be accelerated in the older cancer survivor. This article discusses the distinct contributions occupational therapy practitioners can offer to clients with cognitive dysfunction associated with cancer and cancer-related treatment. Occupational therapists may, through comprehensive evaluation and treatment, facilitate a safe transition to pre-illness levels of function, responsibilities, and roles, or improve cognitive and functional capacity for clients with cancer-related cognitive dysfunction. [ABSTRACT FROM AUTHOR]

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Abstract: Introduction: The cognitive and behavioral effect of deep brain stimulation (DBS) administered to the deep cerebral nuclei for epilepsy treatment is unknown. We investigated the cognitive outcomes at least 12 months after DBS to the bilateral anterior thalamic nucleus (ATN) for controlling intractable epilepsy. Methods: Nine patients with intractable epilepsy who were not candidates for resective surgery, but who were treated by bilateral ATN DBS underwent cognitive and behavioral assessments before implantation and more than 1 year after DBS surgery. Postoperative cognitive assessments were carried out under a continuous stimulation mode. Results: The mean seizure-reduction rate of these patients after ATN DBS was 57.9% (35.6–90.4%). Cognitive testing showed favorable results for verbal fluency tasks (letter and category, p <0.05), and a significant improvement in delayed verbal memory was observed (p =0.017). However, we did not observe any significant changes in general abilities (IQ, MMSE), information processing (digit forward and backward, Trail A, and Digit Symbol), or executive function (Trail B and WCST). Interestingly, we did not observe any significant cognitive decline approximately 1 year (mean, 15.9 months) after ATN DBS surgery. Conclusions: We showed that ATN DBS not only resulted in promising clinical effects but was also associated with improvements in both verbal recall and oral information processing, which may be related to the bilateral activation of the fronto-limbic circuit following DBS surgery. Further controlled, long-term studies with larger populations are warranted for elucidating the clinical effects of ATN DBS. [Copyright &y& Elsevier]

Objectives: The Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological (CERAD-NP) battery represents a commonly used neuropsychological instrument to measure cognitive functioning in the elderly. This study provides normative data for changes in cognitive function that normally occur in cognitively healthy individuals to interpret changes in CERAD-NP test scores over longer time periods. Design: Longitudinal cohort study with three assessments at 1.5-year intervals over a period of 3 years. Setting: Primary care medical record registry sample. Participants: As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 1,450 cognitively healthy general practitioner patients, age 75 years and older, was assessed. Measurements: Age-, education-, and gender-specific Reliable Change Indices (RCIs) were computed for a 90% confidence interval for selected subtests of the CERAD-NP battery. Results: Across different age, education, and gender subgroups, changes from at least six to nine points in Verbal Fluency, four to eight points in Word List Memory, two to four points in Word List Recall, and one to four points in Word List Recognition indicated significant (i.e. reliable) changes in CERAD-NP test scores at the 90% confidence level. Furthermore, the calculation of RCIs for individual patients is demonstrated. Conclusions: Smaller changes in CERAD-NP test scores can be interpreted with only high uncertainty because of probable measurement error, practice effects, and normal age-related cognitive decline. This study, for the first time, provides age-, education-, and gender-specific CERAD-NP reference values on the basis of RCI methods for the interpretation of cognitive changes in older-age groups. [ABSTRACT FROM AUTHOR]

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21), Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-IT and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed. [ABSTRACT FROM AUTHOR]

As a way to better understand the effects of treatment for depression, comparative data on measures of cognition have been compiled previously for adults. Such data should be able to aid the evaluation of cognition and cognitive change, and may provide valuable information for clinicians and researchers alike. In this article, analogous comparative data on cognitive measures associated with depression in children and adolescents are presented. The reviewed instruments assess cognitive errors, attributional style, dysfunctional attitudes, hopelessness, negative self-statements, and Beck's negative cognitive triad. As with adults, these data may have implications for enhancing understanding of empirically supported treatments for children and adolescents, may be useful in vulnerability research, and may be useful to clinicians seeking to develop treatment strategies and to gauge treatment effectiveness. [ABSTRACT FROM AUTHOR]

The authors investigated features of self-statements as predictors of anxiety in children with and without anxiety disorder (AD) and as a mediator of treatment of ADs in children. Children (N = 145) between the ages of 9 and 13 years participated (71 AD youth, 84 controls). Self-statements were classified by valence and content. Results indicated that children's anxious, but not positive or depressed, self-statements significantly predicted anxiety in children with and without AD. For children with AD, changes in anxious self-statements mediated treatment gains, replicating a previously reported finding. A states of mind ratio mediated only 1 outcome measure, and positive and depressive cognitions served no mediating role. The impact of anxious self-talk on children's adjustment and implications for cognitive theory of anxiety in children are discussed. [ABSTRACT FROM AUTHOR]

This article presents a method for using mind mapping to assess social learning outcomes in collaborative environmental restoration and participatory natural resource management initiatives. Using mind mapping for preassessment and postassessment can reveal changes in individual and collective thinking about critical social and ecological issues. On the basis of results from four youth-based environmental restoration programs in Boulder, Colorado, and New York and Cattaraugus Territory, New York, we suggest that mind mapping can serve as an effective data collection strategy and as a method for analyzing cognitive change in environmental restoration programs and civic ecology more broadly. [ABSTRACT FROM AUTHOR]