Embodimetrics: A Principal Component Analysis Study of the Combined Assessment of Cardiac, Cognitive and Mobility Parameters.

There is a growing body of literature investigating the relationship between the frequency domain analysis of heart rate variability (HRV) and cognitive Stroop task performance. We proposed a combined assessment integrating trunk mobility in 72 healthy women to investigate the relationship between cognitive, cardiac, and motor variables using principal component analysis (PCA). Additionally, we assessed changes in the relationships among these variables after a two-month intervention aimed at improving the perception-action link. At baseline, PCA correctly identified three components: one related to cardiac variables, one to trunk motion, and one to Stroop task performance. After the intervention, only two components were found, with trunk symmetry and range of motion, accuracy, time to complete the Stroop task, and low-frequency heart rate variability aggregated into a single component using PCA. Artificial neural network analysis confirmed the effects of both HRV and motor behavior on cognitive Stroop task performance. This analysis suggested that this protocol was effective in investigating embodied cognition, and we defined this approach as "embodimetrics".

Polish adaptation of emotional Stroop test in assessment of pedophilia - a pilot study. / Polska adaptacja zadania Stroopa w warunku emocjonalnym do oceny preferencji pedofilnych ­ badania pilotazowe.

OBJECTIVES: A pilot study was conducted in order to construct a Polish adaptation of emotional Stroop test in assessment of pedophilia. METHODS: The study consisted of two stages. The first stage involved creating test material by ranking words in adequate lists by competent experts. The second stage consisted of empirical verification of the principle of emotional Stroop test in a non-clinical population. RESULTS: Based on the assessment of five competent experts, words were ordered from the most to the least sexually arousing (Kendall's W from 0.368 to 0.693). Six ranked lists were obtained, and the competent experts were subsequently asked to assess whether these lists were suitable for the study (Lawshe's Content Validity Ratio from 0.6 to 1.0). Two categories of words were merged. Five ranked lists were obtained, and the competent experts were subsequently asked again to assess whether these lists were suitable for the study (Lawshe's Content Validity Ratio 1.0). The created lists of words were approved by allcompetent experts. Based on the experimental study conducted on a non-clinical population, it was shown that, in accordance with the principle of the test, the mean response time for sexually related words was longer that for neutral words. The mean response time for children-related words did not differ significantly from response time for neutral words. CONCLUSIONS: Based on the study with competent experts and conducted experiments, an initial Polish adaptation of the emotional Stroop test for diagnosis of pedophilia has been created. Further studies with persons with pedophilia are needed to implement the test in clinical setting.

Assessment of Resilience of the Hellenic Navy Seals by Electrodermal Activity during Cognitive Tasks.

Stress resilience plays a key role in task performance during emergencies, especially in occupations like military special forces, with a routine consisting of unexpected events. Nevertheless, reliable and applicable measurements of resilience in predicting task performance in stressful conditions are still researched. This study aimed to explore the stress response in the Hellenic Navy SEALs (HN-SEALs), using a cognitive-physiological approach. Eighteen candidates under intense preparation for their enlistment in the HN-SEALs and 16 healthy controls (HCs) underwent Stroop tests, along with mental-state and personality examination. Simultaneously, electrodermal activity (EDA) was assessed during each one of cognitive testing procedures. Compared to healthy control values, multiple components of EDA values were found decreased (p < 0.05) in the HN-SEALs group. These results were associated with an increase in resilience level in the HN-SEALs group, since a restricted sympathetic reactivity according to the reduced EDA values was observed during the stressful cognitive testing. This is the first report providing physiological measurements of the sympathetic response of HN-SEALs to a stressful situation and suggests that EDA turns out to be a simple and objective tool of sympathetic activation and it may be used as a complementary index of resilience in HN-SEALs candidates.

Combining transcranial direct current stimulation with a motor-cognitive task: the impact on dual-task walking costs in older adults.

BACKGROUND: The performance of a secondary task while walking increases motor-cognitive interference and exacerbates fall risk in older adults. Previous studies have demonstrated that transcranial direct current stimulation (tDCS) may improve certain types of dual-task performance, and, that tDCS delivered during the performance of a task may augment the benefits of stimulation, potentially reducing motor-cognitive interference. However, it is not yet known if combining multi-target tDCS with the simultaneous performance of a task related to the tDCS targets reduces or increases dual-task walking costs among older adults. The objectives of the present work were (1) To examine whether tDCS applied during the performance of a task that putatively utilizes the brain networks targeted by the neuro-stimulation reduces dual-task costs, and (2) to compare the immediate after-effects of tDCS applied during walking, during seated-rest, and during sham stimulation while walking, on dual-task walking costs in older adults. We also explored the impact on postural sway and other measures of cognitive function. METHODS: A double-blind, 'within-subject' cross-over pilot study evaluated the effects of 20 min of anodal tDCS targeting both the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (lDLPFC) in 25 healthy older adults (73.9 ± 5.2 years). Three stimulation conditions were assessed in three separate sessions: (1) tDCS while walking in a complex environment (tDCS + walking), (2) tDCS while seated (tDCS + seated), and (3) walking in a complex environment with sham tDCS (sham + walking). The complex walking condition utilized virtual reality to tax motor and cognitive abilities. During each session, usual-walking, dual-task walking, quiet standing sway, and cognitive function (e.g., Stroop test) were assessed before and immediately after stimulation. Dual-task costs to gait speed and other measures were computed. RESULTS: The dual-task cost to gait speed was reduced after tDCS + walking (p = 0.004) as compared to baseline values. Neither tDCS + seated (p = 0.173) nor sham + walking (p = 0.826) influenced this outcome. Similar results were seen for other gait measures and for Stroop performance. Sway was not affected by tDCS. CONCLUSIONS: tDCS delivered during the performance of challenging walking decreased the dual-task cost to walking in older adults when they were tested just after stimulation. These results support the existence of a state-dependent impact of neuro-modulation that may set the stage for a more optimal neuro-rehabilitation. TRIAL REGISTRATION: Clinical Trials Gov Registrations Number: NCT02954328.

Probing the Role of a Regional Quantitative Assessment of Amyloid PET.

BACKGROUND: In clinical practice, the amy-PET is globally inspected to provide a binary outcome, but the role of a regional assessment has not been fully investigated yet. OBJECTIVE: To deepen the role of regional amyloid burden and its implication on clinical-neuropsychological features. MATERIALS: Amy-PET and a complete neuropsychological assessment (Trail Making Test, Rey Auditory Verbal Learning Test, semantic verbal fluency, Symbol Digit, Stroop, visuoconstruction) were available in 109 patients with clinical suspicion of Alzheimer's disease. By averaging the standardized uptake value ratio and ELBA, a regional quantification was calculated for each scan. Patients were grouped according to their overall amyloid load: correlation maps, based on regional quantification, were calculated and compared. A regression analysis between neuropsychological assessment and the regional amyloid-ß (Aß) load was carried out. RESULTS: Significant differences were observed between the correlation maps of patients at increasing levels of Aß and the overall dataset. The Aß uptake of the subcortical gray matter resulted not related to other brain regions independently of the global Aß level. A significant association of semantic verbal fluency was observed with ratios of cortical and subcortical distribution of Aß which represent a coarse measure of differences in regional distribution of Aß. CONCLUSION: Our observations confirmed the different susceptibility to Aß accumulation among brain regions. The association between cognition and Aß distribution deserves further investigations: it is possibly due to a direct local effect or it represents a proxy marker of a more aggressive disease subtype. Regional Aß assessment represents an available resource on amy-PET scan with possibly clinical and prognostic implications.

Validity and Reliability of the New Chinese Version of the Frontal Assessment Battery-Phonemic.

BACKGROUND: Alzheimer's disease dementia (ADD) is an important health problem in the world. OBJECTIVE: The present study investigated the validity and reliability of a new version of the Frontal Assessment Battery (FAB) named the FAB-phonemic (FAB-P). METHODS: A total of 76 patients with ADD, 107 patients with amnestic mild cognitive impairment (aMCI), 37 patients with non-amnestic MCI (naMCI), and 123 healthy controls were included in this study. All participants were evaluated with the FAB-P and the cognitive assessments according to a standard procedure. RESULTS: The global FAB-P scores in patients with ADD were lower than those of patients with aMCI, patients with naMCI, and healthy controls (p < 0.001). Patients with aMCI performed worse than healthy controls (p < 0.001). The interrater reliability, test-retest reliability, and Cronbach's alpha coefficient for the FAB-P were 0.997, 0.819, and 0.736, respectively. The test could distinguish the patients with mild ADD, aMCI, and naMCI from healthy controls with classification accuracy of 89.4%, 70.9%, and 61.6%, respectively. It could also discriminate between the patients with ADD and aMCI, between those with ADD and naMCI, and between those with aMCI and naMCI with classification accuracy of 73.8%, 83.9%, and 58.0%, respectively. The regression analysis revealed that the Montreal Cognitive Assessment and the Stroop Color Word Test Part C had the greatest contribution to FAB-P score variance. CONCLUSION: The FAB-P is a valid and reliable tool for evaluating frontal lobe function and can effectively discriminate ADD, aMCI, and naMCI.

Minimal benefit to extending the stroop Interference Task among individuals undergoing outpatient assessment.

The third trial of Golden's Stroop Color and Word Test (SCWT), which involves identifying the color of words printed in a color that contrasts with its spelling, is usually limited to 45 seconds. Some authors have opined on the benefits of extending this portion of the test beyond 45 seconds to increase sensitivity to cognitive deficits and preliminary data among healthy individuals support this notion. This project examined possible benefits of extending the test beyond the standard 45 second time limit. Fifty-four veteran patients completed the SCWT as part of outpatient neuropsychological assessment. Speed of completing items within 45 seconds was compared to the speed of completing items beyond the first 45 seconds. A composite measure made of neuropsychological tests requiring speed and complex attention served as the criterion measure. Results indicated that extending the interference trial of the SCWT did not improve prediction on criterion measures beyond the standard 45 second SCWT. In conclusion, among individuals undergoing clinical evaluations, extending the SCWT beyond 45 seconds is unlikely to yield sufficient meaningful clinical data to offset the additional administration time and potential frustration to examinees.

Do shorter inter-stimulus intervals in the go/no-go task enable better assessment of response inhibition?

Young, Sutherland, and McCoy indicated that a Go/No-Go Task (GNG) becomes more difficult as the inter-stimulus intervals (ISIs) becomes shorter. However, is the number of commission errors under extremely short ISIs a useful metric for assessing response inhibition? This study challenges the assumption that a shorter ISI in the GNG enables better assessment of response inhibition. University students (N = 213) completed the GNG, the Conners Continuous Performance Test 3rd Edition (CCPT), and the Modified Stroop Task. The GNG comprised four blocks of 400, 600, 800, and 1000 ms ISIs, whereas the stimulus presentation was fixed at 250 ms. Consistent with Young et al., shorter ISIs in the GNG resulted in more commission errors. In the block with the shortest ISI, participants also failed more frequently in responses in go trials than in the other blocks, which appears to increase in error variance of commission errors. Consistent with this interpretation, the association between the number of commission errors in the block with 400 ms ISI and CCPT performance was weaker than those between the number of commission errors in other blocks and CCPT performance. It is concluded that using the number of commission errors in the condition with extremely short ISIs in the GNG might be inappropriate for assessing response inhibition.

Community-dwelling older adults with mild cognitive impairments show subtle visual attention costs when descending stairs.

BACKGROUND: Older adults are at greater risk of falls while descending stairs. Cognitive deficits can further influence one's ability and mild cognitive impairments (MCI) specifically affect visual attention and dual tasking behavior. The present study aimed at comparing the attentional costs at different points during the approach to and descent of a staircase between older adults with and without MCI. METHODS: Eleven older adults with MCI and twenty-three healthy older individuals without cognitive impairments were recruited. Neuropsychological tests were carried out. In addition, participants approached and descended a 5-step staircase while a simultaneous visual Stroop dual-task was randomly introduced during the approach, transition or steady state descent phases across trials. Three-dimensional kinematics and accuracy on the Stroop task were analyzed and dual task costs were calculated. RESULTS: The MCI group showed deficits for visuo-spatial attention, memory and multi-tasking abilities, as well as balance and decreased confidence for falls efficacy, but not for daily activity scores. Despite such changes, this group of community-dwelling individuals with MCI presented a functional capacity to descend stairs even during divided visual attention. However, there were subtle, but significant, group differences for movement fluidity and performance on the simultaneous cognitive task, particularly during the approach and transition to descent phases. The MCI group also tended to descend slower while using the handrails more than healthy older adults. CONCLUSION: The present cohort of community-dwelling older adults with MCI were functional, but appeared to prioritize locomotor demands over the simultaneous cognitive task in a possible "posture first" strategy to descend stairs. The present findings should be considered for developing more ecologically based clinical assessments of mobility deficits following cognitive impairments, with the approach and transition phases during stair descent as key points of focus.

Computational Psychometrics Using Psychophysiological Measures for the Assessment of Acute Mental Stress.

The goal of this study was to provide reliable quantitative analyses of psycho-physiological measures during acute mental stress. Acute, time-limited stressors are used extensively as experimental stimuli in psychophysiological research. In particular, the Stroop Color Word Task and the Arithmetical Task have been widely used in several settings as effective mental stressors. We collected psychophysiological data on blood volume pulse, thoracic respiration, and skin conductance from 60 participants at rest and during stressful situations. Subsequently, we used statistical univariate tests and multivariate computational approaches to conduct comprehensive studies on the discriminative properties of each condition in relation to psychophysiological correlates. The results showed evidence of a greater discrimination capability of the Arithmetical Task compared to the Stroop test. The best predictors were the short time Heart Rate Variability (HRV) indices, in particular, the Respiratory Sinus Arrhythmia index, which in turn could be predicted by other HRV and respiratory indices in a hierarchical, multi-level regression analysis. Thus, computational psychometrics analyses proved to be an effective tool for studying such complex variables. They could represent the first step in developing complex platforms for the automatic detection of mental stress, which could improve the treatment.

Do perturbation-evoked responses result in higher reaction time costs depending on the direction and magnitude of perturbation?

To date, little work has focused on whether cognitive-task interference during postural response execution is influenced by the direction and/or magnitude of the perturbation applied. Hypothetically, the increased difficulty associated with a backward loss of balance could necessitate increased allocation of cognitive resources to counteract destabilizing forces. The current study investigated these relationships using a paradigm in which individuals performed a cognitive task (auditory Stroop task during quiet stance; baseline condition). In certain trials, a translation of the support surface was concurrently evoked (magnitude: small or large; direction: forward or backward) which required a postural response to maintain balance. Ten healthy young adults completed four blocks of these experimental trials (26 randomized trials/block). Postural stability during balance recovery was evaluated using the margin of stability (MoS), while Stroop task performance was based on reaction time cost (RTC) and differences between experimental conditions. Results showed no effect of perturbation direction on RTC, but there was an observed MoS increase at peak extrapolated center of mass excursion following a small perturbation evoked concurrently with the cognitive task. No effect of cognitive-task performance was detected for MoS during stepping strategies (followed large perturbations). Instead, increased RTC were observed relative to the fixed base of support responses. In general, young adults adopted a "posture-first" strategy, regardless of perturbation direction, reinforcing the importance of cognition in the maintenance of upright balance.

The Stroop test as a measure of performance validity in adults clinically referred for neuropsychological assessment.

This study was designed to develop performance validity indicators embedded within the Delis-Kaplan Executive Function Systems (D-KEFS) version of the Stroop task. Archival data from a mixed clinical sample of 132 patients (50% male; MAge = 43.4; MEducation = 14.1) clinically referred for neuropsychological assessment were analyzed. Criterion measures included the Warrington Recognition Memory Test-Words and 2 composites based on several independent validity indicators. An age-corrected scaled score ≤6 on any of the 4 trials reliably differentiated psychometrically defined credible and noncredible response sets with high specificity (.87-.94) and variable sensitivity (.34-.71). An inverted Stroop effect was less sensitive (.14-.29), but comparably specific (.85-90) to invalid performance. Aggregating the newly developed D-KEFS Stroop validity indicators further improved classification accuracy. Failing the validity cutoffs was unrelated to self-reported depression or anxiety. However, it was associated with elevated somatic symptom report. In addition to processing speed and executive function, the D-KEFS version of the Stroop task can function as a measure of performance validity. A multivariate approach to performance validity assessment is generally superior to univariate models. (PsycINFO Database Record

The benefits of adding a brief measure of simple reaction time to the assessment of executive function skills in early childhood.

Early childhood represents a period of rapid cognitive developmental change in executive function (EF) skills along with a variety of related cognitive processes, including processing speed. This leads to interpretational challenges in that children's performance on EF tasks reflects more than EF skills per se. We tested whether the inclusion of a brief measure of simple reaction time (SRT) during EF assessments could help to partially address this challenge. Data were drawn from a cross-sectional convenience sample of 830 preschool-aged children. Individual differences in SRT were significantly associated with performance on all tasks (R2s = .09-.26); slower performance on the SRT task was associated with poorer performance on each EF task. Age-related differences in individual EF tasks were reduced by approximately one half after accounting for age-related differences in SRT, and EF task scores were less coherent (i.e., less strongly intercorrelated with each other) after the removal of SRT. Age-related differences in EF were smaller (Cohen ds = 1.36 vs. 0.78), and poverty-related differences in EF were larger (Cohen ds = 0.30 vs. 0.46) after accounting for SRT-related variation. Finally, consistent with previous studies, SRT-related differences in fluid reasoning were mediated by EF skills. Results are discussed with respect to using a brief measure of SRT to partially address the problem of measurement impurity at the level of individual EF tasks.

The human body odor compound androstadienone increases neural conflict coupled to higher behavioral costs during an emotional Stroop task.

The androgen derivative androstadienone (AND) is a substance found in human sweat and thus may act as human chemosignal. With the current experiment, we aimed to explore in which way AND affects interference processing during an emotional Stroop task which used human faces as target and emotional words as distractor stimuli. This was complemented by functional magnetic resonance imaging (fMRI) to unravel the neural mechanism of AND-action. Based on previous accounts we expected AND to increase neural activation in areas commonly implicated in evaluation of emotional face processing and to change neural activation in brain regions linked to interference processing. For this aim, a total of 80 healthy individuals (oral contraceptive users, luteal women, men) were tested twice on two consecutive days with an emotional Stroop task using fMRI. Our results suggest that AND increases interference processing in brain areas that are heavily recruited during emotional conflict. At the same time, correlation analyses revealed that this neural interference processing was paralleled by higher behavioral costs (response times) with higher interference related brain activation under AND. Furthermore, AND elicited higher activation in regions implicated in emotional face processing including right fusiform gyrus, inferior frontal gyrus and dorsomedial cortex. In this connection, neural activation was not coupled to behavioral outcome. Furthermore, despite previous accounts of increased hypothalamic activation under AND, we were not able to replicate this finding and discuss possible reasons for this discrepancy. To conclude, AND increased interference processing in regions heavily recruited during emotional conflict which was coupled to higher costs in resolving emotional conflicts with stronger interference-related brain activation under AND. At the moment it remains unclear whether these effects are due to changes in conflict detection or resolution. However, evidence most consistently suggests that AND does not draw attention to the most potent socio-emotional information (human faces) but rather highlights representations of emotional words.

A comparison of immersive virtual reality with traditional neuropsychological measures in the assessment of executive functions.

OBJECTIVE: This study investigated immersive virtual reality (IVR), as a novel technique to test executive function of healthy younger and older adults. We predicted IVR tasks to have greater predictive power than traditional measures when assessing age-related cognitive functioning due to the real-world validity of the tasks. METHODS: Participants (n=40) completed the Stroop colour-word test and the trail-making test (TMT) as traditional and commonly used assessments of executive functioning. Participants then completed three IVR tasks; a seating arrangement task, an item location task (both set in a virtual chemistry lab), and a virtual parking simulator. RESULTS: Younger adults completed significantly more parking simulator levels (p<0.001), placed significantly more objects (p<0.001), and located significantly more items than older adults (p<0.01), demonstrating higher levels of performance. Significant correlations were found between performance on traditional neuropsychological measures and IVR measures. For example, Stroop CW performance significantly correlated with the number of parking simulator levels completed (τ=0.43, p<0.01). This suggests that IVR measures assess the same underlying cognitive constructs as traditional tasks. In addition, IVR measures contributed a significant percentage of the explained variance in age. CONCLUSION: IVR measures (i.e. number of parking simulator levels completed and number of objects placed in the seating arrangement task) were found to be stronger contributors than existing traditional neuropsychological tasks in predicting age-related cognitive decline. Future research should investigate the implementation of these real-world-based tasks in clinical groups given this promising initial work.

Cognitive capacity limitations and Need for Cognition differentially predict reward-induced cognitive effort expenditure.

While psychological, economic, and neuroscientific accounts of behavior broadly maintain that people minimize expenditure of cognitive effort, empirical work reveals how reward incentives can mobilize increased cognitive effort expenditure. Recent theories posit that the decision to expend effort is governed, in part, by a cost-benefit tradeoff whereby the potential benefits of mental effort can offset the perceived costs of effort exertion. Taking an individual differences approach, the present study examined whether one's executive function capacity, as measured by Stroop interference, predicts the extent to which reward incentives reduce switch costs in a task-switching paradigm, which indexes additional expenditure of cognitive effort. In accordance with the predictions of a cost-benefit account of effort, we found that a low executive function capacity-and, relatedly, a low intrinsic motivation to expend effort (measured by Need for Cognition)-predicted larger increase in cognitive effort expenditure in response to monetary reward incentives, while individuals with greater executive function capacity-and greater intrinsic motivation to expend effort-were less responsive to reward incentives. These findings suggest that an individual's cost-benefit tradeoff is constrained by the perceived costs of exerting cognitive effort.

The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment.

INTRODUCTION: Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS: Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS: Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS: Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.

Executive function assessment in New Zealand 2-year olds born at risk of neonatal hypoglycemia.

A growing number of babies are born with perinatal risk factors that may impair later development. These children are often assessed at 2 years to help predict outcome and direct support services. Executive function is an important predictor of academic achievement and behavior, but there are limited assessments of executive function in 2-year-olds and few have been tested in at-risk populations. Therefore, we developed a battery of four age-appropriate tasks to assess executive function in 2-year-olds. At 24 months' corrected age 368 children completed tasks assessing attention, inhibition, working memory and cognitive flexibility. Scores on different tasks were weakly correlated, suggesting that they measured separate aspects of executive function, with combined scores for this cohort approximating a normal distribution. Significantly more boys (67%) than girls (57%) were unable to inhibit their behavior on the Snack Delay Task and girls (M = 3.24, SD = 2.4) had higher mean scores than boys (M = 2.7, SD = 2.7) on the Ducks and Buckets Reverse Categorization Task of working memory. Performance was significantly affected by family socioeconomic status. Mean scores were lower on all four individual tasks and on the global score of overall performance in children from a low household income (<$40,000) compared to those from medium ($40,001-$70,000) and high income households (>$70,001). Maternal education was only associated with scores on the working memory task and the global score; and a measure of neighborhood deprivation was only associated with scores on the two inhibitory tasks and the global score. Our findings confirm the feasibility of assessing executive function in 2-year-olds, and its ability to discriminate effects of socioeconomic status, a common confounder in child development research. Further development and standardization of this test battery comparing at-risk children with a normative population would provide a much-needed measure of executive function in early childhood.

Synergistic effects of aerobic exercise and cognitive training on cognition, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline: study protocol for a randomized controlled trial.

BACKGROUND: Aerobic exercise and cognitive training have been effective in improving cognitive functions; however, whether the combination of these two can further enhance cognition and clinical outcomes in stroke survivors with cognitive decline remains unknown. This study aimed to determine the treatment effects of a sequential combination of aerobic exercise and cognitive training on cognitive function and clinical outcomes. METHODS/DESIGN: Stroke survivors (n = 75) with cognitive decline will be recruited and randomly assigned to cognitive training, aerobic exercise, and sequential combination of aerobic exercise and cognitive training groups. All participants will receive training for 60 minutes per day, 3 days per week for 12 weeks. The aerobic exercise group will receive stationary bicycle training, the cognitive training group will receive cognitive-based training, and the sequential group will first receive 30 minutes of aerobic exercise, followed by 30 minutes of cognitive training. The outcome measures involve cognitive functions, physiological biomarkers, daily function and quality of life, physical functions, and social participation. Participants will be assessed before and immediately after the interventions, and 6 months after the interventions. Repeated measures of analysis of variance will be used to evaluate the changes in outcome measures at the three assessments. DISCUSSION: This trial aims to explore the benefits of innovative intervention approaches to improve the cognitive function, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline. The findings will provide evidence to advance post-stroke cognitive rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02550990 . Registered on 6 September 2015.