Disentangling cognitive flexibility: a model-based assessment of women with anorexia nervosa.

Cognitive flexibility (CF) has been proposed as a potential trait marker in anorexia nervosa (AN), although findings have been inconsistent. To address this inconsistency, we applied a model that distinguishes between three subtypes of CF: task switching, switching sets, and stimulus-response mapping, which we then assessed using a paradigm-based task battery. The aim of the study was to investigate how AN is associated with these three CF subtypes. Thirty-three women with AN and 37 age- and education-matched controls performed a battery of computerized cognitive tasks to assess the three CF subtypes. Compared to the control group, individuals with AN exhibited poorer performance on the task switching and switching sets subtypes, as measured by response time switch cost, but not on the stimulus-response mapping subtype. No differences were found between the groups in response accuracy. Furthermore, switching sets as compared to the task switching and stimulus-response mapping subtypes was found to better explain the differences between the groups. These findings indicate a domain-specific impairment in CF among patients with AN, reflecting deficits observed in subtypes related to the disorder's characteristics, particularly that associated with visual perception. Therefore, CF impairment in AN should not be viewed dichotomously, but rather as a relative impairment that varies depending on the specific CF subtype.

Determinants of Quality of Life in Individuals With Spinal Cord Injury Using Structural Equation Modeling.

OBJECTIVE: The objective of this study is to examine the interdependent associations between International Classification of Functioning, Disability and Health (ICF) domains and their relationship with environmental factors with regard to quality of life (QoL) in individuals with spinal cord injury (SCI). DESIGN: Survey, cross-sectional study, and model testing using structural equation modeling. SETTING: Two inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel. PARTICIPANTS: Convenience sample of 156 individuals with SCI (N=156). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: QoL assessed by the World Health Organization Quality of Life Assessment-BREF. Neurological impairment after SCI reflected by lesion completeness and neurologic level of injury as measured by the International Standards for Neurological Classification of Spinal Cord Injury. The Spinal Cord Independence Measure to assess SCI-related task performance. ICF Brief Core Sets composition scores to assess impairment in body structure and function domains, limitations in activities, restriction in participation constructs, and the effect of environmental factors within the ICF model. RESULTS: Level of spinal cord injury and ICF Brief Core Sets composite score relating to activities and participation construct demonstrated a direct significant association with QoL. Moreover, a significant indirect association with QoL was found between the composite scores in ICF body structure and function and environmental factors, level of spinal cord injury, time since injury onset, and sex. Because the Spinal Cord Independence Measure was not related to QoL, we inferred that the categories related to instrumental activities of daily living and participation exert the most significant influence on QoL. CONCLUSIONS: In order to optimize improvements in quality of life, current rehabilitation programs should target limitations specifically related to instrumental activities of daily living and participation restrictions. It may serve as a focal point for further development of current therapeutic models and analytical methods that optimize rehabilitation planning and decision making among both health care professionals and patients.

Working memory development in different modalities in children and young adults.

Research on working memory (WM) development is concentrated largely on the verbal and visuospatial domains, whereas the tactile modality has received much less attention. The current study aimed to compare the development of storage and manipulation in the tactile sense with other modalities in children and young adults. A total of 96 typically developed individuals were divided into three equally numbered age groups in the ranges of 7 and 8, 11 and 12, and 20 to 29 years. They were asked to perform a battery of span tasks, including forward and backward stages, in the verbal, visual, visuospatial, and tactile modalities. Results showed improvement of WM performance across age in all modalities. In addition, in the forward stage, the Tactual Span was shorter than all other tasks and the Visuospatial Span was shorter than the Visual-Digit Span. In the backward stage, the Digit Span and Tactual Span had lower scores than the Visuospatial Span. Finally, interaction effects for the forward and backward stages were also significant, mainly indicating greater improvement in both storage and manipulation of the tactile sense compared with the other senses. It can be concluded that the tactile modality shows a course of WM development similar to the other modalities, in all of which the storage and manipulation components are affected differently. In addition, tactile WM improves more during growth than other modalities. Therefore, professionals in the field of education and neuropsychology are encouraged to use tactile tasks to assess and treat WM, particularly in response to the increased use of digital technology during recent years.

Deductive Reasoning and Working Memory Skills in Individuals with Blindness.

Deductive reasoning and working memory are integral parts of executive functioning and are important skills for blind people in everyday life. Despite the importance of these skills, the influence of visual experience on reasoning and working memory skills, as well as on the relationship between these, is unknown. In this study, fifteen participants with congenital blindness (CB), fifteen with late blindness (LB), fifteen sighted blindfolded controls (SbfC), and fifteen sighted participants performed two tasks of deductive reasoning and two of working memory. We found that while the CB and LB participants did not differ in their deductive reasoning abilities, the CB group performed worse than the sighted controls, and the LB group performed better than the SbfC group. Those with CB outperformed all the other groups in both of the working memory tests. Working memory is associated with deductive reasoning in all three visually impaired groups, but not in the sighted group. These findings suggest that deductive reasoning is not a uniform skill, and that it is associated with visual impairment onset, the level of reasoning difficulty, and the degree of working memory load.

Visuospatial and Tactile Working Memory in Individuals with Congenital Deafness.

Studies examining visuospatial working memory (WM) in individuals with congenital deafness have yielded inconsistent results, and tactile WM has rarely been examined. The current study examined WM span tasks in the two modalities among 20 individuals with congenital deafness and 20 participants with typical hearing. The congenital deafness group had longer forward and backward spans than typical hearing participants in a computerized Corsi block-tapping test (Visuospatial Span), whereas no such difference was found in the Tactual Span (tactile WM). In the congenital deafness group, age of sign language acquisition was not correlated with either condition of the visuospatial task, and Tactual and Visuospatial Spans scores were correlated in the backward but not the forward condition. The typical hearing group showed no correlation between the tasks. The findings suggest that early deafness leads to visuospatial but not tactile superiority in WM, specifically with respect to the storage component. More broadly, it appears that deafness-related compensation mechanisms in WM do not affect the other modalities in a uniform manner.

Executive functioning and spatial processing in anorexia nervosa: an experimental study and its significance for the allocentric lock theory.

PURPOSE: The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames-egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN). METHODS: Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress. RESULTS: AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients. CONCLUSIONS: The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency. LEVEL OF EVIDENCE: Level III: case-control analytic study.

Verbal Versus Figural Fluency Tests in Currently Ill and Weight Restored Anorexia Nervosa Patients.

Fluency tests allow domain-specific assessment of verbal and non-verbal executive functions (EF) comparison and also enable utilizing of both quantitative and qualitative scoring methods. Thirty-five currently ill anorexia nervosa patients (PANs), 33 weight-restored patients (WRAN) and 47 healthy controls (HCs) were administered the word fluency test and the five-point test. Results show that WRANs tended to perseverate more than HCs in the verbal-fluency test. In addition, PANs produced significantly less correct figures and perseverated more than HCs and WRANs; HCs used more strategy methods than PANs and WRANs. Additionally, a positive correlation was found in the HC group between the total number of words in the verbal phonemic test and the number of designs produced and the number of correct designs. No such correlations were found in both anorexia groups. In conclusion, there is a differentiation between verbal and non-verbal EF in PANs and WRANs, showing a deficiency in the non-verbal domain. These findings may contribute to our understanding of the cognitive nature of the disorder.

Persistent extreme regressive behavior in severe traumatic brain injury patients: a rare neurological phenomenon.

Regressive behavior is a known sequela after severe traumatic brain injury (TBI). However, prolonged "infantile-like" behavior has received little attention in the literature, suggesting that this is a rare phenomenon. It is typically characterized by long-lasting childish, extremely dependent, and sometimes aggressive behavior, which is distinguished from the expected recovery process. The relevant theoretical framework lies in the field of disorders called "Neuropathologies of the self" (NPS). We report three cases of young adults who, following a severe TBI, developed continual regressive behavior. The Disability Rating Scale (DRS) was used to assess possible change in their condition. First, while admitted, which was performed in retrospect, and again 6 years later at the time stated. Inter-rater reliability for the scale items showed adequate correlation. Results showed no significant difference in patients' scores, indicating persistent functional difficulties. We conclude that this "regressive syndrome" presents an unusual form of behavior that is stable over time. It seems to be in line with other NPS disorders, and may stem from an interaction of organic factors and primary mental complexity. Nevertheless, further research is required to examine the factors affecting the emergence and recovery from this phenomenon.

The sorting test of the D-KEFS in current and weight restored anorexia nervosa patients.

OBJECTIVE: Efforts have been made to characterize executive functions (EF) in anorexia nervosa (AN) both in the acute stage of the illness and after weight gain, yet many questions remain. The question of verbal versus visuo-perceptual stimuli in this regard has not been adequately addressed. The aim of this study is to further examine EF in women with past and present AN and to compare their performances in verbal and visual modalities with women who have never suffered from an eating disorder. METHOD: Thirty-five underweight AN patients, 33 weight-restored patients symptom-free for at least 2 years, and 48 healthy female controls completed the Delis-Kaplan Executive Function System Sorting Test, so as to evaluate their EF. RESULTS: No differences were observed between the scores of women with current and past AN. Both groups scored lower than controls on most test variables. However, while in the visuo-perceptual domain the performance of the AN groups was worse than that of controls, in the verbal domain they performed similarly to them. DISCUSSION: Women with a past or present diagnosis of AN show difficulties in visuo-perceptual EF, whereas verbal EF seem to be preserved. There may be a dissociation between verbal and visuo-perceptual EF that persists after weight restoration.

Employing executive functions of perceptual and memory abilities in underweight and weight-restored anorexia nervosa patients.

PURPOSE: Executive functions (EF) have been widely investigated in anorexia nervosa (AN) revealing difficulties in various aspects. We aimed at testing the effects of EF on stimuli perception and its representations in memory. METHODS: Thirty AN underweight patients, 30 weight-restored AN patients, and 44 control participants, were recruited. Various EF were assessed using the Rey-Osterrieth Complex Figure Test, analyzed with the Boston Qualitative Scoring System. RESULTS: No differences were found in visuo-constructional measures in either AN groups compared to controls on the copy and memory stages. However, both groups performed significantly worse than controls on most EF variables in the copy stage, while in the immediate and delayed memory stages the difference was less substantial. CONCLUSIONS: Difficulties in EF among AN patients, current and weight restored, are more pronounced in the perceptual module and less so when employed through memory retrieval. The pattern, which is apparent after weight gain, suggests that there is no ameliorative effect on these difficulties.

Forward versus backward recall: Modality testing.

OBJECTIVES: One of the most frequently applied paradigms in the clinical and experimental fields for assessing working memory is the simple span task, composed of forward and backward recall conditions. However, the utility of the simple span measures and their relation to working memory modalities has yet to be elucidated. The current study aimed to address which of the span measures is more sensitive to the differentiation between forward and backward recall in the tactile, verbal, and visuo-spatial modalities, and to test if working memory modalities differ in the disparity between the two conditions. METHODS: 134 healthy young adults performed the Tactual, Digit, and Visuo-spatial Span tasks, producing Total Correct scores and Longest Sequence score measures. RESULTS: There was an interaction effect for condition and modality type, showing better performance for the forward compared to the backward recall in both measures. However, the effect size of the Longest Sequence score was significantly higher than the Total Correct score in all tasks. Furthermore, the Visuo-spatial Span exhibited a larger difference between forward and backward recall compared to the Digit and Tactual Span, whereas no difference was found between the latter two. CONCLUSIONS: Forward and backward recall are distinguished in all three modalities, and the Longest Sequence score is more sensitive to differentiate between storage and manipulation components of working memory than the Total Correct score. Additionally, the cognitive demand imposed by manipulation compared to storage is the greatest in the visuo-spatial modality.

Laterality in tactile working memory: The one-hand version of the Tactual Span.

The Tactual Span assesses tactile working memory (WM) using both hands while applying forward and backward conditions. The study objectives were to validate a one-hand version of the Tactual Span and to evaluate WM laterality in the tactile modality. Of the 145 participants, 80 performed the Tactual Span with their right hand, and 65 performed it with their left hand. Moreover, all participants performed two span tasks in the visuo-spatial and auditory modalities, each encompassing forward and backward conditions. Results revealed adequate Cronbach's alpha values for each hand in both conditions of the Tactual Span, along with a positive correlation between forward and backward conditions in each hand. However, overall performance on the Tactual Span was poorer compared to performance on the Auditory and Visuo-spatial Spans. Furthermore, in the forward condition, there was a correlation between the Auditory Span and the Tactual Span, but only for the right hand. In the backward condition, the Auditory Span correlated with the Tactual Span in both hands. The findings indicate that there is no effect of hand laterality in tactile WM, showing the two hands are related to each other in their WM function. Additionally, the one-hand version of the Tactual Span is deemed useful for evaluating tactile WM and can therefore be used in empirical and clinical settings for neuropsychological assessment purposes.

Aging's Effect on Working Memory-Modality Comparison.

Research exploring the impact of development and aging on working memory (WM) has primarily concentrated on visual and verbal domains, with limited attention paid to the tactile modality. The current study sought to evaluate WM encompassing storage and manipulation across these three modalities, spanning from childhood to old age. The study included 134 participants, divided into four age groups: 7-8, 11-12, 25-35, and 60-69. Each participant completed the Visuospatial Span, Digit Span, and Tactual Span, with forward and backward recall. The findings demonstrated a consistent trend in both forward and backward stages. Performance improved until young adulthood, progressively diminishing with advancing age. In the forward stage, the Tactual Span performance was worse than that of the Digit and Visuospatial Span for all participants. In the backward stage, the Visuospatial Span outperformed the Digit and Tactual Span across all age groups. Furthermore, the Tactual Span backward recall exhibited significantly poorer performance than the other modalities, primarily in the youngest and oldest age groups. In conclusion, age impacts WM differently across modalities, with tactile storage capacity being the most vulnerable. Additionally, tactile manipulation skills develop later in childhood but deteriorate sooner in adulthood, indicating a distinct component within tactile WM.

Cognitive flexibility in women who recovered from anorexia nervosa - a model-based approach.

Research findings on cognitive flexibility (CF) functioning in women who recovered from anorexia nervosa (RAN) were found to be inconsistent. This was attributed to the multiple definitions of CF and the diverse measuring tools used to assess it. Applying a deductive approach to explore CF function may address these inconsistencies; thus, we used a model that divides CF into three subtypes, namely, stimulus-response mapping, switching sets and task switching. Additionally, we explored the association between CF subtypes and the disorder's clinical measures to assess the relation of CF to recovery. Forty-three RAN and 54 healthy controls performed tasks designed to assess CF subtypes based on the model's division, and the RAN group completed the Eating Disorder Examination Questionnaire. The results showed that the RAN group performed significantly worse than controls only in the stimulus-response mapping subtype. Additionally, there were no correlations between CF subtypes and clinical symptoms or the disorder measures - current and nadir body mass index, age of onset, time since recovery, and disorder duration. In conclusion, the study revealed CF impairment after recovery from AN, specifically in stimulus-response mapping. The variability in performance of the CF subtypes supports the application of a theory-driven perspective viewing CF as a modular ability in RAN. Additionally, CF is unrelated to clinical measures post-recovery and thus may not be used as a criterion for evaluating recovery.

Matching patients with therapists in culturally diverse rehabilitation services during civil unrest.

A primary consideration in rehabilitation is the compatibility between clinicians and patients, where cultural diversity is a defining feature for both. The intricacies of cultural considerations in patient-clinician matching are heightened in areas of conflict and civil unrest. This paper presents three perspectives of the significance of cultural considerations in such assignments: patient-centred approach - prioritizing patients' preferences; professional-centred approach - clinicians' safety, social-emotional, and training needs; and utilitarian approach - what is best for the majority. A case study from an Israeli rehabilitation clinic is presented to exhibit the multifaceted considerations in patient-clinician matching within areas of conflict and civil unrest. The reconciliation of these three approaches in the context of cultural diversity is discussed, suggesting the benefit of a case-by-case strategy involving combinations of the three. Further research could examine how this might feasibly and beneficially optimize outcomes for all in culturally diverse societies in times of unrest.

Working Memory for Faces among Individuals with Congenital Deafness.

BACKGROUND: Studies examining face processing among individuals with congenital deafness show inconsistent results that are often accounted for by sign language skill. However, working memory for faces as an aspect of face processing has not yet been examined in congenital deafness. PURPOSE: To explore working memory for faces among individuals with congenital deafness who are skilled in sign language. RESEARCH DESIGN: A quasi-experimental study of individuals with congenital deafness and a control group. STUDY SAMPLE: Sixteen individuals with congenital deafness who are skilled in sign language and 18 participants with intact hearing, matched for age, and education. INTERVENTION: The participants performed two conditions of the N-back test in ascending difficulty (i.e., 1-back and 2-back). DATA COLLECTION AND ANALYSIS: Levene's and Shapiro-Wilk tests were used to assess group homoscedasticity and normality, respectively. A two-way repeated measures analysis of variance was applied to compare the groups in response time and accuracy of the N-back test, as well as Pearson correlation between response time and accuracy, and sign language skill duration. RESULTS: The congenital deafness group performed better than controls, as was found in the response time but not in the accuracy variables. However, an interaction effect showed that this pattern was significant for the 1-back but not for the 2-back condition in the response time but not the accuracy. Further, there was a marginal effect in response time but a significant one in accuracy showing the 2-back was performed worse than the 1-back. No significant correlation was found between response time and accuracy, and sign language skill duration. CONCLUSIONS: Face processing advantage associated with congenital deafness is dependent on cognitive load, but sign language duration does not affect this trend. In addition, response time and accuracy are not equally sensitive to performance differences in the N-back test.

Does lack of brain injury mean lack of cognitive impairment in traumatic spinal cord injury?

OBJECTIVE: Traumatic spinal cord injury (tSCI) has implications in many areas, including cognitive functioning. Findings regarding cognitive problems in people with SCI are inconsistent, presumably due to multiple variables than can affect performance, among them emotional variables. The purpose of the current study was to elucidate cognitive sequalae in some individuals with tSCI with no medical record of brain injury, while taking emotional variables into consideration. DESIGN: Cross-sectional, with two groups. SETTING: A public rehabilitation center. PARTICIPANTS: Twenty participants with tSCI at least ten months post injury and twenty non-SCI controls, matched for sex, age, and education. INTERVENTION: None. OUTCOME MEASURES: A battery of neuropsychological tests tapping executive functions, memory, attention, and naming abilities, in addition to questionnaires assessing depression and distress. RESULTS: When emotional variables were statistically controlled, participants with tSCI showed higher levels of depression and distress and scored lower than non-SCI control participants on all cognitive tests except naming. Executive functions were found to have the highest effect size, though no specific ability was sensitive enough to differentiate between the groups in a binary logistic regression analysis. CONCLUSION: In some individuals with chronic tSCI, lower cognitive ability that is unrelated to emotional distress might result from spinal cord damage and its implications in a population who's medical records show no indication of brain injury. This highlights the importance of conducting cognitive evaluation following SCI, so that deficits can be effectively addressed during rehabilitation.

Working memory in intact modalities among individuals with sensory deprivation.

The sensory compensation hypothesis posits that sensory deficits in one modality can lead to enhanced performance of cognitive tasks relying on another, intact modality. Most studies in this area have explored the visual and auditory senses, with inconsistent findings. Meanwhile, the tactile modality has rarely been examined in this context. The present study compared working memory (WM) abilities in the intact senses of individuals with sensory deprivation. Fourteen participants with blindness and 20 with deafness performed a tactile WM task and a verbal or visuospatial WM tasks, respectively. They were compared to 22 age- and education-matched controls who performed all WM tasks. Results showed participants with blindness outperform the other two groups in the tactile WM task and are better than controls in the auditory task. The deafness group outperformed the controls in the visuospatial but not the tactile task. The forward span was longer than the backward span in all modality types and no group by modality interaction was found. Finally, the effect size of differences between blindness and control groups were significantly higher than those of the deafness and control groups' differences. These findings show that blindness and deafness are associated with WM superiority in the intact modality, although not equally. Therefore, the sensory compensation hypothesis in the context of WM is only partially supported as factors, other than deprivation per se may influence performance.

Assessment of the unmediated relationship between neurological impairment and health-related quality of life following spinal cord injury.

Objective: To assess the unmediated association between neurological impairment and quality of life (QoL) among persons with spinal cord injury (SCI), in the context of both early post-acute and long-term rehabilitation settings.Design: An observational prospective cross-sectional study.Setting: Two neurological rehabilitation centers, specializing in spinal cord injury, within a university hospital.Methods: 156 adults with spinal cord injury in the early post-acute and chronic stages of rehabilitation.Outcome Measures: Participants were categorized into tetraplegia or paraplegia groups based on neurological level of injury, and into complete or incomplete groups based on American Spinal Injury Association (ASIA) Impairment Scale (AIS) score. QoL was assessed by means of the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF), Satisfaction with Life Scale (SWLS), Life Satisfaction Questionnaire (LISAT-9), and Personal Well-Being Index (PWI).Results: WHOQOL-BREF and PWI predicted Level of Injury group classification and WHOQOL-BREF predicted Setting group classification. None of the questionnaires differentiated between the Type of Injury groups. At the early post-acute stage of rehabilitation, the QoL scores of participants with tetraplegia and paraplegia did not differ significantly, while significantly higher QoL scores were revealed in paraplegics in the long-term setting group.Conclusions: A direct, unmediated effect of severity of neurological impairment was revealed with the WHOQOL-BREF, which distinguished between the tetraplegia and paraplegia groups, but not between the complete and incomplete injuries. QoL was significantly higher in paraplegia than in tetraplegia following the early post-acute stage of rehabilitation.

Cognitive functions and disability progression in relapsing-remitting multiple sclerosis: A longitudinal study.

Longitudinal studies have shown inconsistent findings regarding the association between cognition, demographic characteristics, and clinical decline in relapsing-remitting multiple sclerosis (RRMS). Our objective was to further explore these relations, over time, while also considering age and sex. A total of 183 patients with RRMS were assessed at two time points, using a neuropsychological battery and the Expanded Disability Status Scale (EDSS). For the first assessment, participants were divided by age (<29, 30-39, 40-49, 50-60) and sex. Next, they were divided according to their participation in one of three interval assessment points: 2-3, 4-5, and 6-8 years. Cognitive function was not correlated with disease duration but was negatively correlated with EDSS score. Men under 29 and women under 39 showed negative correlations between cognitive and clinical impairment. Executive functions, attention, and information processing speed (IPS) showed cognitive decline between the first and second assessments. Furthermore, at the 4-5 year interval IPS predicted EDSS scores, while at the 6-8 year interval it was IPS and visuo-spatial ability. Therefore, relation between clinical status and cognition is not consistent across different age and sex groups. Additionally, cognitive deterioration is only partially evident longitudinally; however, IPS appears to be the most sensitive in predicting one's future clinical condition.