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Objective: To analyze the association between physical fitness, cognitive function, and depressive symptoms among older adults in long-term care facilities (LTCFs). Methods: Seventy-six institutionalized male and female elderly individuals (65 years and older) living in LTCFs participated of this study. Physical fitness (aerobic capacity and strength), cognitive functions (global cognition, short-term and working and semantic memories, and executive function), and depressive symptoms were assessed. Linear regression and contingency analyses were performed. Significance was accepted at p-values ≤ 0.05. Results: Aerobic capacity predicted 32% of variance in global cognition (p < 0.01) and 25% of variance in semantic fluency/executive function (p < 0.01). Low levels of upper limb strength, lower limb strength, and aerobic capacity were associated with semantic fluency/executive function (OR = 1.38, p = 0.01, OR = 1.26, p = 0.03, and OR = 1.07, p = 0.01, respectively) and depressive symptoms (OR = 1.06, p < 0.01). Conclusion: Poor physical fitness is associated with cognition and depressive symptoms in institutionalized older adults. Low levels of strength and aerobic fitness increase the odds of presenting with impaired semantic fluency and executive function, possibly denoting an increased risk of developing dementia.

Background Adult attention-deficit/hyperactivity disorder (ADHD) is associated with impaired executive function (EF), depressive/anxiety symptoms, and poor quality of life (QoL). In this study, we aimed to investigate correlations among these variables and to build a simple or serial mediation model for exploring the mechanisms between adult ADHD and QoL. Methods This was a cross-sectional study. The sample included 223 participants with ADHD and 54 healthy volunteers. Participants were required to complete the following scales: ADHD Rating Scale (ADHD-RS), Brief Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS). Correlations among EF, depressive/anxiety symptoms and QoL were analyzed using Pearson correlation. The simple and serial mediation models were analyzed using PROCESS (version 3.3). Results The correlations between EF and QoL, depressive/anxiety symptoms and QoL, and depressive/anxiety symptoms and EF were statistically significant. In ADHD adults with comorbidities, the correlation coefficients were between -0.19 and -0.47, -0.20 and -0.62, 0.28 and 0.50, respectively. In simple mediation models, EF and depressive/anxiety symptoms were significant mediators respectively between ADHD and QoL, respectively. In a serial two-mediator model, ADHD could affect QoL indirectly via EF and then via depressive/anxiety symptoms significantly. Limitations The average age was young, the degree of education was high, and only self-reported scales were relied on. Conclusions There is a mutual effect between EF and emotional symptoms. This was the first study to build a serial two-mediator model between ADHD and QoL, suggesting the importance of EF and depressive/anxiety symptoms.

Objectives: Prior work has demonstrated that executive function training or physical exercise can improve older adults’ cognition. The current study takes an exploratory approach to compare the feasibility and efficacy of online executive function training and low-intensity aerobic exercise for improving cognitive and psychosocial functioning in healthy older adults. Method: Following a standard pretest-training-posttest protocol, 40 older adults (aged 65 and above) were randomly assigned to an executive function or a physical training group. A battery of cognitive and psychosocial outcome measures were administered before and after training. During the 10 weeks of self-guided training at home (25–30 min/day, 4 days/week), the executive function training group practiced a set of adaptive online executive function tasks designed by Lumos Labs, whereas the physical training group completed an adaptive Digital Video Disc (DVD)-based low-intensity aerobic exercise program. Results: Training transfer effects were limited. Relative to low-intensity aerobic exercise, executive function training yielded cognitive improvement on the 64-card Wisconsin Card Sorting Task (WCST-64), a general executive function measure. Depression and stress levels dropped following both training programs, but this could be driven by decreased stress or excitement in performing the tasks over time. Discussion: The results revealed limited cognitive benefits of the online executive function training program, specifically to a near transfer test of general executive control. Importantly, the current study supports the feasibility of home-based self-guided executive function and low-intensity physical training with healthy older adults.

The autism spectrum disorder (ASD) is a neurodevelopmental condition, frequently accompanied by medical and psychiatric pathology. One of the most commonly found problems associated with ASD is sleep disturbances, which are estimated to affect approximately 80% of the people with ASD, not only during childhood but also in the adolescence and adult stages. Nevertheless, the relationship of these sleep difficulties with autism severity, as well as other associated impairments such as executive functioning and psychiatric disorders (eg, depression), has not yet been widely studied. The main objective of the present study was to explore the relationship between sleep disturbances, subjective measures of executive function, and psychiatric pathology in the ASD population. To reach that goal, a group of 89 participants with ASD (44 children/adolescents and 45 adults) was recruited and evaluated with self-reported measures of executive function performance and psychiatric pathology tests. Multivariate analysis showed a significant association between sleep disturbances and psychiatric symptoms in both ASD groups, with greater sleep disturbances predicting more severe psychiatric pathology. No significant association was found with executive function in any group. Limitations included a small sample size and lack of objective measures. Sleep problems seem to be associated with the severity of psychiatric pathology throughout the lifespan, increasing the chance of developing psychiatric symptoms when they were present. Improving sleep quality in ASD at all ages may result in preventing and/or decreasing psychiatric pathology in this population.

Objectives Early detection of mild cognitive impairment (MCI) is necessary to prevent irreversible brain damage caused by incipient Alzheimer's disease. It has been showing that amnestic MCI (a-MCI) subjects exhibit subtle deficits in executive function that can be tested using saccade eye movements. Eye-tracking technology is a sensitive method to measure cognitive impairments in dementia and MCI. Methods In this study, we used eye-tracking technology to explore saccade impairments to distinguish between a-MCI and the variants of reference controls. 21 patients with AD, 40 patients with a-MCI, and 59 normal participants were recruited in current study. We measured saccade reaction time, saccade errors, saccade omission, and uncorrected saccades using anti-saccade and pro-saccade tasks with 'gap' and 'overlap' procedures. These parameters were used as markers of executive function and visual attention deficits.Results: The findings revealed that more errors, more omissions, and fewer corrections characterized the saccade behavior of the a-MCI group compared to the reference group. These eye-tracking characteristics can be considered as inhibitory control and working memory deficits in a-MCI subjects. Our results thus demonstrate the applicability of the anti-saccade task as a cognitive marker in a-MCI. Conclusion The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of executive function in aging with cognitive impairments.

The current study examined the utility of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P) in capturing emerging deficits in executive function in preschool children with a history of perinatal stroke. Parents and teachers of 55 clinically referred preschool children (3-5 years of age) provided ratings using the BRIEF-P. Both parent (

This study aimed to examine individual and combined associations between after-school sedentary time (ST) and daily physical activity (PA) with executive function development in children.The study included 4304 children aged 6 to 12 years. ST and PA were assessed using the International Physical Activity Questionnaire Short Form, and executive function was assessed using the Behavior Rating Inventory of Executive Function (Parent Version). Participants were classified as low (2 h per day) or high (≥2 h per day) ST and low (not meeting guidelines) or high (meeting guidelines) PA. Resulting groups were defined as 1) low ST/high PA, 2) low ST/low PA, 3) high ST/high PA, and 4) high ST/low PA.Children in group 4 had the highest mean T-scores for BRIEF indices (48.23 ± 8.44, indicating increased symptoms of executive function dysfunction), followed by those in group 3 (47.10 ± 8.05), group 2 (45.81 ± 7.78), and group 1 (44.41 ± 7.31). ST was positively related to the T-score of all indices, independent of moderate-to-vigorous physical activity (MVPA). Significantly negative associations were observed between MVPA and Metacognition Index only in the high ST subgroup.Low ST and high PA were positively associated with executive function development in children. Notably, children with high ST and high PA demonstrated more significant deficits in executive function than those with low ST and low PA, suggesting that intervention efforts should focus on ST reduction in addition to promoting PA.

An increasing number of studies has focused on the after-effects of acute aerobic exercise on executive function. To date, empirical evidence lacks consensus regarding whether acute aerobic exercise has beneficial effects on executive function. To identify possible sources of this discrepancy, the present study focused on executive function demands and pre-test cognitive performance, and performed the first meta-analysis of individual participant data (IPD meta-analysis) in this area of research. Results indicated that the beneficial after-effects of acute aerobic exercise on cognitive performance were greater in participants with lower cognitive performance at pre-test. Acute aerobic exercise offered general benefits to cognitive performance irrespective of executive function demands, when pre-test cognitive performance was appropriately controlled. Thus, the present IPD meta-analysis suggests that pre-test cognitive performance is one possible source of the conflicting findings in acute exercise studies. Future research is encouraged to consider pre-test cognitive performance to avoid underestimating the beneficial after-effects of acute exercise.

BACKGROUND Difficulties with executive functions (EF) are very common among individuals with Williams syndrome (WS). To characterise the pattern of relative strengths and weaknesses in EF for children and adolescents with WS, we considered the performance of a large sample on the parent version of the Behavior Rating Inventory of Executive Function-2 (BRIEF-2). Associations between distinct components of EF and adaptive behaviour, behaviour problems and intellectual ability were investigated. The concurrent effects of components of behaviour regulation and emotion regulation on attention problems and anxiety problems also were evaluated. METHODS Participants were 308 6-17-year-olds with genetically confirmed classic WS deletions. Parent report of EF was measured by the BRIEF-2 questionnaire. Most participants (223/308) completed the Differential Ability Scales-II as a measure of intellectual ability. The parents of these individuals also completed the Child Behavior Checklist and the interview form of the Scales of Independent Behavior-Revised. RESULTS As a group, the participants evidenced considerable parent-reported EF difficulty. A profile of relative strength and weakness was found at the index level, with performance on both the Behavior Regulation Index and the Emotion Regulation Index significantly better than performance on the Cognitive Regulation Index. Within each index, a statistically significant pattern of relative strength and weakness also was identified. Difficulties with behaviour regulation and emotion regulation were related to both behaviour problems and adaptive behaviour limitations. Higher inflexibility and more difficulty with self-monitoring were associated with lower overall intellectual ability. Difficulty with inhibition was uniquely associated with attention problems, and inflexibility was uniquely associated with anxiety problems. CONCLUSIONS Executive function difficulties are highly prevalent among children and adolescents with WS and are associated with adaptive behaviour limitations, both internalising and externalising behaviour problems and more limited intellectual ability. These results highlight the importance of designing and delivering research-based interventions to improve the EF of children and adolescents with WS.

Observational studies show that serum uric acid levels associate with cardiometabolic risk factors and subclinical target organ damage. The aim of the present study is to investigate the association of traditional cardiometabolic risk factors and uric acid with the executive performance in children and adolescents. Ninety-nine children and adolescents aged 5 to 18 years referred for assessment of primary hypertension were included. Traditional cardiometabolic risk factors, uric acid, and ambulatory blood pressure parameters were assessed. Executive performance was assessed by the validated Behavior Rating Inventory of Executive Function parent questionnaire. Serum uric acid correlated with cardiometabolic parameters, daytime and nighttime systolic blood pressure. High uric acid levels and ambulatory hypertension were associated with behavior regulation independently of other cardiometabolic risk factors or presence of metabolic syndrome. Participants with combined hypertension and high uric acid levels presented the lowest behavior regulation performance. Children with high uric acid had worse behavior regulation indices T scores with estimated marginal means 56.47 (95% CI, 51.68–61.27) compared with 49.22 (95% CI, 45.91–52.53) in those with low uric acid levels ( P =0.023, adjusted for age, sex, nighttime systolic blood pressure, daytime and nighttime heart rate). Mediation analysis showed that part of the effect of high uric acid levels on behavior regulation was mediated by nighttime systolic blood pressure. In conclusion, we found a positive association of serum uric acid with worse executive performance in children at risk for primary hypertension. Extending these cross-sectional findings with longitudinal studies may determine whether high uric acid levels increases the risk of cognitive decline in youth.

The parent-report Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) is a widely used pediatric neuropsychological measure. Unfortunately, despite meaningful changes from its predecessor, few studies have examined its internal factor structure (now with Behavioral Regulation [BRI], Emotion Regulation [ERI], and Cognitive Regulation [CRI]), and no available literature has investigated higher order models for the BRIEF-2. This study sought to address this shortcoming in the literature by investigating and reporting on the dimensionality of the parent-report BRIEF-2 in a clinical sample. Two hundred and two (202) pediatric neuropsychology examinees (

Impaired executive function (EF), verbal comprehension, and theory of mind (ToM) may contribute to social difficulties in children with autism spectrum disorder (ASD). The linkage between cool (cognitive) EF and ToM has been widely investigated, but the relations between hot (affective) EF and ToM remain largely unknown. The roles of cool EF and verbal comprehension have not been previously explored together to address hot EF-ToM relations. This study applied mediation analysis to investigate the mediating effects of cool EF and verbal comprehension to further elaborate the link between hot EF and ToM in children with ASD and average intellectual abilities. A total of 97 children with ASD aged from 6 to 12 years participated in this study. Children's cool EF, hot EF, and verbal comprehension were, respectively, measured with the computerized Dimensional Change Card Sort task, Children's Gambling Task, and the verbal comprehension index of the Wechsler Intelligence Scale for Children-fourth edition. Children's ToM was assessed with the Theory of Mind Task Battery. Partial correlation coefficients indicated that hot EF was significantly related with ToM with age controlled for. The results of the mediation analysis showed that cool EF and verbal comprehension mediated the linkage between hot EF and ToM. These findings highlight not only the connections between hot EF and ToM but also the importance of cool EF and verbal comprehension on hot EF-ToM relations in clinical assessments and interventions for school-aged children with ASD and average intellectual abilities. LAY SUMMARY: Relatively few studies have investigated the hot (affective) executive function (EF)-theory of mind (ToM) relations in children with autism spectrum disorder (ASD). This study discovered that hot EF was significantly related to ToM, while cool (cognitive) EF and verbal comprehension mediated the relationship between hot EF and ToM. Therefore, the influence of cool EF and verbal comprehension on hot EF-ToM relations should be considered in studies involving children with ASD. Autism Res 2021, 14: 921-931. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

People often learn from the outcomes of their actions, even when these outcomes do not involve material rewards or punishments. How does our brain provide this flexibility? We combined behavior, computational modeling, and functional neuroimaging to probe whether learning from abstract novel outcomes harnesses the same circuitry that supports learning from familiar secondary reinforcers. Behavior and neuroimaging revealed that novel images can act as a substitute for rewards during instrumental learning, producing reliable reward-like signals in dopaminergic circuits. Moreover, we found evidence that prefrontal correlates of executive control may play a role in shaping flexible responses in reward circuits. These results suggest that learning from novel outcomes is supported by an interplay between high-level representations in prefrontal cortex and low-level responses in subcortical reward circuits. This interaction may allow for human reinforcement learning over arbitrarily abstract reward functions.

Much attention has been focused on physical exercise benefits to mental health such as mood and cognitive function. Our recent studies have consistently shown that a single bout of exercise elicits increased task-related brain activation mainly in the dorsolateral part of the prefrontal cortex (DLPFC), which results in improved executive performance. As the DLPFC is associated with the modulation of mood as well as executive function, it is tempting to hypothesize that exercising while in a positive mood would facilitate the beneficial effects of exercise on executive function via DLPFC activation. Thus, we conceived an experiment that used music to elicit a positive mood during exercise. Thirty-three young adults performed ten minutes of moderate-intensity (50% V.O2peak) pedaling exercise with two experimental conditions: listening to music and listening to beeps at a steady tempo. Mood and executive function were respectively assessed using the Two-Dimensional Mood Scale and a color-word-matching Stroop task before and after the exercise sessions. Prefrontal activation during the Stroop task was monitored using functional near-infrared spectroscopy. Exercise with music elicited greater enhancement of a positive mood (vitality) than did exercise with beeps. Contrary to our hypothesis, there were no significant differences between conditions in improvement in Stroop task performance and task-related cortical activation in the left-DLPFC. The correlation analyses, however, revealed significant correlations among increased vitality, shortened Stroop interference time and increased activation in the left-DLPFC. These results support the hypothesis that positive mood while exercising influences the benefit of exercise on prefrontal activation and executive performance.

Objective This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. Design A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel Index at discharge (controlling for Barthel Index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. Results Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. In contrast, general cognitive abilities, depression, medical comorbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. Conclusions For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are common in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. To claim cme credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Cme objectives Upon completion of this article, the reader should be able to (1) Discuss the role of baseline affective, cognitive, and medical impairments in impacting functional outcomes of older adults undergoing rehabilitation; (2) Describe the behavioral change and motivational approaches that are core features of the novel intervention known as Enhanced Medical Rehabilitation (E-MR); and (3) Determine the role of baseline executive function in moderating the effect of rehabilitation intervention on functional outcomes in older adults. Level Advanced. Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Assessment of intelligence and executive function in 9-10-year-old preterm children as compared to a full-term comparison group and to reveal the background of the individual differences in the outcomes by analyzing the effects of perinatal and social-economic factors.Seventy-two preterm children (divided into two groups: 32 extremely low birth weight, 40 very low birth weight) and a matched group of 33 healthy full-term children, aged 9-10 years, were tested using the Wechsler Intelligence Scales for Children (WISC-IV) and digital versions of tasks measuring executive function. As background information perinatal variables and maternal education were entered in the analysis.In the WISC-IV all three groups performed in the normal range. The preterm children, particularly the ELBW subgroup, scored significantly lower than the full-term comparison group in several outcome measures. Behind the group means there were massive scatters of the individual scores. Lower maternal education, male gender, and bronchopulmonary dysplasia (BPD) increased the risk for performance deficits.Low-to-moderate risk preterm children as groups are disadvantaged in the development of intelligence and executive function as compared to healthy full-term children even until school-age. However, with appropriate protective factors they may have chances to develop comparably with their full-term, non-risk counterparts.

Objectives Cardiovascular disease is disproportionally prevalent in bipolar disorder (BD) and has been linked to cognition in preliminary studies. Herein we evaluate the association between known risk factors for cardiovascular disease and executive function in BD patients compared to healthy controls. Methods In a sample of n=57 individuals (n=23 BD, n=34 controls) we assessed two subdomains of executive function; cognitive flexibility (using the Trail Making Test - Part B) and cognitive inhibition (using the Stroop Colour Word Interference Task). Cardiovascular risk was assessed by means of serum triglyceride levels, body mass index (BMI) and waist circumference, as well as dietary saturated fat intake and a sex-specific cumulative cardiovascular risk score calculated using the Framingham Heart Study method. Results Patients with BD had higher BMI and waist circumference, with more BD patients categorized as having central obesity than controls. In the BD group only, higher triglyceride levels were associated with worse cognitive flexibility, and elevated cumulative cardiovascular disease risk was associated with worse cognitive inhibition. No correlations between cardiovascular risk factors and executive function were evident in the control group. Limitations The study was limited by the small sample size and should be considered hypothesis-generating Conclusions The associations between triglyceride levels, cumulative cardiovascular disease risk and executive functioning evident in BD in this study preliminarily indicate the potential for mechanistic overlap of physical health and cognitive function in the disorder.

Background: Cerebral microbleed (CMB) is an increasingly important risk factor for cognitive impairment due to population aging. Controversies, however, remain regarding the exact association between CMB and cognitive dysfunction. Objective: We aimed to determine the relationship between CMB burden and cognitive impairment, and also explore the characteristics of cognitive decline in CMB patients for middle-aged and elderly people. Methods: The present cross-sectional study included 174 participants (87 CMB patients and 87 controls) who underwent brain magnetic resonance imaging and a battery of neuropsychological test. Global cognitive function was measured using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Compound z-scores were calculated for three cognitive subdomains: memory, executive function and processing speed. Results: CMB patients had lower scores of MMSE (p 0.05). Conclusion: CMB is associated with impairment in global cognition as well as for all tested subdomains. Strongest effect sizes were seen for tests which rely on executive functioning, where performance deficits increased in proportion to degree of CMB burden. Prospective studies are needed to evaluate whether the association between CMB and executive dysfunction is causal.

Although decline of cognitive abilities in late life is regarded as a common facet of aging, there is inter-individual variability in this decline. Possible contributors are cardiometabolic risk factors associated with cerebrovascular dysfunction, but a dearth in unifying health-cognition models confound exactly how these risk factors mediate age-related changes in executive function (EF) and episodic memory. This study investigated the indirect effect of age on these cognitive abilities via cardiometabolic risk factors using a structural equation modeling approach. Participants included 738 adults (64% female) ranging from 21 to 85 years of age (M = 47.47, SD = 18.28). An exploratory factor analysis was applied to an EF battery yielding a two-factor solution, consisting of inhibition and cognitive flexibility, that showed acceptable fit (χ(2)(48) = 101.84, p < .001, CFI = .980, RMSEA = .039, SRMR = .035). The EF latent factors were then included in a confirmatory factor analysis exploring the indirect role of age on episodic memory and EF via blood pressure, cholesterol, triglycerides and body mass index. The theoretical model demonstrated acceptable fit, χ(2)(108) = 204.071, p < .001, CFI = .972, RMSEA = .035, SRMR = .035. Blood pressure was associated with lower cognitive flexibility (β = −.20, p < .001) and there was a significant indirect effect of age on episodic memory through cognitive flexibility (β = .07, p = .021). Results support the “Executive Decline Hypothesis” of age-related episodic memory decline and specifically implicate lower blood pressure control and cognitive flexibility in these changes.

Objectives The aims of the study were to assess executive function performance in children and adolescents with primary and secondary hypertension, and to investigate for associations with central SBP and ambulatory blood pressure. Methods Forty-six pediatric patients with secondary hypertension because of kidney diseases and 46 patients with primary hypertension underwent ambulatory blood pressure monitoring, pulse wave analysis, and assessment of executive function using Behavior Rating Inventory of Executive Function. Results for comparisons are presented as mean (SD). Analysis of covariance was performed to examine the effect of blood pressure parameters and hypertension cause. Results Patients with secondary hypertension had higher T scores in parent and self-reported Metacognition Indices compared with those with primary hypertension (51.2 ± 8.9 vs. 47.6 ± 7.5, P = 0.05 and 49.6 ± 9.1 vs. 42.1 ± 7.9, P = 0.001, respectively), but did not differ in Behavior Regulation Index T scores, as well as in mean arterial pressure z-score. Patients with secondary hypertension had higher central SBP z-scores (P = 0.05). Adjustment for central SBP attenuated differences in parent Metacognition Index between groups. Central SBP z-score associated with parent Metacognition (B = 0.95, 95% CI 0.02-1.87), Behavior Regulation (B = 1.14, 95% CI 0.07-2.21), and self-reported Metacognition Indices T scores (B = 1.48, 95% CI 0.39-2.56), independent of mean arterial pressure z-score, age, sex, socioeconomic status, hypertension cause, and antihypertensive treatment. Conclusion Central SBP associates with executive function performance in youth with hypertension and could have complementary role to ambulatory blood pressure for identifying children at risk for adverse cognitive outcomes.

BACKGROUND AND PURPOSE: While it is known that breastfeeding promotes healthy brain development in children, the potential effects of formulas substantially differing in composition (ie, milk-based versus soy-based) during infancy on brain development are unclear. MATERIALS AND METHODS: Seventy-one 8-year-old children who were predominantly breastfed, milk formula fed, or soy formula fed during infancy were recruited for an MR imaging examination of the brain and a Behavior Rating Inventory of Executive Function assessment (completed via a questionnaire to the parents). Brain cortical features measured from MR imaging such as cortical thickness and surface area were extracted and compared among groups and correlated with Behavior Rating Inventory of Executive Function test scores. RESULTS: Clusters in the frontal and occipital lobes showed significant differences (cluster-wise P ≤ .05, corrected for multiple comparisons) in cortical thickness or surface area among the 3 diet groups. The effects were more prominent for boys, particularly for comparison of the milk formula fed versus soy formula fed boys. Assessments of executive function and behavior showed significantly lower Behavior Rating Inventory of Executive Function test scores in soy formula fed versus milk formula fed groups, which were mostly attributed to differences in boys. There were no differences between milk formula fed and breastfed groups for either sex. Mean cortical thickness for several of the clusters in the brain showing infant diet–associated effects significantly correlated with Behavior Rating Inventory of Executive Function scores. CONCLUSIONS: Choices of infant diets (ie, breastfed, milk formula fed, soy formula fed) may have long-term and sex-specific effects on the cortical development and executive function and behavior of children’s brains.

OBJECTIVE. This study examined whether carrying dopamine-related “risk” genes—either the dopamine transporter (DAT1) 10-repeat allele or dopamine receptor-4 (DRD4) 7-repeat allele—moderated the association of family environment and executive function (EF) following traumatic brain injury in early childhood. METHOD. Caregivers of children with traumatic brain injury (TBI) or orthopedic injury (OI) completed the Behavior Rating Inventory of Executive Function (BRIEF) at post-injury visits. General linear models examined gene-environment interactions as moderators of the effects of TBI on EF at 12 months and 7 years post-injury. RESULTS. At 12 months, we did not find any significant gene by environment interactions. At 7 years, we found a significant 3-way interaction among combined carrier status, level of permissive parenting, and injury type. For children exposed to more optimal parenting, carriers of DAT1 and/or DRD4 risk alleles with TBI showed significantly worse parent-reported EF compared to carriers with OI. In those with less optimal parenting, carriers and non-carriers with TBI, as well as carriers with OI, showed significantly worse parent-reported EF compared to non-carriers with OI, with medium to large effect sizes. CONCLUSIONS. The findings highlight the importance of considering polygenetic and environmental factors in future studies of recovery following TBI and other injuries in childhood.

Background Executive functions (EF) support engagement in goal-directed behaviors, including several health behaviors. Stressful and cognitively demanding events can disrupt EFs and interfere with health behavior, possibly to a greater extent in those with preexisting EF deficits. This study examined the association between preexisting EF deficits and subsequent negative changes in eating patterns, physical activity, sedentariness, and alcohol/substance use during the COVID-19 pandemic. Method Participants were 374 young adults in a follow-up study of the longitudinal, multisite Study of Early Child Care and Youth Development (SECCYD). Preexisting EF deficits were assessed with the Barkley Deficits in Executive Function Scales-Short Form, and personally impactful negative changes in four health behaviors (physical activity, unhealthy eating, sedentary time, alcohol/substance use) during the COVID-19 pandemic were subsequently assessed with the Epidemic-Pandemic Impacts Inventory. Results In ordered logistic regression models, higher preexisting total EF deficits were associated with greater negative impactful changes in physical activity and unhealthy eating, independent of sociodemographic variables, obesity, and (as relevant) accelerometer-based physical activity and pre-COVID-19 diet quality. Socioeconomic status moderated the association between total EF deficits and impactful change in alcohol/substance use, with EF deficits linked to greater impactful change in alcohol/substance use only in higher socioeconomic strata. Conclusion Individuals with preexisting EF deficits appear more vulnerable to the negative impact of the COVID-19 pandemic on several key health behaviors. As the pandemic unfolds, strategies may be needed to identify those with EF deficits (e.g., screening tools) and provide them with tailored support for chronic disease risk reduction.

Introduction An alteration in postoperative cognitive function varies according to the patients’ background characteristics, such as etiology, focus, and seizure duration. Accurate prediction and assessment of postoperative cognitive function is difficult in each patient. Adaptive behavior could describe the typical performance of daily activities and represents the ability to translate cognitive potential into real-world skills. We examined the relationship between alterations of executive function (EF) and adaptive behavior in school children undergoing surgery for intractable epilepsy. Methodology We enrolled 31 children with focal resection or corpus callosotomy for intractable epilepsy [mean age at surgery, 12.5 years; 16 boys; mean intellectual quotient, 73.3]. We surveyed answered questionnaires on attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and adaptive behavior using the Vineland Adaptive Behavior Scale, 2nd edition (VABS-II), and performed continuous performance tests (CPTs) on children pre- and postoperatively. Result ADHD and ASD symptoms improved after epilepsy surgery. The omission error (OE) in the CPT variable improved after epilepsy surgery, especially in children with a shorter preoperative period. Improved ASD symptoms led to an increased score of the coping skills subdomain. The reduced OE observed after surgery also increased the score of the community skills subdomain. Conclusion Improvement in EF and ASD symptoms resulted in better adaptive behavior postoperatively. These results were important for the pre- and postoperative evaluation and re-evaluation of children with epilepsy requiring special education and related services.

Objective/Background: Personality traits are regarded as risk factors for cognitive impairment in older adults, while sleep disturbance and physical inactivity are also considered as modifiable risk factors. Therefore, it could be beneficial to investigate the effects of those modifiable risk factors on the relationship between personality traits and cognitive functions, to prepare appropriate strategies for mitigating cognitive impairment. Participants: A total of 155 cognitively unimpaired older adults were included. Methods: All participants underwent cognitive function tests using the Seoul Neuropsychological Screening Battery and examinations for personality traits using the Big Five Inventory. Individual physical activity and sleep quality were assessed using the International Physical Activity Questionnaire and Pittsburgh Sleep Quality Index, respectively. A hierarchical linear multiple regression analysis was performed to demonstrate the direct association between personality traits and cognitive functions, and the multiple moderator analysis was used to analyze the moderating effects of lifestyle factors on this association. Results: Among the five personality traits, only neuroticism was negatively associated with the frontal executive and visuospatial functions after controlling age, sex, and years of education. Interestingly, the negative relationship between neuroticism and frontal executive function was alleviated in older adults with higher sleep quality. Conclusions: Our findings demonstrated that higher sleep quality has significant moderating effects on the negative association between neuroticism and frontal executive functions in older adults, which suggests intervention for improving sleep quality such as cognitive behavioral therapy can be considered in older adults who have personality traits associated with a high risk of cognitive impairment.

Purpose: The number of adolescent and young adult (AYA) survivors of childhood cancer is increasing, and the impacts of therapy on their daily lives are not well understood. Adaptive functions are ...

“Executive functions” (EFs) is an umbrella term for higher cognitive functions such as working memory, inhibition, and cognitive flexibility. These functions refer to dissociable mechanisms that are also intricately related, justifying the view of EF as a unitary mental faculty. One of the most challenging theoretical problems in this field of research has been to explain how the wide range of cognitive processes subsumed as EFs are controlled without an all-powerful but ill-defined central executive in the brain. Efforts to localize control mechanisms in circumscribed brain regions have not led to breakthrough in understanding how the brain controls and regulates itself, and no single brain system underlying a ‘central executive’ has yet been identified. We discuss how a distributed control network view can help to refine our understanding of the neurophysiological mechanisms underlying EFs. In this view, executive control functions are realized by spatially distributed brain networks, thus precluding the need for a modular central executive. We further discuss how graph-theory driven analysis of brain networks offers a unique lens on this problem by providing a reference frame to study brain connectivity in EFs in a holistic way and how neuroscience network research endeavors to investigate clinical neuropathology of disrupted EFs.

Extant research is mixed regarding the relations between lifetime exposure to stressors, adrenocortical activity, and executive function (EF), particularly in children. Aggregate measures of adrenocortical activity like hair cortisol concentration (HCC), timing of stress exposure, and age at assessment may clarify these associations. This cross-sectional study examined the association between parent-reported exposure to stressors, hair cortisol concentration (HCC), and children’s executive function via a tablet task in a community sample (n = 318, 52.5% female) of children across a wide age range (4–13 years, M = 9.4, SD = 2.3). Path analyses revealed that parent-reported child lifetime exposure to stressors, but not past-year stressful life events, negatively predicted HCC. There was also a marginally significant moderation by age such that HCC was associated negatively with EF for younger children (age < 9.7 years) but not older children. HCC did not significantly mediate the association between lifetime exposure to stressors and EF. Findings are consistent with the proposition that chronically high cortisol production has a neurotoxic effect on brain regions supporting EF. However, lifetime exposure to stressors predicted relatively lower cumulative cortisol production, consistent with a stress inoculation effect in this normative-risk sample.

Background Maintaining urinary continence is not an automatic process, but relies on continuous processing of sensory signals from the bladder and suppression of the desire to void. Urinary incontinence (UI) and lower urinary tract symptoms (LUTS), including urinary urgency, frequency, and nocturia are highly prevalent among the general population. This prevalence rises in association with increasing age, and this may be in part due to changes in the central nervous system rather than the urinary tract. The aim of this study was to assess if older adults with overactive bladder (OAB) had demonstrable impairment in executive function. Methods This was a cross-sectional study comparing the performance of adults aged 65 and over with and without OAB on two cognitive tests, the Trail Making Test B (TMT-B) and simple reaction time (SRT). OAB was defined as urgency, with at least weekly urgency incontinence and a daytime urinary frequency of 8 or more. The control group were defined as a Bladder control Self-Assessment Questionnaire (B-SAQ) score of ≤4. Results 56 participants were recruited, of whom 35 met criteria for OAB. The OAB group took significantly longer to complete the TMT-B than the control group (103s vs. 77s, p = .003). There was no difference in the SRT Conclusions In this sample of older adults, OAB was associated with measurable slower performance on the TMT-B, suggesting that impaired executive function is associated with OAB.

Background\udScales measuring cognitive and executive functions are integral to the assessment and management of patients with suspected cognitive impairment. Some of the most commonly used cognitive tests are now subject to copyright restrictions. Furthermore, no existing scale assesses both executive and cognitive abilities.\ud\udAims\udWe aimed to develop and validate a novel hybrid scale for use in clinical practice which integrate measures of cognition and executive abilities (‘Free-Cog’).\ud\udMethods\udThe instrument was devised through a national collaboration including health professionals, those with lived experience of dementia and researchers. Following ethics committee approval, the Free-Cog was assessed in 25 real-world clinical settings across England, Wales and Scotland. It was compared to three other cognitive tests routinely administered in clinical practice: the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MOCA), and the Addenbrooke's Cognitive Examination (ACE).\ud\udResults\udThe Free-Cog was tested in 960 patients with clinical diagnoses of dementia, Mild Cognitive Impairment (MCI), and normal controls. Similar to the MMSE, MOCA and ACE, it discriminated well between the three groups (p < 0.001). It correlated well with the other instruments. Using a receiver operating characteristic curve analysis, Free-Cog achieved an Area Under Curve of 0.94 for dementia versus controls, 0.80 for MCI versus controls and 0.77 for dementia versus MCI. A version of the tool adapted for telephone consultation, the Tele Free-Cog, also discriminated well between patient groups.\ud\udConclusions\udFree-Cog is a non-proprietary, empirically derived, concise assessment. Uniquely, it combines cognitive and executive function questions in the one instrument. It could be used to inform the assessment of people presenting with cognitive impairment and is available to anyone interested in trialling it.

This study aimed to analyze the associations of activity-rest pattern indicators with academic achievement, executive function, and intelligence and to explore whether these associations are mediated by the total gray matter volume among children with overweight/obesity. Ninety-five children (10 ± 1 year, 37 girls) with overweight/obesity (based on the World Obesity Federation body mass index cutoff points) were included in this cross-sectional study. Hip- and wrist-worn ActiGraph GT3X + accelerometers were used to assess the activity-rest pattern. Interdaily stability (IS), intradaily variability (IV), the mean value of the lowest 5 hours (L5), and the mean value of the maximum 10 hours (M10) of activity and their respective timing (TL5, TM10) were used as indicators of the activity-rest pattern throughout the day. Chronotype and social jetlag were used as indicators of circadian preference. Academic achievement, executive function, and intelligence were assessed with standardized tests. Gray matter volume was acquired by magnetic resonance imaging (MRI). IS was positively associated with executive function (β = 0.244, P = .014). IV was negatively associated with mathematics and academic applications (β: -0.211 to -0.238, P's ≤ .026). Later TM10 in the day was related to lower writing, academic skills, and intelligence (β: -0.229 to -0.271, P's ≤ .025). None of the associations found were mediated by gray matter volume. A non-fragmented and stable activity-rest pattern and earlier physical activity in the day were associated with better academic achievement, executive function, and intelligence in children with overweight/obesity. Further studies are required to corroborate or contrast our findings.

Dopamine (DA) signaling is critical for optimal cognitive performance. Aging is accompanied by a change in the strength of this signaling, with a loss of striatal and extrastriatal D2 binding potential. The reduction in dopamine modulation with age negatively influences various aspects of cognition. DRD2 C957T (rs6277) impacts DA D2 receptor density and availability, with C homozygotes linked to lower striatal DA availability and reduced executive functioning (EF), but also high extrastriatal binding potential. Here, we investigated in 176 participants aged 20–94 years whether: (1) DRD2 C carriers differ from T carriers in cortical thickness or subcortical volume in areas of high concentrations of D2 receptors that receive projections from mesocortical or nigrostriatal dopaminergic pathways; (2) whether the DRD2*COMT relationship has any synergistic effects on cortical thickness; (3) whether the effect of DRD2 on brain structure depends upon age; and (4) whether DRD2-related regional thinning affects executive function performance. We show that DRD2 impacts cortical thickness in the superior parietal lobule, precuneus, and anterior cingulate (marginal after FDR correction), while statistically controlling sex, age, and COMT genotype. Specifically, C homozygotes demonstrated thinner cortices than both heterozygotes and/or T homozygotes in an age-invariant manner. Additionally, DRD2 predicted executive function performance via cortical thickness. The results highlight that genetic influences on dopamine availability impact cognitive performance via the contribution of brain structure in cortical regions influenced by DRD2.

Background Dexterity is a component of motor function. Executive function, a subdomain of cognition, may affect dexterity in older adults recovering from critical illness after discharge from an intensive care unit (ICU). Objectives To explore associations between executive function (attention and cognitive flexibility) and dexterity (fine motor coordination) in the early post-ICU period and examine dexterity by acuity of discharge disposition. Methods The study involved 30 older adults who were functionally independent before hospitalization, underwent mechanical ventilation in the ICU, and had been discharged from the ICU 24 to 48 hours previously. Dexterity was evaluated with the National Institutes of Health Toolbox (NIHTB) Motor Battery 9-Hole Pegboard Dexterity Test (PDT); attention, with the NIHTB Cognition Battery Flanker Inhibitory Control and Attention Test (FICAT); and cognitive flexibility, with the NIHTB Cognition Battery Dimensional Change Card Sort Test (DCCST). Exploratory regression was used to examine associations between executive function and dexterity (fully corrected T scores). Independent-samples t tests were used to compare dexterity between participants discharged home and those discharged to a facility. Results FICAT (β = 0.375, P = .03) and DCCST (β = 0.698, P = .001) scores were independently and positively associated with PDT scores. Further, PDT scores were worse among participants discharged to a facility than among those discharged home (mean [SD], 26.71 [6.14] vs 36.33 [10.30]; t24 = 3.003; P = .006). Conclusions Poor executive function is associated with worse dexterity; thus, dexterity may be a correlate of both post-ICU cognitive impairment and functional decline. Performance on dexterity tests could identify frail older ICU survivors at risk for worse discharge outcomes.

The study aimed to investigate sex differences in the boosting effects of household income on children&rsquo, s executive function in the US. This is a cross-sectional study using data from Wave 1 of the Adolescent Brain Cognitive Development (ABCD) study. Wave 1 ABCD included 8608 American children between ages 9 and 10 years old. The independent variable was household income. The primary outcome was executive function measured by the stop-signal task. Overall, high household income was associated with higher levels of executive function in the children. Sex showed a statistically significant interaction with household income on children&rsquo, s executive function, indicating a stronger effect of high household income for female compared to male children. Household income is a more salient determinant of executive function for female compared to male American children. Low-income female children remain at the highest risk regarding poor executive function.

Background Controversy exists regarding the optimal surgical approach for non-syndromic sagittal synostosis. This study provides the first comparative analysis of the long-term behavioral, psychological, and executive function outcomes for patients who underwent either cranial vault remodeling (CVR) or spring-assisted strip craniectomy (SAS). Methods Thirty-six CVR patients and 39 SAS patients were evaluated. Parents and caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Behavior Assessment System for Children, Second Edition (BASC-2) to evaluate behavioral, emotional, social, adaptive, and executive functioning skills. Results There were no statistically significant differences between the CVR and the SAS groups (P > 0.05) in any of the BRIEF areas of function. Furthermore, the BASC-2 battery illustrated no significant differences in all areas analyzed except one. Among the 2 groups, the CVR group was rated as having fewer social withdrawal symptoms on the BASC-2 (47.00 ± 10.27) compared to the SAS cohort (54.64 ± 10.96), F = 6.79, P = 0.012, Cohen d = 0.688. However, both means were still within the normal range. Conclusions Children undergoing SAS and CVR procedures for isolated sagittal synostosis were not rated as having clinically significant behavioral, emotional, social, adaptive, or executive functioning problems on parental forms.

Copyright © 2020 the American Physiological Society. A single bout of aerobic exercise improves executive function; however, the mechanism for the improvement remains unclear. One proposal asserts that an exercise-mediated increase in cerebral blood flow (CBF) enhances the efficiency of executive-related cortical structures. To examine this, participants completed separate 10-min sessions of moderate- to heavy-intensity aerobic exercise, a hypercapnic environment (i.e., 5% CO2), and a nonexercise and nonhypercapnic control condition. The hypercapnic condition was included because it produces an increase in CBF independent of metabolic demands. An estimate of CBF was achieved via transcranial Doppler ultrasound and near-infrared spectroscopy that provided measures of middle cerebral artery blood velocity (BV) and deoxygenated hemoglobin (HHb), respectively. Exercise intensity was adjusted to match participant-specific changes in BV and HHb associated with the hypercapnic condition. Executive function was assessed before and after each session via antisaccades (i.e., saccade mirror-symmetrical to a target) because the task is mediated via the same executive networks that demonstrate task-dependent modulation following single and chronic bouts of aerobic exercise. Results showed that hypercapnic and exercise conditions were associated with comparable BV and HHb changes, whereas the control condition did not produce a change in either metric. In terms of antisaccade performance, the exercise and hypercapnic, but not control, conditions demonstrated improved postcondition reaction times (RT), and the magnitude of the hypercapnic and exercise-based increase in estimated CBF was reliably related to the postcondition improvement in RT. Accordingly, results evince that an increase in CBF represents a candidate mechanism for a postexercise improvement in executive function. NEW & NOTEWORTHY Single-bout aerobic exercise “boosts” executive function, and increased cerebral blood flow (CBF) has been proposed as a mechanism for the benefit. In this study, participants completed 10 min of aerobic exercise and 10 min of inhaling a hypercapnic gas, a manipulation known to increase CBF independently of metabolic demands. Both exercise and hypercapnic conditions improved executive function for at least 20 min. Accordingly, an increase in CBF is a candidate mechanism for the postexercise improvement in executive function.

Early life environment can have a lasting effect on brain development and behavior. Diet is a potent environmental factor that can positively or negatively affect neurodevelopment, and unfortunately, the likelihood of a poor diet is high during adolescence. Adverse effects of adolescent high fat diet have been observed on reward-related behaviors, reversal learning, and hippocampal-dependent learning tasks in rodents when tested in adulthood. The prefrontal cortex (PFC) continues to develop throughout adolescence and is thus vulnerable to environmental insults such as poor diet. Therefore, we sought to examine the effects of a high fat diet (HFD) consumed only during adolescence on later life adult PFC-dependent executive function. Male and female mice were fed a HFD (60% energy from fat) during either early or late adolescence then switched to standard chow and tested in a battery of touchscreen-based operant tests of executive function in adulthood. Contrary to our prediction of an adverse effect of HFD, there was no effect of adolescent HFD in males, and females showed faster learning and decreased inattention in adulthood. We conclude that the effects of adolescent-limited HFD on adult executive function are mild, positive, and vary by sex.

Research regarding the effects of high-intensity interval training (HIIT) on executive function has grown exponentially in recent years. However, there has been no comprehensive review of the current state of literature. Therefore, the aim of this systematic review is to summarize previous research regarding the acute and chronic effects of HIIT on executive function across the lifespan and highlight future research directions. The results indicated that acute bouts of HIIT has a positive effect on inhibition in children/adolescents and adults, and further that chronic HIIT benefits inhibition and working memory in children. More research employing chronic interventions, focusing on middle-aged and older adults, and examining the effects on the working memory and cognitive flexibility domains of executive function are needed. Future research should also focus on a) the use of stronger research designs, b) the effects of HIIT dosage/modality, c) consideration of individual differences, d) possible underlying mechanisms, and e) examining the feasibility of translating HIIT to real-word settings.

Agreement between parent and adolescent ratings of executive function (EF) is not known in adolescents with solid organ transplant (SOT), even though pressing concerns about EF deficits are being raised in this population. The current study investigated EF in adolescents with SOT using parent and self report. Twenty-five adolescents (

Objective Rumination is a maladaptive emotional-regulation strategy that is strongly associated with depression. Impaired executive function can lead to difficulties in disengaging from rumination, thus exacerbating depression. In this study, we inspect an electroencephalograph neurofeedback protocol that enhance the target peak alpha frequency (PAF) activation in the prefrontal region. We examine the protocol's effects on depression and rumination. Methods We randomly assigned 30 dysphoric participants into either the neurofeedback training group or the control group. We then evaluated their depression, rumination, and executive function at pre- and posttraining so as to examine the effects of the neurofeedback. Results The results show that this neurofeedback protocol can specifically enhance participants' target PAF. The participants' executive function performances significantly improved after undergoing 20 neurofeedback sessions. Compared with those in the control group, those in the neurofeedback group had significantly fewer depressive symptoms and significantly reduced rumination. Moreover, as target PAF and executive function improved, depression and rumination both declined. Conclusion Our data are in line with those of previous studies that indicated a relationship between upper-band alpha activity and executive function. This PAF neurofeedback can effectively enhance participants' executive function, which can reduce rumination and ameliorate depression. This neurofeedback training is based on basic cognitive neuroscience, so it sheds light on depression's pathological factors and etiology.

Empirical findings suggest that there is an overlap between schizophrenia and obsessive-compulsive disorder (OCD). These disorders also have a high comorbidity rate. However, little is known about the impact of co-occurring schizotypal and obsessive-compulsive traits on executive function, emotion experience, and emotion expressivity in the normal population. The present study examined the prevalence of coexisting schizotypal and obsessive-compulsive traits and the relationship between these two traits in a sample of healthy college students. We also conducted a moderation analysis to explore the effect of these two type of traits on executive function, emotion experience, and emotion expressivity. We recruited 3,319 participants to complete the Schizotypal Personality Questionnaire (SPQ) and the Obsessive-Compulsive Inventory - Revised (OCI-R). A subset of them (n = 575) also completed the Chinese versions of the Dysexecutive Questionnaire (DEX), the Temporal Experience of Pleasure Scale (TEPS), and the Emotional Expressivity Scale (EES). We found that the prevalence of co-occurring schizotypal and OCD traits was 3.33%. All the subscales of the SPQ and the OCI-R significantly correlated with each other. Both traits had a negative impact on executive function and emotion expressivity. The interaction between the disorganization dimension of schizotypal traits and OCD traits had a significant effect on executive function, but not emotion experience or emotion expressivity. This study was limited by its cross-sectional design and recruitment of only college students. These findings suggest that there is an approximately 3% rate of co-occurring schizotypal and obsessive-compulsive traits in a healthy college student sample. The interaction between these two types of traits may influence executive function.

Self-awareness is commonly impaired after traumatic brain injury and impacts on rehabilitation engagement and community re-integration outcomes. Interventions which incorporate metacognitive strategy instruction have the potential to improve rehabilitation engagement and outcomes. This study aimed to determine whether an occupation-based intervention incorporating metacognitive strategy instruction resulted in goal achievement and improved online awareness and executive function performance during goal-related tasks. A single-case experimental design using a multiple-baseline design across behaviours was used with two participants with severe traumatic brain injury to evaluate the effectiveness of the 6-week intervention. Repeated measures of goal-related performance, percentage of self-corrected errors and executive function were made via independent analysis of video footage and documentation logs. Data analysis involved 2SD bandwidth analysis and overlap data, reliable change index and evaluation of goal achievement across phases. There were improvements in self-corrected errors for one participant, which were maintained. Significant reductions in anxiety (RCI = ±5.98) were evident for both participants, with a significant reduction in stress (RCI = ±7.05) for one participant following the intervention. The occupation-based intervention incorporating metacognitive strategy instruction led to improvements compared to baseline performance in some targeted goals, online awareness and executive function performance during goal-related tasks and reduced stress and anxiety.

The modern understanding of the term metacognition encompasses two levels of processing: a lower level awareness or knowledge of one’s own thoughts and a higher level regulation or control of our thinking. Metacognition, therefore, bears conceptual similarity with executive function: both are concerned with top-down monitoring and control of cognition in the service of ongoing goal-directed behaviour. Previous studies have shown a possible executive function advantage in multilingual speakers but also a possible disadvantage in metacognitive processing. To progress theory on metacognitive processing and the relationship with executive function and linguistic experience across the lifespan, we conducted a study testing 330 healthy individuals in four age groups from 7 to 80 years old. All participants performed a metacognition task and two measures of executive function, which included the Simon task and the Tower of London task. Half the participants were multilingual speakers since birth. We built developmental trajectories of metacognitive and executive function across the lifespan. The best metacognitive efficiency was observed in mid-adulthood, whereas the best executive function processing reached its peak in young adulthood. A steep cognitive decline was observed in older age, while metacognitive efficiency was preserved. Exploratory factor analysis indicated that metacognition and executive function are served by different factors across all ages. Contrary to previous findings in the bilingual literature, a multilinguistic experience conferred neither any significant advantage nor disadvantage in both executive function and metacognitive processing across the lifespan.

Autonomous sensory meridian response (ASMR) is a special perceptual phenomenon in which some people can experience a tingling, static-like sensation in response to some certain auditory/visual stimulations. This study compared the performance of executive function (working memory, set shifting, and inhibitory control) between ASMR participants and control participants after three auditory treatment conditions, i.e., ASMR-triggering audio (Triggering), normal-speaking audio (Normal), and with no auditory treatment (Baseline). The results showed that the ASMR individuals did not differ in executive function with the control participants in either Normal or Baseline condition. However, the set shifting and inhibitory control of ASMR individuals slowed down after ASMR-triggering auditory treatment. In this study, ASMR individuals with ASMR-triggering auditory treatment reported that they all experienced three ASMR episodes before completing executive function tasks. These findings indicated that there was no intrinsic difference in executive function between ASMR and control individuals. But ASMR individuals’ executive function would be interfered when the ASMR was triggered.

The ability to perceive differences in environmental contrast is critical for navigating complex environments safely. People with Parkinson's disease (PD) report a multitude of visual and cognitive deficits which may impede safe obstacle negotiation and increase fall risk. Enhancing obstacle contrast may influence the content of visual information acquired within complex environments and thus target environmental fall risk factors. 17 PD with a history of falls and 18 controls walked over an obstacle covered in a high and low contrast material in separate trials whilst eye movements were recorded. Measures of visual function and cognition were obtained. Gaze location was extracted during the approach phase. PD spent longer looking at the obstacle compared to controls regardless of contrast (p .05), however group differences were largest for the low contrast obstacle. When accounting for group differences in approach time, PD spent longer looking at the low contrast obstacle and less time looking at the ground beyond the low contrast obstacle compared to controls (p .05). The response to obstacle contrast in PD (high-low) was significantly associated with executive function. Better executive function was associated with spending longer looking at the low contrast obstacle and at the ground beyond the high contrast obstacle. Enhancing the contrast of ground-based trip hazards may improve visual processing of environmental cues in PD, particularly for individuals with better executive function. Manipulating contrast to attract visual attention is already in use in the public domain, however its utility for reducing fall risk in PD is yet to be formally tested in habitual settings.

Background Knowledge about patients' executive function is important in the rehabilitation of language and communication in stroke patients with aphasia. Due to linguistic demands, most neuropsychological tests are unsuitable for this population, and it might seem appealing to use informant report of executive function as a substitute. Objective To investigate the relationships between scores on a neuropsychological test and informant ratings of executive function, as well as between the informant ratings and the functional communication ability, in people with severe aphasia after stroke. Methods Thirty-eight people with severe aphasia and their significant others participated. Executive function was tested with parts of the neuropsychological screening instrument CLQT and rated by significant others (informants) using BRIEF-A. Functional communication was assessed with a standardised test and rated by significant others. Results Results revealed few correlations between CLQT and BRIEF-A. There was no correlation between informant ratings on BRIEF-A and scores on the measures of functional communication. Conclusions Informant ratings of executive function do not measure the same construct as, and cannot be used as a substitute for, standardised neuropsychological tests. Informant ratings of executive function do not seem to provide information that is relevant to the understanding of functional communication in people with severe aphasia.

Background In youth and young adults with autism spectrum disorder (ASD), executive function (EF) deficits may be a promising treatment target with potential impact on everyday functioning. Objective To conduct a pilot randomized, double-blind, parallel, controlled trial evaluating repetitive transcranial magnetic stimulation (rTMS) for EF deficits in ASD. Method In Toronto, Ontario (November 2014 to June 2017), a 20-session, 4-week course of 20 Hz rTMS targeting dorsolateral prefrontal cortex (DLPFC) (90%RMT) was compared to sham stimulation in 16–35 year-olds with ASD (28 male/12 female), without intellectual disability, who had impaired everyday EF performance (n = 20 active/n = 20 sham). Outcome measures evaluated protocol feasibility and clinical effects of active vs. sham rTMS on EF performance. The moderating effect of baseline functioning was explored. Results Of eligible participants, 95% were enrolled and 95% of randomized participants completed the protocol. Adverse events across treatment arms were mild-to-moderate. There was no significant difference between active vs. sham rTMS on EF performance. Baseline adaptive functioning moderated the effect of rTMS, such that participants with lower baseline functioning experienced significant EF improvement in the active vs. sham group. Conclusions Our pilot RCT demonstrated the feasibility and acceptability of using high frequency rTMS targeting DLPFC in youth and young adults with autism. No evidence for efficacy of active versus sham rTMS on EF performance was found. However, we found promising preliminary evidence of EF performance improvement following active versus sham rTMS in participants with ASD with more severe adaptive functioning deficits. Future work could focus on examining efficacy of rTMS in this higher-need population. Clinical trial registration Repetitive Transcranial Magnetic Stimulation (rTMS) for Executive Function Deficits in Autism Spectrum Disorder and Effects on Brain Structure: A Pilot Study; https://clinicaltrials.gov/ct2/show/NCT02311751?term = ameisr NCT02311751. The trial was funded by: an American Academy of Child and Adolescent Psychiatry (AACAP) Pilot Research Award, the Innovation Fund from the Alternate Funding Plan of the Academic Health Sciences Centres of Ontario, and an Ontario Mental Health Foundation (OMHF) Project A Grant and New Investigator Fellowship.

Background: Emerging evidence suggests that opioid receptor antagonists, such as naltrexone, are effective pharmacotherapies for alcohol, opioid, and possibly stimulant use disorders. It is posited that naltrexone exerts its effects, in part, by increasing functional connectivity between neural reward circuitry and frontal systems implicated in executive function. Yet no studies had examined whether executive function moderates these effects. Objectives: This study examined whether a composite measure of executive function (EF) moderates the effect of naltrexone on craving for methamphetamine and subjective responses following infusion of the drug. Methods: Individuals with methamphetamine use disorder (N = 30; 27% female) completed baseline neurocognitive assessments of premorbid and executive function, and an executive function factor was computed. Participants then underwent a randomized, double-blind, cross-over study of titration with naltrexone and placebo. Participants then received a 30-mg intravenous methamphetamine infusion and completed subjective response questionnaires at 8 times in the 120 minutes post-infusion. Results: Multilevel mixed models indicated a significant EF × medication interaction, reflecting greater effects of naltrexone to decrease "desire to access the drug", "want more of the drug", "crave the drug", "feel drug effects" and "feel high" in participants with low EF compared to those with high EF (Bs = .36-1.29, SEs = .14-.17, ps

Whether bilingualism can improve aspects of cognitive function in late adulthood is hotly debated. A few limited studies have reported that bilingualism may provide a limited buffer against age-related cognitive decline; however, others have not. The present study furthered this inquiry by analyzing the combined effects of age and language experience upon executive function in a geographically diverse online sample.Amazon Mechanical Turk was used to recruit a sample of younger (YA) and older adults (OA) from 24 countries. A total of 81 monolingual participants (YA = 37; OA = 44) and 82 bilingual/multilingual participants (YA = 43; OA = 39) completed task-pure executive function assessments of inhibition, memory updating, and attention switching.YAs performed better than OAs on both the inhibition and updating tasks. On the attention switching task, a greater switch cost occurred when participants had less time to process a stimulus cue. Notably, no effects of language (i.e., bilingualism) were significant: no main effects or interactions with aging were found for executive function performance.The results of the present study challenge the claim that extensive experience with multiple languages can be a reliably protective factor against some normative age-related declines in executive function.

BACKGROUND AND OBJECTIVES: In adult chronic kidney disease (CKD), metabolic acidosis is associated with diminished cognition, notably executive function (EF). Data from the Chronic Kidney Disease in Children (CKiD) study demonstrate a risk for impairment of EF, a finding associated with heightened blood pressure variability (BPV). We sought to determine whether low serum bicarbonate is also associated with performance on tests of EF in pediatric CKD and to investigate potential interaction with BPV. DESIGN/METHODS: CKiD participants with serum bicarbonate, blood pressure, and selected cognitive measurements available were evaluated. An EF summary score was derived from scores on the Delis Kaplan Executive Function System, Conners’ Continuous Performance Test, and Digit Span Backwards subtest from the Wechsler Intelligence Scale for Children-IV-Integrated. Parents completed the Behavioral Rating Inventory of Executive Function (BRIEF) to yield a Global Executive Composite (GEC) score. Linear mixed models with bicarbonate and hypertension as predictors and linear regression with bicarbonate and BPV were used to predict EF level. RESULTS: Data were available for 865 children. Twenty-two percent had low bicarbonate (CO(2) ≤ 20 mmol/L) at baseline. On multivariate analysis, there was no relationship between bicarbonate, hypertension, and EF. There was no significant CO(2)×hypertension interaction found. A significant interaction (p= 0.01) between high CO(2) (≥ 26 mmol/L) and BPV was detected in the model with GEC as the EF outcome, indicating that while higher BPV was associated with worse EF in the low and normal CO(2) groups, higher BPV was associated with better EF in the high CO(2) group. CONCLUSIONS: Our analyses revealed an interaction between one measure of BPV and low bicarbonate on neurocognition in pediatric CKD, suggesting a potential role for control of both bicarbonate and blood pressure in preserving cognition in early CKD. Further research is needed to confirm and further define this association.