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Introduction: Mothers' representations of their infants are important intervention targets because they predict the observed quality of infant-mother interactions. The current study investigated the influence of a video-feedback infant-parent intervention on mothers' representations of their infants beyond the effect of standard treatment., Methods: Data from a naturalistic, randomized controlled trial of 152 predominantly low- to moderate-risk mothers (mean age = 29.7 years) with infants (mean age = 7.3 months) were used. At Well Baby Centers, all families followed the universal program, which was treatment as usual (TAU), whereas half of the families also received the intervention. The Working Model of the Child Interview categories and scales as well as three latent factors generated from a factor analysis were used to assess maternal representations at baseline and follow-up (9-13 months after baseline). A linear mixed model analysis was used to analyze the data., Results: There were no differences in representation changes from baseline to follow-up between the control group (TAU) and intervention group. When both groups were combined, there were minor improvements in the mothers' representations at the follow-up., Discussion: Aspects of the intervention, the quality of TAU, and the homogeneity scores of the predominantly low-risk sample may explain the intervention's lack of effect on mothers' representations beyond TAU. The supportive services at Norwegian Well Baby Centers as well as the infants' increasing age putatively contributed to the improved features of the mothers' representations in the total sample. That standard community care may affect maternal representations has not been shown before. Future research should identify the core components in interventions targeting maternal representations and examine whether those components can be incorporated in primary care. Including measures of mothers' reflective functioning could broaden our knowledge of representations and their changeability., Clinical Trial Registration: This study is registered in the International Standard Randomized Controlled Trial Number registry under the reference number ISRCTN 99793905., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sandnes, Berg-Nielsen, Lydersen and Kårstad.)

Background: Persons with attention-deficit/hyperactivity disorder (ADHD) frequently experience symptoms of anxiety and depression. In this population, there is a need for validated brief self-report screening questionnaires to assess the severity of comorbid mental health problems. The Patient Health Questionnaire 4 (PHQ-4) is a self-report questionnaire that may contribute to this purpose as it can screen for both disorders efficiently. However, this will be the first study examining the factor structure of the PHQ-4 in samples of adults with ADHD, and also evaluating the validity of the Norwegian version of the PHQ-4., Objectives: The aim of the current cross-sectional study was to examine the factor structure and validity of the Norwegian version of the PHQ-4 in a sample of adults who reported having been diagnosed with ADHD., Methods: Of 496 invited, a total of 326 participants (66%) completed the PHQ-4, The World Health Organization Five Well-Being Index, the Oslo Social Support Scale and the 4-item Perceived Stress Scale electronically in a web-portal between the 9th and 30th of June 2020., Results: Confirmatory factor analysis of the PHQ-4 supported a two-factor structure [RMSEA = 0.038 (90% CI 0.000-0.159), CFI = 1.00, TLI = 0.999, SRMR = 0.004], consisting of a depression factor and an anxiety factor. Standardized factor loadings were 0.79 to 0.97. The PHQ-4 was negatively correlated with well-being and social support and positively correlated with perceived level of stress., Conclusion: This study indicates promising psychometric properties of the PHQ-4 as a measure of anxiety and depressive symptoms in adults with self-reported ADHD who are fluent in Norwegian. The questionnaire's brevity makes it a valuable resource in research and clinical settings. However, more studies are needed to test the instrument in a clinical sample., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Havnen, Lydersen, Mandahl and Lara-Cabrera.)

Introduction: Enrolling in childcare represents the first transition in toddlers' lives and lays the foundation for their well-being in childcare centers going forward. Child cortisol levels may be an indicator of how toddlers themselves experience their introduction to childcare. In the present study, we explored changes in toddler cortisol levels during their first month in childcare and at a 3-month follow-up, as well as the perceptions of parents and professional caregivers regarding the toddlers' settling-in process during the same period., Method: This study used a mixed-method design. Saliva samples were collected from 113 toddlers and their cortisol levels analyzed. Qualitative notes were collected from parents ( n  = 87) and professional caregivers ( n  = 101). The data were analyzed using linear mixed model and thematic analyses, respectively., Results: Changes in toddler cortisol levels and their parents' and professional caregivers' perceptions of the transition process fit well. Both data sources indicated an easy start in childcare when parents were present, while the first weeks separated from parents seemed quite demanding. After 3 months, the cortisol levels returned to a low level, while child well-being was perceived as high., Discussion: Toddlers need time to adapt to childcare settings. Even if they are well taken care of by their keyworkers during the day, many toddlers are tired and exhausted in the evenings at home, particularly in the first weeks of separation from their parents. Both professional caregivers and parents should be aware of toddlers' need for emotional support during their transition to childcare., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Drugli, Nystad, Lydersen and Brenne.)

Objectives: To assess neurocognitive function in adults born with low birthweight compared with controls and to explore associations between neurocognitive function and psychopathology in these groups., Methods: In this prospective cohort study, one group born preterm with very low birthweight (VLBW: birthweight <1,500  g , n  = 53), one group born small for gestational age at term (SGA: birthweight <10th percentile, n  = 63) and one term-born control group (birthweight ≥10th percentile, n  = 81) were assessed with neurocognitive tests, diagnostic interviews, and self-report questionnaires at 26 years of age., Results: The VLBW group scored significantly below the control group on several neurocognitive measures, including IQ measures, psychomotor speed, verbal fluency, aspects of visual learning and memory, attention, social cognition, working memory and fine motor speed. The SGA group consistently scored at an intermediate level between the VLBW and the control group and had significantly lower scores than controls on Performance IQ and psychomotor speed, including switching. In the VLBW group, associations were found between lower spatial working memory and the presence of anxiety disorders, internalizing and attention problems, and autistic traits. Furthermore, lower Full scale IQ was associated with attention problems when adjusting for sex and parental socioeconomic status., Conclusion: Adults born preterm with VLBW or born term SGA displayed neurocognitive difficulties. Spatial working memory was associated with difficulties with attention, anxiety, and social function of VLBW adults. The finding and its clinical applicability should be further explored., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Weider, Lærum, Evensen, Reitan, Lydersen, Brubakk, Skranes and Indredavik.)

Background: Cognitive decline and decline in physical performance are common after stroke. Concurrent impairments in the two domains are reported to give increased risk of dementia and functional decline. The concept of dual impairment of physical performance and cognition after stroke is poorly investigated. Clinically accessible imaging markers of stroke and pre-existing brain pathology might help identify patients at risk., Objective: The primary aim of this study was to investigate to which extent pre-stroke cerebral pathology was associated with dual impairment in cognition and physical performance at time of stroke. Secondary aims were to examine whether white matter hyperintensities, medial temporal lobe atrophy, and stroke lesion volume and location were associated with dual impairment., Methods: Participants from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study with available MRI data at baseline were included in this cross-sectional study. Logistic regression analyses were conducted, with impairment status (no impairment, impaired cognition, impaired physical performance, and dual impairment) as the dependent variable and MRI markers as covariates. Pre-existing brain pathologies were classified into neurodegenerative, cerebrovascular, or mixed pathology. In addition, white matter hyperintensities and medial temporal lobe atrophy were included as independent covariates. Stroke volume and location were also ascertained from study-specific MRI scans., Results: Participants' ( n  = 348) mean (SD) age was 72.3 (11.3) years; 148 (42.5%) were women. Participants with dual impairment ( n  = 99) were significantly older, had experienced a more severe stroke, and had a higher comorbidity burden and poorer pre-stroke function. Stroke lesion volume (odds ratio 1.03, 95%, confidence interval 1.00 to 1.05, p  = 0.035), but not stroke location or pre-existing brain pathology, was associated with dual impairment, after adjusting for age and sex., Conclusion: In this large cohort of stroke survivors having suffered mainly mild to moderate stroke, stroke lesion volume-but not pre-existing brain pathology-was associated with dual impairment early after stroke, confirming the role of stroke severity in functional decline., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Einstad, Schellhorn, Thingstad, Lydersen, Aamodt, Beyer, Saltvedt and Askim.)

Objective: Attention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of anxiety disorders in children and adolescents. The reasons for this association are poorly understood. Preliminary findings with young adults have suggested that executive functions and functional impairment may mediate the relationship between symptoms of ADHD and mixed anxiety and depressive symptoms. The objective of this study was to explore whether ADHD symptoms, executive functions and functional impairment predict anxiety in a clinical adolescent population. In addition, we investigated the possible mediating role of executive functions and functional impairment in this relationship., Method: One hundred adolescents with ADHD and their parents completed the ADHD Rating Scale IV (ADHD RS-IV), the Behavior Rating Inventory of Executive Function (BRIEF), and the Weiss Functional Impairment Rating Scale (WFIRS) in relation to an RCT study. The adolescents also completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Analyses were conducted using regression and a serial multiple mediator model., Results: In the regression analyses, parent-rated ADHD symptoms were unable to predict anxiety, but ADHD inattention symptoms predicted anxiety in the self-ratings. Executive dysfunction and functional impairment predicted anxiety in both the parent- and self-reports. In the mediation analyses ADHD symptoms alone did not predict anxiety, but executive dysfunction mediated this relationship as expected. Functional impairment mediated this relationship indirectly through executive functions. The results were similar in the parent- and self- reports., Conclusion: The results pinpoint executive dysfunction as an important treatment target for alleviating anxiety in adolescents with impairing ADHD symptoms., Competing Interests: Authors A-LH, AS, and TN have received a speaker's fee and a travel honorarium from Medice during the last 3 years. Author PT has received speakers fee from Medice and Takeda within last 3 years. Author PT has received royalties from several publishers for books on ADHD and related disorders. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Haugan, Sund, Thomsen, Lydersen and Nøvik.)

Background: Cognitive impairment is common after stroke. So is cortical- and subcortical atrophy, with studies reporting more atrophy in the ipsilesional hemisphere than the contralesional hemisphere. The current study aimed to investigate the longitudinal associations between (I) lateralization of brain atrophy and stroke hemisphere, and (II) cognitive impairment and brain atrophy after stroke. We expected to find that (I) cortical thickness and hippocampal-, thalamic-, and caudate nucleus volumes declined more in the ipsilesional than the contralesional hemisphere up to 36 months after stroke. Furthermore, we predicted that (II) cognitive decline was associated with greater stroke volumes, and with greater cortical thickness and subcortical structural volume atrophy across the 36 months., Methods: Stroke survivors from five Norwegian hospitals were included from the multisite-prospective "Norwegian Cognitive Impairment After Stroke" (Nor-COAST) study. Analyses were run with clinical, neuropsychological and structural magnetic resonance imaging (MRI) data from baseline, 18- and 36 months. Cortical thicknesses and subcortical volumes were obtained via FreeSurfer segmentations and stroke lesion volumes were semi-automatically derived using ITK-SNAP. Cognition was measured using MoCA., Results: Findings from 244 stroke survivors [age = 72.2 (11.3) years, women = 55.7%, stroke severity NIHSS = 4.9 (5.0)] were included at baseline. Of these, 145 (59.4%) had an MRI scan at 18 months and 72 (49.7% of 18 months) at 36 months. Most cortices and subcortices showed a higher ipsi- compared to contralesional atrophy rate, with the effect being more prominent in the right hemisphere. Next, greater degrees of atrophy particularly in the medial temporal lobe after left-sided strokes and larger stroke lesion volumes after right-sided strokes were associated with cognitive decline over time., Conclusion: Atrophy in the ipsilesional hemisphere was greater than in the contralesional hemisphere over time. This effect was found to be more prominent in the right hemisphere, pointing to a possible higher resilience to stroke of the left hemisphere. Lastly, greater atrophy of the cortex and subcortex, as well as larger stroke volume, were associated with worse cognition over time and should be included in risk assessments of cognitive decline after stroke., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Aamodt, Lydersen, Alnæs, Schellhorn, Saltvedt, Beyer and Håberg.)

Background: Parental chronic illness is associated with an elevated risk for developing social-emotional and behavioral problems in children, in particular internalizing symptoms. This study aimed to investigate the associations between parental chronic illness when participants were adolescents and subsequent internalizing symptoms in young adulthood and whether adolescent attachment to parents or peers mediates these associations. Methods: The study used longitudinal survey data from the Youth and Mental Health Study, a cohort study including a representative sample of youth in central Norway assessed in the period from 1999 to 2000 (mean age 14.9 years) and in 2012 (mean age 27.2 years) ( N = 1,266). The data consist of youth self-reports at both time points. Parental chronic illness was reported by the adolescents, quality of attachment was measured using the Inventory of Parent and Peer Attachment (IPPA), and internalizing problems were assessed in young adulthood by using the Adult Self-Report (ASR). Data were analyzed using parallel mediation analyses, controlling for adolescent sex, parental socioeconomic status, and divorce. In addition, separate analyses were conducted for adolescent girls and boys. Results: The total longitudinal effect was significant for both maternal and paternal chronic illness on internalizing problems in young adulthood. The direct effect on internalizing problems was only significant for maternal chronic illness. Attachment to fathers partially mediated the relationship between maternal chronic illness in adolescence and internalizing symptoms in young adulthood, whereas attachment to both mothers and fathers fully mediated the relationship between paternal chronic illness in adolescence and internalizing symptoms in young adulthood. A separate analysis for girls and boys indicated that the results were only significant for girls. Parental chronic illness did not play a significant indirect effect via attachment to peers on internalizing problems. Conclusions: Identifying protective factors in the pathways between parental chronic illness and mental distress in children could guide measures that promote the well-being of the child and family. The study demonstrates the importance of targeting the entire family in chronic illness care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kaasbøll, Skokauskas, Lydersen and Sund.)

The effectiveness of the Thrive by Three intervention, a 10-month, multicomponent, in-service professional development model to promote the quality of caregiver-toddler interactions (i.e., process quality), was tested utilizing a clustered randomized controlled design. Eighty childcare centers with 187 toddler classrooms in Norway were randomly assigned to either the Thrive by Three intervention group ( n =87) or a usual-activity wait list control group ( n =100). Interactional quality was assessed with the Toddler version of the Classroom Assessment Scoring System (CLASS-Toddler) at three timepoints: pre-, mid-, and post-intervention. There were significant group differences in change in quality during the intervention period in both CLASS domains, Emotional and Behavioral Support (EBS), and Engaged Support for Learning (ESL), with greater overall differences in the ESL domain. Quality increased in the intervention groups, but quality decreased in the control group from baseline to post-intervention. There were significant group differences in quality at baseline. The Thrive by Three intervention had a positive effect on teacher-toddler interactions in both the EBS and ESL domains. Results need to be replicated preferably in more diverse samples. Clinical Trial Registration: ClinicalTrials.gov #NCT03879733., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Buøen, Lekhal, Lydersen, Berg-Nielsen and Drugli.)

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors ( n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI. Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively). Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI., Competing Interests: IS and A-BK have been investigators in the Boehringer Ingelheim drug trial 1346.0023, and A-BK has also been an investigator for Roche BN29553. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Aam, Gynnild, Munthe-Kaas, Saltvedt, Lydersen, Knapskog, Ihle-Hansen, Ellekjær, Eldholm and Fure.)

Background: Polycystic ovary syndrome (PCOS) and metabolic inflexibility are linked to insulin resistance, and women with PCOS appear to be metabolic inflexible in the rested, insulin-stimulated state. Exercise training is a primary lifestyle intervention in PCOS. Exercise training improves whole-body fat oxidation during submaximal exercise in healthy women, yet little is known about the effect on this outcome in women with PCOS. Methods: We measured whole-body fat oxidation rates during sub maximal exercise before and after 16 weeks of high-intensity interval training (HIT) in women with PCOS randomly allocated to either: low- or high-volume HIT ( n = 41; low-volume HIT, 10 × 1 min work bouts at maximal, sustainable intensity and high-volume HIT, 4 × 4 min work bouts at 90-95% of maximal heart rate) or non-exercise control ( n = 23), and in women without PCOS (Non-PCOS) allocated to low- or high volume HIT ( n = 15). HIT was undertaken three times weekly. In a subset of women with and without PCOS, we measured mitochondrial respiration in abdominal and gluteal subcutaneous adipose tissue using high-resolution respirometry, as well as fat cell sizes in these tissues. Results: At baseline, women with PCOS had lower whole-body fat oxidation and mitochondrial respiration rates in abdominal adipose tissue compared to Non-PCOS. Peak oxygen uptake (mL/min/kg) increased in women with PCOS (~4%, p = 0.006) and Non-PCOS (~6%, p = 0.003) after 16 weeks of HIT. Whole-body fat oxidation only improved in Non-PCOS after HIT. No changes were observed in mitochondrial respiration and cell size in abdominal and gluteal adipose tissue after HIT in either group of women. Conclusion: We observed exercise-induced improvements in whole-body fat oxidation during submaximal exercise in Non-PCOS, but not in women with PCOS, after 16 weeks of HIT, suggesting metabolic inflexibility in women with PCOS. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02419482 and NCT02943291., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lionett, Kiel, Røsbjørgen, Lydersen, Larsen and Moholdt.)

Rationale: Exergaming may be a viable alternative to more traditional exercise. As high-intensity exercise can provide substantial health benefits, the purpose of this study was to investigate the long-term effectiveness of providing inactive adults with access to a high-intensity exergaming platform., Methods: In this study, 52 inactive adults (<150 min of exercise per week), aged 18 years or older, were randomized (1:1) into an exergaming ( N = 27) or a control group ( N = 25). Exergaming participants were given access to the Playpulse exergaming platform for 6 months, where they decided how frequently they wanted to use the platform. The primary outcome measure, analyzed with a mixed model, was peak oxygen uptake (V̇O 2peak ). Secondary outcomes included body composition, blood pressure, and blood markers of cardiometabolic health., Results: Mean V̇O 2peak at 6 months was 42.3 (SD 7.0) mL⋅kg -1 ⋅min -1 and 41.9 (SD 7.4) mL⋅kg -1 ⋅min -1 for the exergaming and control group, respectively with no significant between-group differences (-0.7, 95% CI -2.7 to 1.3, P = 0.49). Apart from increased moderate-intensity physical activity in the exergaming group at 3 months (21.9 min⋅day -1 , 95% CI: 2.2 to 41.5, P = 0.03) compared to the control group, there were no significant between-group differences for any outcome at either 3 or 6 months. On average, participants in the exergaming group performed 12 (SD 13) exergaming sessions with an average heart rate of 74.5 (SD 7.5)% of maximum heart rate, throughout the intervention., Conclusion: Due to low exergaming frequency over the 6-month intervention, exergaming participants showed no significant health benefits compared to control. Our study indicates that although the Playpulse exergaming platform is found enjoyable, this is not enough to motivate inactive adults to regularly engage in exercise and thereby improve health., Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT03513380., (Copyright © 2020 Berg, Wang, Lydersen and Moholdt.)

MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression post-transcriptionally. In women with polycystic ovary syndrome (PCOS), several miRNAs are differentially expressed compared to women without PCOS, suggesting a role for miRNAs in PCOS pathophysiology. Exercise training modulates miRNA abundance and is primary lifestyle intervention for women with PCOS. Accordingly, we measured the expression of eight circulating miRNAs selected a priori along with miRNA expression from gluteal and abdominal adipose tissue (AT) in 12 women with PCOS and 12 women matched for age and body mass index without PCOS. We also determined the miRNA expression "signatures" before and after high-intensity interval training (HIT) in 42 women with PCOS randomized to either: (1) low-volume HIT (LV-HIT, 10 × 1 min work bouts at maximal, sustainable intensity, n = 13); (2) high-volume HIT (HV-HIT, 4 × 4 min work bouts reaching 90-95% of maximal heart rate, n = 14); or (3) non-exercise control (Non-Ex, n = 15). Both HIT groups trained three times/week for 16 weeks. miRNAs were extracted from plasma, gluteal and abdominal AT, and quantified via a customized plate array containing eight miRNAs associated with PCOS and/or exercise training responses. Basal expression of circulating miRNA-27b (c-miR-27b), implicated in fatty acid metabolism, adipocyte differentiation and inflammation, was 1.8-fold higher in women with compared to without PCOS ( P = 0.006) despite no difference in gluteal or abdominal AT miR-27b expression. Only the HV-HIT protocol increased peak oxygen uptake (VO 2 peak L/min; 9%, P = 0.008). There were no changes in body composition. In LV-HIT, but not HV-HIT, the expression of c-miR-27b decreased (0.5-fold, P = 0.007). None of the remaining seven circulating miRNAs changed in LV-HIT, nor was the expression of gluteal or abdominal AT miRNAs altered. Despite increased cardiorespiratory fitness, HV-HIT did not alter the expression of any circulating, gluteal or abdominal AT miRNAs. We conclude that women with PCOS have a higher basal expression of c-miR-27b compared to women without PCOS and that 16 weeks of LV-HIT reduces the expression of this miRNA in women with PCOS. Intense exercise training had little effect on the abundance of the selected miRNAs within subcutaneous AT depots in women with PCOS., (Copyright © 2020 Lionett, Kiel, Camera, Vanky, Parr, Lydersen, Hawley and Moholdt.)

Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile. Methods: Stroke survivors ( n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR). Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51-0.66) and 0.51 (0.52-0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001). Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation., (Copyright © 2020 Aam, Einstad, Munthe-Kaas, Lydersen, Ihle-Hansen, Knapskog, Ellekjær, Seljeseth and Saltvedt.)

The aims of this study were to investigate visual-construction and organizational strategy among individuals with severe obesity, as measured by the Rey Complex Figure Test (RCFT), and to examine the validity of the Q-score as a measure for the quality of performance on the RCFT. Ninety-six non-demented morbidly obese (MO) patients and 100 healthy controls (HC) completed the RCFT. Their performance was calculated by applying the standard scoring criteria. The quality of the copying process was evaluated per the directions of the Q-score scoring system. Results revealed that the MO did not perform significantly lower than the HC on Copy accuracy (mean difference -0.302, CI -1.374 to 0.769, p = 0.579). In contrast, the groups did statistically differ from each other, with MO performing poorer than the HC on the Q-score (mean -1.784, CI -3.237 to -0.331, p = 0.016) and the Unit points (mean -1.409, CI -2.291 to -0.528, p = 0.002), but not on the Order points score (mean -0.351, CI -0.994 to 0.293, p = 0.284). Differences on the Unit score and the Q-score were slightly reduced when adjusting for gender, age, and education. This study presents evidence supporting the presence of inefficiency in visuospatial constructional ability among MO patients. We believe we have found an indication that the Q-score captures a wider range of cognitive processes that are not described by traditional scoring methods. Rather than considering accuracy and placement of the different elements only, the Q-score focuses more on how the subject has approached the task.

Executive functions are often affected in autism spectrum disorders (ASD). The underlying biology is however not well known. In the DSM-5, ASD is characterized by difficulties in two domains: Social Interaction and Repetitive and Restricted Behavior, RRB. Insistence of Sameness is part of RRB and has been reported related to executive functions. We aimed to identify differences between ASD and typically developing (TD) adolescents in Event Related Potentials (ERPs) associated with response preparation, conflict monitoring and response inhibition using a cued Go-NoGo paradigm. We also studied the effect of age and emotional content of paradigm related to these ERPs. We investigated 49 individuals with ASD and 49 TD aged 12-21 years, split into two groups below (young) and above (old) 16 years of age. ASD characteristics were quantified by the Social Communication Questionnaire (SCQ) and executive functions were assessed with the Behavior Rating Inventory of Executive Function (BRIEF), both parent-rated. Behavioral performance and ERPs were recorded during a cued visual Go-NoGo task which included neutral pictures (VCPT) and pictures of emotional faces (ECPT). The amplitudes of ERPs associated with response preparation, conflict monitoring, and response inhibition were analyzed. The ASD group showed markedly higher scores than TD in both SCQ and BRIEF. Behavioral data showed no case-control differences in either the VCPT or ECPT in the whole group. While there were no significant case-control differences in ERPs from the combined VCPT and ECPT in the whole sample, the Contingent Negative Variation (CNV) was significantly enhanced in the old ASD group ( p = 0.017). When excluding ASD with comorbid ADHD we found a significantly increased N2 NoGo ( p = 0.016) and N2-effect ( p = 0.023) for the whole group. We found no case-control differences in the P3-components. Our findings suggest increased response preparation in adolescents with ASD older than 16 years and enhanced conflict monitoring in ASD without comorbid ADHD during a Go-NoGo task. The current findings may be related to Insistence of Sameness in ASD. The pathophysiological underpinnings of executive dysfunction should be further investigated to learn more about how this phenomenon is related to core characteristics of ASD.