Cognitive trajectories after surgery: Guideline hints for assessment and treatment.

Elderly patients who undergo major surgery (not-neurosurgical) under general anaesthesia frequently complain about cognitive difficulties, especially during the first weeks after surgical "trauma". Although recovery usually occurs within a month, about one out of four patients develops full-blown postoperative Neurocognitive disorders (NCD) which compromise quality of life or daily autonomy. Mild/Major NCD affect approximately 10% of patients from three months to one year after major surgery. Neuroinflammation has emerged to have a critical role in the postoperative NCDs pathogenesis, through microglial activation and the release of pro-inflammatory cytokines which increase blood-brain-barrier permeability, enhance movement of leukocytes into the central nervous system (CNS) and favour the neuronal damage. Moreover, pre-existing Mild Cognitive Impairment, alcohol or drugs consumption, depression and other factors, together with several intraoperative and post-operative sequelae, can exacerbate the severity and duration of NCDs. In this context it is crucial rely on current progresses in serum and CSF biomarker analysis to frame neuroinflammation levels, along with establishing standard protocol for neuropsychological assessment (with specific set of tools) and to apply cognitive training or neuromodulation techniques to reduce the incidence of postoperative NCDs when required. It is recommended to identify those patients who would need such preventive intervention early, by including them in pre-operative and post-operative comprehensive evaluation and prevent the development of a full-blown dementia after surgery. This contribution reports all the recent progresses in the NCDs diagnostic classification, pathogenesis discoveries and possible treatments, with the aim to systematize current evidences and provide guidelines for multidisciplinary care.

Activity-Based Prospective Memory in Insomniacs.

OBJECTIVE: To investigate the activity-based prospective memory performance in patients with insomnia, divided, on the basis of actigraphic evaluation, into sleep onset, maintenance, mixed and negative misperception insomnia. METHODS: A total of 153 patients with insomnia (I, 83 females, mean age + SD = 41.37 + 16.19 years) and 121 healthy controls (HC, 78 females, mean age + SD = 36.99 + 14.91 years) wore an actigraph for one week. Insomnia was classified into sleep onset insomnia (SOI), maintenance insomnia (MaI), mixed insomnia (MixI) and negative misperception insomnia (NMI). To study their activity-based prospective memory performance, all the participants were required to push the actigraph event marker button twice, at bedtime (task 1) and at get-up time (task 2). RESULTS: Only patients with maintenance and mixed insomnia had a significantly lower accuracy in the activity-based prospective memory task at get-up time compared with the healthy controls. CONCLUSION: The results show that maintenance and mixed insomnia involve an impaired activity-based prospective memory performance, while sleep onset and negative misperception insomnia do not seem to be affected. This pattern of results suggests that the fragmentation of sleep may play a role in activity-based prospective memory efficiency at wake-up in the morning.

External validity of the reduced Morningness-Eveningness Questionnaire for Children and Adolescents: an actigraphic study.

The aim of this study was to examine the external validity of the reduced Morningness-Eveningness Questionnaires for Children and Adolescents, using circadian motor activity, assessed through actigraphy, as an external criterion. Overall, 458 participants (269 females), with a mean (standard deviation) age of 15.75 (1.16) years, took part in this study. Each adolescent was requested to wear the actigraph Micro Motionlogger Watch actigraph (Ambulatory Monitoring, Inc., Ardlsey, NY, USA) around the non-dominant wrist for 1 week. At the end of the actigraphic recording, participants completed the reduced Morningness-Eveningness Questionnaires for Children and Adolescents. We extracted the motor activity counts, minute-by-minute over the 24 h, to depict the 24-h motor activity pattern, and we adopted the statistical framework of functional linear modelling to examine its changes according to chronotype. According to the reduced Morningness-Eveningness Questionnaires for Children and Adolescents cut-off scores, 13.97% of participants (n = 64) belonged to the evening-types category, 9.39% (n = 43) to morning-types, while the remaining (76.64%, n = 351) to the intermediate-types category. Evening types moved significantly more than the intermediate and morning types from around 10:00 p.m. to 2:00 a.m., while the opposite pattern of results was observed around 4:00 a.m. The results highlighted a significant difference in the 24-h motor activity pattern between chronotypes, in line with the expectations based on their well-known behaviour. Therefore, this study shows that the external validity of the reduced Morningness-Eveningness Questionnaire for Children and Adolescents, established by considering motor activity (recorded through actigraphy) as an external criterion, is satisfactory.

Activity-Based Prospective Memory in ADHD during Motor Sleep Inertia.

Prospective memory (PM) is essential in everyday life because it concerns the ability to remember to perform an intended action in the future. Individuals diagnosed with attention deficit hyperactivity disorder (ADHD) often show poor performance in PM. Because age can be confounding, we decided to test PM in ADHD patients (children and adults) and healthy controls (children and adults). We examined 22 children (four females; mean age = 8.77 ± 1.77) and 35 adults (14 females; mean age = 37.29 ± 12.23) with ADHD, in addition to 92 children (57 females; mean age = 10.13 ± 0.42) and 95 adults (57 females; mean age = 27.93 ± 14.35) as healthy controls. Each participant originally wore an actigraph around the non-dominant wrist and was requested to push the event-marker at get-up time. To assess the efficiency of PM performance, we calculated the time elapsing between the end of sleep in the morning and the pushing of the event-marker button. The results showed lower PM performance in ADHD participants, regardless of age. However, the differences between ADHD and control groups were more evident in the children group. Our data seem to confirm that PM efficiency is compromised in individuals diagnosed with ADHD regardless of age, and agree with the idea of considering the PM deficit as a neuropsychological marker of ADHD.

Correspondence effect driven by salient visual asymmetries in integral object stimuli.

The handle-to-hand correspondence effect consists of faster and more accurate responses when the responding hand is aligned with the handle side of an object tool, compared to when they lay on opposite sides. This effect has been attributed to the activation of affordances. Recent studies, however, claimed that it may depend on the spatial coding of the object on the basis of its visual asymmetry (location-coding account). Affordances are namely direct and meaningful relations between recognized objects and the observers' action system. Therefore, any manipulation that disrupts the body structure of object tools could potentially affect their identification and prevent the activation of affordances. The present study investigated the nature of the handle-to-hand correspondence effects by manipulating structural asymmetry and visual salience of object tools, while preserving their integrity that is, leaving unaltered the original possibilities to activate grasping affordances. Three experiments were run. Results were consistent with the location-coding account and claim for accurate control of visual asymmetries in object stimuli during investigation of affordance effects.

Do already grasped objects activate motor affordances?

This study investigated whether in a stimulus-response compatibility (SRC) task affordance effects in response to picture of graspable objects emerge when these objects appear as already grasped. It also assessed whether the observed effects could be explained as due to spatial compatibility between the most salient part in the object/display and the hand of response rather than to action potentiation. To this aim, we conducted three behavioural experiments in which participants were required to discriminate the vertical orientation (upright vs. inverted) of an object presented in the centre of the screen, while ignoring the right-left orientation of its handle. The object could be presented alone, as already grasped, as partially masked (Experiment 1) or with a human hand close to its graspable side (Experiment 2). In addition, to assess the role of perceptual salience, the object could be presented with a human hand or a non-biological (a geometrical shape) distractor located opposite to the object's graspable side. Results showed faster responses when the object's handle was located on the same side of the responding hand with a larger effect when upright objects were shown as already grasped (Experiment 1) or when a hand was displayed close to its handle (Experiment 2), and a smaller reversed effect when the hand or the geometrical shape was located opposite to the handled side (Experiment 3). We interpreted these findings as indicating that handle orientation effects emerging in SRC tasks may result from the interplay between motor affordance and spatial compatibility mechanisms.

Influence of time-of-day on joint Navon effect.

The shared attention theory suggests that people devote greater cognitive resources to those features co-attended simultaneously with others, determining better performance in several types of tasks. When co-actors performed a go/no-go Navon task attending different features of target letters, the performance was impaired, reflecting a joint Navon effect (the representation of a co-actor's attentional focus made it more difficult to select and apply one's own focus of attention), probably due to asynchronous co-attention with a decrease in cognitive resources involved. Researches in chronobiology and chronopsychology demonstrated that not only selective attention (involved in a Navon task), but also cognitive resources have a daily fluctuations, mainly paralleling the circadian rhythm of body temperature (i.e. increasing values from the morning to evening with a subsequent decline in the night). The study was conducted to assess whether the presence of joint attention, as measured by the joint Navon effect, was influenced by the time-of-day. Sixteen pairs of participants sitting next to each other were required to respond to the identity letters in a go/no-go Navon task twice: in the morning (09:00-10:00) and early afternoon (13:00-14:00). The results showed a joint Navon effect in the morning session only, suggesting that joint attention was affected by the time-of-day effect on cognitive resources.

Synchrony effect on joint attention.

Research on joint attention has demonstrated that individuals are sensitive to a coactor's attentional relation to jointly attended stimuli. Within a chronobiological approach, a study was conducted to assess whether the presence of joint attention, as measured by the joint Navon effect, was influenced by the synchrony effect. Pairs of participants sitting next to each other were required to respond to the identity letters in a go/no-go Navon task. The joint Navon task was performed by morning, intermediate and evening types (81 pairs) at different times of day (09:00-10:00; 13:00-14:00; 17:00-18:00). The joint Navon effect on task performance was highlighted at the optimal time of day (in the morning for morning types, in the early afternoon for intermediate types and in the evening for evening types), but it disappeared or decreased at the non-optimal time of day, with the exception of evening types. The results demonstrated that joint attention was affected by the synchrony effect.

24-h actigraphic monitoring of motor activity, sleeping and eating behaviors in underweight, normal weight, overweight and obese children.

PURPOSE: Within a chronobiological perspective, the present study aimed to describe 24 h of sleep-wake cycle, motor activity, and food intake patterns in different body mass index (BMI) categories of children through 7 days of actigraphic recording. METHODS: Height and weight were objectively measured for BMI calculation in a sample of 115 Italian primary schoolchildren (10.21 ± 0.48 years, 62.61 % females). According to BMI values, 2.60 % were underweight, 61.70 % were of normal weight, 29.60 % were overweight and 6.10 % were obese. Participants wore a wrist actigraph continuously for 7 days to record motor activity and describe sleep-wake patterns. In addition, participants were requested to push the event-marker button of the actigraph each time they consumed food to describe their circadian eating patterns. RESULTS: BMI group differences were found for sleep quantity (i.e. midpoint of sleep and amplitude), while sleep quality, 24-h motor activity and food intake patterns were similar between groups. Regression analyses showed that BMI was negatively predicted by sleep duration on schooldays. BMI was also predicted by motor activity and by food intake frequencies recorded at particular times of day during schooldays and at the weekend. CONCLUSIONS: The circadian perspective seems to provide promising insight into childhood obesity, but this aspect needs to be further explored.

Circadian typology and the Alternative Five-Factor Model of personality.

Two studies were carried out to explore the relationship between circadian typology and the Alternative Five-Factor Model of personality. In the first study, 379 participants (232 females) were administered the reduced version of the Morningness-Eveningness Questionnaire and the Zuckerman-Kuhlman Personality Questionnaire. Evening types reported higher impulsive sensation-seeking scores than morning and intermediate types, whereas morning types scored higher than evening types on activity factor. In the second study, the association between morningness and activity personality factor was verified through the objective-actigraphic monitoring of the rest-activity cycle. Actigraphy allowed us to operationalise both circadian typology, through the computing of midpoint of sleep (early values, expressed in hours and minutes, correspond to an advanced phase of the sleep/wake cycle), and activity factor by the means of motor activity recording. Fifty-one individuals (30 females) wore an actigraph on the nondominant wrist continuously for 1 week. A negative correlation was observed between midpoint of sleep and mean diurnal motor activity, demonstrating that an early phase of the sleep/wake cycle (i.e. morningness preference) was related to higher diurnal motor activity. Assessed both subjectively and objectively, the results of both studies highlight a significant relationship between morningness and activity personality factor.

The consensus sleep diary: quantitative criteria for primary insomnia diagnosis.

OBJECTIVE: The aim of the study was to put forward quantitative criteria for the Consensus Sleep Diary, to differentiate people with insomnia from normal sleepers. METHODS: In this retrospective study, we analyzed 295 sleep diaries of patients with primary insomnia (43% were male, ages ranging between 17 and 76 years) collected in two clinical centers for insomnia and 536 sleep diaries of normal sleepers (47% were male, ages ranging between 15 and 82 years). We considered the following sleep parameters: time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, terminal wakefulness, and subjective feeling of rest. Using the Youden index, we calculated the quantitative criteria that performed best for each sleep parameter. Finally, we created receiver operating characteristic curves to test the accuracy of each identified criterion. RESULTS: Individuals with insomnia significantly differed from controls on all sleep indices (p < .001). Differentiation between individuals with insomnia from controls was optimal for terminal wakefulness (>15 minutes, area under the curve [AUC] = 0.83), wake after sleep onset (cutoff >20 minutes, AUC = 0.81), total sleep time (<390 minutes, AUC = 0.80), and particularly sleep efficiency (<87.5%, AUC = 0.92, sensitivity = 0.80, specificity = 0.90). Time in bed was the least differentiating variable (<500 minutes, AUC = 0.57). CONCLUSIONS: The quantitative criteria of the sleep diary in this study agree with the few available data in the literature. This confirms that the sleep diary could be a useful screening tool for assessing patients with primary insomnia.

Effects of dawn simulation on attentional performance in adolescents.

PURPOSE: This study aimed at examining the effects of 2 weeks of dawn simulation on attentional performance in adolescents. METHODS: On the whole, 56 adolescents (24 females and 32 males) took part to the study, with a mean age of 17.68 ± 0.97 years (age ranging between 15 and 20 years). Each adolescent was requested to participate for 5 consecutive weeks and the research design included the baseline and two counterbalanced conditions, dawn simulator and control (no dawn simulator). Attentional performance of adolescents was measured through the attention network test (ANT) that allowed assessing the efficiency of three separable attentional networks, namely alerting, orienting and executive. Overall, participants performed the ANT three times (i.e., one time for each condition), while sleep quality, sleep duration and sleep timing were concurrently monitored by means of actigraphy and were treated as potential confounders. RESULTS: The only improvement of the attentional performance attributable to the use of dawn simulator was observed for the efficiency of alerting network (45.97 ± 32.76 ms) that significantly increased in comparison to the baseline (31.57 ± 26.97 ms) (p < 0.05). On the contrary, the sleep quality, sleep quantity and sleep timing did not significantly change. CONCLUSION: These results show for the first time that, controlling for sleep quality, sleep duration and sleep timing, the use of dawn simulator across 2 weeks is able to determine an alerting effect in adolescents.

Remember to do: insomnia versus control groups in a prospective memory task.

Primary insomnia is characterized by difficulty in falling asleep and/or remaining asleep, by early morning awakening and/or nonrestorative sleep, and resultant daytime dysfunction in the absence of specific physical, mental, or substance-related causes. However, the studies on daytime cognitive functioning of insomnia patients report inconclusive results. This retrospective study aimed to compare the performance of insomnia patients (N = 54) to that of controls (N = 113) in a naturalistic prospective memory task. Task performance was defined by the percentage of times the event-marker button of an actigraph was pressed, at lights-off time and at wake-up time. The performance pattern in the prospective memory task was similar in both groups. In addition, the task was performed better at lights-off time than at wake-up time regardless of group. Post-hoc subgroup analysis showed that there were more insomnia patients who performed the task perfectly (i.e., 100%) than controls. Performance at wake-up time was significantly correlated to objective sleep quality (i.e., sleep efficiency) only in insomnia patients.

Psychometric goodness of the Mini Sleep Questionnaire.

AIM: The current study was conducted to evaluate the psychometric properties and analyze the convergent validity of the Italian version of the Mini Sleep Questionnaire (MSQ). In addition, it was aimed to put forward cut-off values to be used in screening protocols. METHODS: The MSQ was administered to 1830 participants (age range 18-87 years), of whom 1208 also completed the Sleep Disorder Questionnaire (age range 18-87 years). A subgroup of 187 (age range 18-71 years) participants was randomly chosen to test the test-retest reliability. A complete psychometric evaluation was performed on the MSQ. To study the validity of the tool, the Sleep Disorder Questionnaire was used as an external criterion to validate the MSQ. Using the Youden index, we calculated the cut-off values that performed best. Finally, we created receiver-operator curves to test the accuracy of each cut-off value identified. RESULTS: For the MSQ, Cronbach's alpha score was 0.77 while homogeneity was 0.26. Factorial analyses confirmed the presence of two dimensions: sleep (Cronbach's alpha 0.75; homogeneity 0.37) and wake (Cronbach's alpha 0.75; homogeneity 0.44). For each dimension, a cut-off value was identified (>16 and >14, respectively). Both cut-off values obtained an area under the curve higher than 0.80. CONCLUSIONS: Psychometric evaluation of the MSQ was satisfactory. The cut-off values analyzed in the present study showed good performance. On the whole, the results of this study suggest that the MSQ can be a useful screening tool.

A more accurate assessment of circadian typology is achieved by asking persons to indicate their preferred times rather than comparing themselves with most people.

The aim of the present work was to compare two circadian questionnaires: the Preference Scale (PS) and the reduced version of the Morningness-Eveningness Questionnaire (rMEQ). A sample of 849 (35.10% men) university students, 421 of whom were Spanish (27.55% men; mean age 21.07 + 2.31) and 428 Italian (42.52% men; mean age 23.26 + 3.01), were administered both questionnaires. Gender (higher morningness in women) and nationality (higher eveningness in Spaniards) differences were replicated with rMEQ but not with PS, in which an inverse association between nationality and circadian preference was observed (i.e. higher morningness in Spaniards). Taking into account that the formulation of the rMEQ items, with its specific times, makes the answers less influenced by socio-cultural bias, we conclude that rMEQ is preferable to PS when evaluating circadian preference in young adults.

Pentatonic sequences and monaural beats to facilitate relaxation: an EEG study.

Introduction: In two studies we investigated if specific acoustic stimulations could be more effective to induce a relaxation response in comparison to silence. Acoustic stimulations included monaural beats and musical sequences based on a pentatonic scale. Methods: In the first study, 47 participants evaluated monaural beats and pentatonic sequences presented through loudspeakers and varying along three frequencies (0.2, 2, 4 Hz). In the second study, 31 participants relaxed with their eyes closed for 10 min during a passive listening of monaural beats and a pentatonic sequence presented through loudspeakers. A silence condition was introduced as control. All auditory stimuli were designed with a temporal modulation of 0.2 Hz. Concomitant EEG was recorded with a 64-channel system and spectral analysis was performed on delta, theta, alpha, beta, and gamma oscillations to test if each of the three auditory stimulations had a significant effect on EEG spectral power in comparison to silence. Results: In the first study, pentatonic sequences were evaluated as more pleasant and more relaxing than monaural beats. Pleasantness and relaxation were inversely related to frequency. Visual imagery and emotion induction had higher frequency and were rated with a more positive valence in pentatonic sequences than in monaural beats. In the second study monaural beats in comparison to silence strongly decreased beta and gamma oscillations in the first three minutes and strongly increased theta oscillations in the last three minutes. Pentatonic sequences increased delta, theta, and alpha oscillations in the last three minutes while decreasing beta, and gamma oscillations for the whole auditory stimulation. Discussion: The results show that auditory signals with a very low temporal modulation (0.2 Hz) could be more effective than silence in inducing a relaxation response. Although 0.2 Hz monaural beats were effective in inducing a relaxation response, they tended to be perceived as unpleasant. Pentatonic sequences could be considered as a better alternative to promote relaxation by auditory stimulation.

Month of birth and mood seasonality: a comparison between countries in the northern and southern hemispheres.

AIMS: A previous study has reported a significant month-of-birth effect on mood seasonality in the northern hemisphere. Higher mood seasonality was observed for university students born during spring or summer months (long photoperiod) compared to those born during autumn or winter months (short photoperiod). The aim of this study was to test the hypothesized photoperiod effect by comparing the correlation between month of birth and mood seasonality in two countries located at the opposite poles of the terrestrial globe: Italy (northern hemisphere) and New Zealand (southern hemisphere). On the basis of the photoperiod-at-birth hypothesis, we expected to find higher mood seasonality among individuals born in months with longer photoperiods in both countries. METHODS: The Seasonal Pattern Assessment Questionnaire was administered to 1514 young adults (1088 women, 426 men; 1027 Italians, 487 New Zealanders), with ages ranging from 18 to 34 years. The Global Seasonality Score, which is a measure of mood seasonality, was calculated from the Seasonal Pattern Assessment Questionnaire. RESULTS: A significant overall month-of-birth effect was observed on the Global Seasonality Score, but only for men. Men born in April and August (corresponding in Italy to a long photoperiod, in New Zealand to a short photoperiod) had higher mood seasonality than those born in February, regardless of country. CONCLUSIONS: A significant month-of-birth effect was found on mood seasonality, but results do not support the hypothesis based on the photoperiod effect.

The Association between Sleep Patterns, Educational Identity, and School Performance in Adolescents.

Adolescents' school experience can be developmentally related to adolescents' sleep. This study aimed to understand how sleep patterns (i.e., sleep duration and sleep-schedule) and weekend sleep-recovery strategies (i.e., social jetlag and weekend catch-up sleep) are associated with adolescents' school experience (i.e., educational identity and school performance). Moreover, the differences in the school experiences between adolescents with different numbers of weekend-sleep-recovery strategies were assessed. For this purpose, 542 Italian adolescents (55.2% females, mean age 15.6 years) wore an actigraph for one week. After the actigraphic assessment, questionnaires on educational identity and school performance were administered. Results showed that short sleep-duration, later bedtime during weekdays and weekends, and a higher amount of social jetlag were negatively associated with school performance. Furthermore, adolescents who did not use any sleep-recovery strategy during the weekend presented lower levels of educational in-depth exploration compared to adolescents with higher levels of catch-up sleep but not social jetlag. These data pointed out a potentially detrimental role of social jetlag on school performance and differences in identity processes between adolescents who used and those who did not use sleep-recovery strategies, which could affect adolescents' psychosocial adjustment.

The Longitudinal Interplay between Sleep, Anthropometric Indices, Eating Behaviors, and Nutritional Aspects: A Systematic Review and Meta-Analysis.

Sleep is fundamental for adolescents' healthy development but undergoes dramatic changes in quantity and quality due to the conflict between biological and social rhythms. Insufficient sleep has been associated with worse physical health status and irregular eating behaviors in adolescents. This review aims to systematically synthesize the longitudinal associations between adolescents' sleep dimensions (i.e., duration, timing, quality, and insomnia symptoms) and physical health indicators (i.e., anthropometric indices, fat percentage, and risk of obesity), eating behaviors, and nutritional aspects (i.e., type of diet related to the intake of specific foods and nutrients, amount and timing of food consumption, energy expenditure). A total of 28 longitudinal studies were included. The meta-analytic results showed that longer sleep duration, better sleep quality, and lower insomnia symptoms were associated with lower BMI and fat percentage and that shorter sleep duration (<7 h) and lower sleep quality were associated with a higher risk of obesity. Conversely, anthropometric indices were not related to sleep over time. Limited literature examined the bidirectional association between adolescents' sleep and their eating behaviors and nutritional aspects. Such knowledge sheds new light on the role of sleep for adolescents' health, highlighting the need to examine further the interplay between these variables.

Gender composition of pairs influences joint action effect.

Research on joint action has demonstrated that individuals are sensitive to a coactor's attentional relation to jointly attend stimuli. It has also been suggested that some features are necessary to resolve the discrimination problem (i.e., self-own and other-own actions). In the present study, we aimed to test whether the gender composition of interacting pairs modulated the joint action effect. Same- (female-female or male-male) and mixed- (female-male) gender pairs performed a joint version of flanker tasks in Experiment 1 (90 participants, 50% males), while in Experiment 2 (154 participants, 50% males) Navon tasks were performed. In Experiment 1, a higher joint flanker effect in same-gender pairs than in mixed-gender pairs, and this joint effect was similar to the classical flanker effect reported by males and females in a classical procedure of the task (70 participants, 50% males). In Experiment 2, the same-gender pairs reported a joint Navon effect, which was reversed in mixed-gender pairs. In conclusion, our findings support how the gender composition of interacting pairs plays a role in joint attentional tasks.