Does neurocognition contribute to age-related deficits in the online navigation of electronic patient health portals?

OBJECTIVE: The internet serves an increasingly critical role in how older adults manage their personal health. Electronic patient portals, for example, provide a centralized platform for older adults to access lab results, manage prescriptions and appointments, and communicate with providers. This study examined whether neurocognition mediates the effect of older age on electronic patient portal navigation. METHOD: Forty-nine younger (18-35 years) and 35 older adults (50-75 years) completed the Test of Online Health Records Navigation (TOHRN), which is an experimenter-controlled website on which participants were asked to log-in, review laboratory results, read provider messages, and schedule an appointment. Participants also completed a neuropsychological battery, self-report questionnaires, and measures of health literacy and functional capacity. RESULTS: Mediation analyses revealed a significant indirect effect of older age on lower TOHRN accuracy, which was fully mediated by the total cognitive composite. CONCLUSIONS: Findings indicate that neurocognition may help explain some of the variance in age-related difficulties navigating electronic patient health portals. Future studies might examine the possible benefits of both structural (e.g., human factors web design enhancement) and individual (e.g., training and compensation) cognitive supports to improve the navigability of electronic patient health portals for older adults.

A pilot study of cognition and creativity among persons with HIV disease referred for neuropsychological evaluation.

Creativity can help people to innovate, overcome obstacles, and successfully navigate challenges in daily life. Some aspects of creativity rely on the prefrontostriatal loops and executive functions, which can be compromised in persons with HIV (PWH). This pilot study examined whether neuropsychological functioning plays a role in creativity in PWH. A consecutive series of 41 PWH who were referred to an urban neuropsychology clinic in southeastern Texas were enrolled. Participants completed the Abbreviated Torrance Test for Adults (ATTA) to measure creativity, from which standardized creativity scores of fluency, originality, elaboration, and flexibility were derived. Participants also completed several measures of everyday functioning and a brief clinical neuropsychological battery measuring executive functions, motor skills, memory, and visuoconstruction. Global neuropsychological functioning showed a large, positive association with ATTA creativity performance that did not vary meaningfully by creativity domain and was independent of premorbid IQ. ATTA creativity scores were not associated with any measure of everyday functioning. Findings from this pilot study suggest that higher levels of neuropsychological functioning may support multiple dimensions of creativity in adults with HIV disease. Future studies might examine whether creativity moderates the association between HIV-associated neurocognitive impairment and various health behaviors (e.g., adherence, appointment attendance).

Age and neurocognition are associated with credibility evaluations of health websites.

The internet has become a common means by which many older adults seek out health information. The prevalence of misinformation on the internet makes the search for accurate online health information a more complex and evaluative process. This study examined the role of age and neurocognition in credibility evaluations of credible and non-credible health websites. Forty-one older adults and fifty younger adults completed a structured credibility rating task in which they evaluated a series of webpages displaying health information about migraine treatments. Participants also completed measures of neurocognition, internet use, and health literacy. Results suggested that older adults rated non-credible health websites as more credible than younger adults, but the age groups did not differ in their ratings of credible sites. Within the full sample, neurocognition was associated with credibility ratings for non-credible health websites, whereas health literacy was related to the ratings of credible sites. Findings indicate that older adults may be more likely to trust non-credible health websites than younger adults, which may be related to differences in higher-order neurocognitive functions. Future work might examine whether cognitive-based supports for credibility training in older adults can be used to improve the accuracy with which they evaluate online health information.

Neuropsychological aspects of internet-based transit navigation skills in older adults.

Older adults commonly experience difficulties efficiently searching the Internet, which can adversely affect daily functioning. This study specifically examined the neuropsychological aspects of online transit planning in 50 younger (M = 22 years) and 40 older (M = 64 years) community-dwelling adults. All participants completed a neuropsychological battery, questionnaires, and measures of Internet use and skills. Participants used a live transit planning website to complete three inter-related tasks (e.g., map a route from an airport to a specific hotel at a particular time). On a fourth Internet transit task, participants were randomized into either a support condition in which they received brief goal management training or into a control condition. Results showed that older adults were both slower and less accurate than their younger counterparts in completing the first three Internet transit tasks. Within the older adults, Internet transit accuracy showed a medium association with verbal memory, executive functions, and auditory attention, but not visuomotor speed, which was the only domain associated with Internet transit task speed in both groups. The goal management training was beneficial for plan development in younger, but not older adults. The planning supports did not impact actual Internet transit task performance in either group. Findings indicate that older adults experience difficulties quickly and accurately using a transit website to plan transportation routes, which is associated with poorer higher-order neurocognitive functions (e.g., memory). Future work might examine the benefits of established memory strategies (e.g., spaced retrieval practice) for online transit planning.

Gender disparities in the author bylines of articles published in clinical neuropsychology journals from 1985 to 2019.

Objective: Women are becoming more prevalent in clinical neuropsychology, but gender bias and disparities persist across multiple professional domains. This study examined potential gender disparities in historical authorship trends across commonly read journals in clinical neuropsychology. Method: Analyses were conducted on 10,531 articles published in six clinical neuropsychology journals from 1985 to 2019. Each author was coded as either a man or a woman using the OpenGenderTracking Project database. Results: On average, women comprised 43.3% (±30.6) of the authors listed in clinical neuropsychology article bylines and were lead and/or corresponding author on 50.3% of these papers. Findings varied by journal, with Child Neuropsychology having the best representation of women across several study metrics. Women comprised an increasing proportion of authors over time and the gender gap in clinical neuropsychology is smaller than was recently reported for the broader field of psychology; nevertheless, the recent rates of women as authors lag behind the prevalence of women in clinical neuropsychology. Encouragingly, gender was not associated with the number of times an article was cited. Articles that included women in leadership roles had significantly more authors overall and specifically more women authors. Conclusions: Women are under-represented as authors in clinical neuropsychology journals, but they are becoming more common and their papers are cited just as frequently as men. Efforts to increase women as research mentors and sponsors may help to further close the publishing gender gap in clinical neuropsychology.

Internet navigation skills for financial management: Associations with age, neurocognitive performance, and functional capacity.

Objective: Online banking is becoming increasingly common among middle-aged and older adults, who may experience difficulties effectively navigating this sometimes complicated technology. This study examined age effects on a performance-based internet banking task and its association with neurocognitive, functional, and numerical abilities. Method: Thirty-five older adults (age 51-75) and 50 younger adults (age 18-32) completed an experimenter-controlled online banking measure in which they independently performed a series of naturalistic financial tasks (e.g., account transfers, bill paying). Participants also completed standardized tests of cognition, numeracy, and functional capacity. Results: Older adults were markedly slower and less accurate in completing the internet-based banking task, which was not confounded by other demographic, mood, or computer use factors. Higher scores on measures of neurocognition, numeracy, and financial functional capacity were both strongly associated with higher internet-based banking among older, but not younger adults. Conclusions: Findings suggest that older adults experience difficultly quickly and accurately navigating online banking platforms, which may be partly related to age-related declines in neurocognitive functions and basic financial capacity. Future studies might examine whether neurocognitive approaches to remediation and compensation can be used to improve online banking capacity in older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Older age and online health information search behaviors: The mediating influence of executive functions.

INTRODUCTION: Searching the internet for health-related information is a complex and dynamic goal-oriented process that ostensibly places demands on executive functions, which are higher-order cognitive abilities that can deteriorate with older age. This study examined the effects of older age on electronic health (eHealth) search behavior and the potential mediating influence of executive functions. METHOD: Fifty younger adults (≤ 35 years) and 41 older adults (≥50 years) completed naturalistic eHealth search tasks involving fact-finding (Fact Search) and symptom determination (Symptom Search), a neurocognitive battery, and a series of self-report questionnaires. RESULTS: Multiple regression models controlling for potentially confounding psychiatric symptoms, health conditions, literacy, and demographic variables revealed that older adults were slower and less accurate than younger adults on the eHealth Fact Search task, but not on the eHealth Symptom Search task. Executive functions mediated the relationship between age and Fact and Symptom Search accuracy, independent of basic processing speed and attention. Parallel mediation models showed that episodic memory was not an independent mediator of age and search accuracy for either eHealth task once speed/attention and executive functions were included. CONCLUSIONS: Older adults can experience difficulty searching the internet for some health-related information, which is at least partly attributable to executive dysfunction. Future studies are needed to determine the benefits of training in the organizational and strategic aspects of internet search for older adults and whether these findings are applicable to clinical populations with executive dysfunction.

Latent Structure of a Brief Clinical Battery of Neuropsychological Tests Administered In-Home Via Telephone.

OBJECTIVE: To examine the factor structure and sociodemographic correlates of a battery of clinical neuropsychological tests administered in-home and via telephone. METHOD: Participants included 280 healthy adults who completed a 35-40 min battery consisting of seven auditory-verbal neuropsychological tests (i.e., 10 variables) that included digit span, list learning and memory, prospective memory, verbal fluency, and oral trail making. RESULTS: After removing oral trail making part A, a three-factor model comprised of executive functions, memory and attention demonstrated the best fit to the data. Nevertheless, the shared variance between the nine remaining neuropsychological variables was also adequately explained by a single-factor model and a two-factor model comprised of executive functions and memory. Factor scores were variably associated with education, race/ethnicity, and IQ, but not with sex or age. CONCLUSIONS: Findings provide preliminary support for the feasibility and factor structure and sociodemographic correlates of a brief telephone-based screening neuropsychological battery comprised mostly of commonly administered clinical measures. Future studies are needed to determine the test-retest reliability, sensitivity, and ecological relevance of this battery, as well as equivalency to in-person assessment.

How did individual differences in neurocognition and health literacy influence the initial uptake and use of health-related information about COVID-19?

Introduction: The rapid development of coronavirus disease 2019 (COVID-19) into a pandemic required people to quickly acquire, evaluate, and apply novel complex health-related information about the virus and transmission risks. This study examined the potentially unique and synergistic roles of individual differences in neurocognition and health literacy in the early uptake and use of COVID-19 public health information.Method: Data were collected between April 23 and 21 May 2020, a period during which 42 out of 50 states were under a stay-at-home order. Participants were 217 healthy adults who completed a telephone-based battery that included standard tests of neurocognition, health literacy, verbal IQ, personality, and anxiety. Participants also completed measures of COVID-19 information-seeking skills, knowledge, prevention intentions, and prevention behaviors.Results: A series of hierarchical multiple regressions with data-driven covariates showed that neurocognition (viz, episodic verbal memory and executive functions) was independently related to COVID-19 knowledge (e.g. symptoms, risks) at a medium effect size, but not to information-seeking skills, prevention intentions, or prevention behaviors. Health literacy was independently related to all measured aspects of COVID-19 health information and did not interact with neurocognition in any COVID-19 health domain.Conclusions: Individual differences in neurocognition and health literacy played independent and meaningful roles in the initial acquisition of knowledge related to COVID-19, which is a novel human health condition. Future studies might examine whether neurocognitive supports (e.g. spaced retrieval practice, elaboration) can improve COVID-19-related knowledge and health behaviors in vulnerable populations.

Carbohydrate-based micelle clusters which enhance hydrophobic drug bioavailability by up to 1 order of magnitude.

Amphiphilic chitosan-based polymers (Mw < 20 kDa) self-assemble in aqueous media at low micromolar concentrations to give previously unknown micellar clusters of 100-300 nm in size. Micellar clusters comprise smaller 10-30 nm aggregates, and the nanopolarity/drug incorporation efficiency of their hydrophobic domains can be tailored by varying the degree of lipidic derivatization and molecular weight of the carbohydrate. The extent of drug incorporation by these novel micellar clusters is 1 order of magnitude higher than is seen with triblock copolymers, with molar polymer/drug ratios of 1:48 to 1:67. On intravenous injection, the pharmacodynamic activity of a carbohydrate propofol formulation is increased by 1 order of magnitude when compared to a commercial emulsion formulation, and on topical ocular application of a carbohydrate prednisolone formulation, initial drug aqueous humor levels are similar to those found with a 10-fold dose of prednisolone suspension.