The Frontal Assessment Battery 20 years later: normative data for a shortened version (FAB15).

OBJECTIVE: The Frontal Assessment Battery (FAB) is a neuropsychological tool largely used to assess executive functions. Prior studies found a marked ceiling effect for the prehension behavior subtest (PBT) in healthy and clinical populations. Aims of the present study were (i) to examine the psychometric properties of the FAB without the contribution of PBT and (ii) to provide normative data for a revised version of the FAB after exclusion of PBT (FAB15). METHODS: The normative sample included 1,187 healthy participants. PBT had near-zero variance, poor content validity, and no discrimination power. Internal consistency increased when PBT was excluded. We assessed the FAB15 factorial structure, interrater, and test-retest reliabilities. Normative data  for the FAB15 were extracted through a regression-based procedure according to sex, age, and education. RESULTS: The principal component analysis revealed a single "executive factor" or alternatively a bifactorial solution reflecting the different degree of discriminative capability vs. difficulty of the subtests. The FAB15 demonstrated excellent interrater and test-retest reliabilities. Regression analysis showed that sex (lowly educated women < lowly educated men), higher age, and lower education affected FAB15 score. Accordingly, three grids for adjustment of raw scores (men, women, and both) were constructed. The cut-off was fixed at the non-parametric outer tolerance limit on the fifth centile (9.36, 95% CI). CONCLUSION: The observation of a ceiling effect in healthy subjects makes PBT not suitable for inclusion in a neuropsychological battery. The FAB15 may successfully replace the conventional FAB as a more severe and valid short screening tool to assess executive functioning.

Italian version of the Starkstein Apathy Scale (SAS-I) and a shortened version (SAS-6) to assess "pure apathy" symptoms: normative study on 392 individuals.

OBJECTIVES: The present normative study aimed to (1) develop the Italian version of the Starkstein Apathy Scale (SAS-I) and (2) construct a shortened version including only the most sensitive items to "pure apathy" experiences. METHODS: The normative sample included 392 healthy subjects. A regression-based procedure was used to explore the effects of sex, age, and education on the raw SAS-I score. A correction grid was designed for adjusting raw scores by adding or subtracting the contribution of any significant variable and net of sociodemographic interindividual differences. Cutoff scores were also calculated and fixed at the external tolerance limit on the ninety-fifth centile. To obtain the shortened version, each SAS-I item was correlated with the Beck's Depression Inventory (BDI) score. The only items showing no correlation with BDI were implemented to bypass the well-known overlap between apathetic and depressive symptoms. RESULTS: The mean raw SAS-I score was 11.27 (SD = 4.42). A significant education effect was observed, with highly educated subjects obtaining lower scores than lowly educated ones. The proposed general cutoff score was 20.68. The SAS-I had fair internal consistency and discriminant validity. Internal consistency increased by removing item 3. The new SAS-6 included items 1, 2, 4, 10, 11, and 13 of the original scale. CONCLUSION: The SAS-I is a reliable assessment tool to support the diagnosis of apathy. The SAS-6, instead, is a brief questionnaire useful for quickly screening apathetic symptoms in outpatient practice, addressing or not the clinician to further investigations.

Psychometric properties of the STAI-Y scales and normative data in an Italian elderly population.

BACKGROUND: Early detection of anxiety symptoms in older people is capital as it may be linked to increased physical/functional disabilities, onset and progression of neurodegenerative disorders, and poor cognitive functioning. Nonetheless, there is a paucity of psychometrically validated anxiety measures in the elderly. AIMS: This study aimed at assessing the psychometric properties of the State-Trait Anxiety Inventory-Form Y (STAI-Y) and providing the first normative data for the Italian elderly population. METHODS: The sample included 361 individuals aged 65-94. All subjects underwent the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the state (S-Anxiety) and trait anxiety (T-anxiety) scales of the STAI-Y. RESULTS: The S-Anxiety and T-Anxiety scales showed reliable internal consistency and, overall, good item characteristics. Divergent validity was "apparently" threatened, with S-Anxiety scale correlating with MMSE and GDS, and T-Anxiety scale only with GDS. The principal component analysis revealed a three-factor solution for both scales, i.e., presence and absence of state (or trait) anxiety, and performance anxiety. Since no effect of sociodemographic variables was found, unadjusted cutoffs were provided. CONCLUSIONS: Although some questions on the psychometric properties of the STAI-Y remain unanswered, this normative study can help clinicians and researchers to monitor anxiety levels in the Italian elderly population.

Daily exposure to digital displays may affect the clock-drawing test: from psychometrics to serendipity.

BACKGROUND: The clock-drawing test (CDT) is a neuropsychological screening tool largely used to explore cognitive functioning. It requires participants to draw an analog clock face. Many studies have reported a good correlation between the CDT and the Mini-Mental State Examination (MMSE). The CDT has also showed a variable specificity. There are, however, some inconsistencies concerning the effect of sociodemographic variables (sex, age, education) on clock-drawing abilities. The present study aimed at examining these issues in a sample of middle-aged/young-old healthy adults. METHOD: Participants (n = 97) performed the MMSE and CDT. Clock drawings were assessed by five formal scoring systems (Wolf-Klein, Watson, Freedman, Manos, Shulman). In addition, three naïve raters provided a dichotomous judgment (normal vs. abnormal) for each clock. RESULTS: Sociodemographic variables did not affect CDT performance. Unlike earlier studies, CDT scores did not correlate with MMSE. Moreover, test specificity was appropriate only for Freedman's, Shulman's, and Wolf-Klein's methods. Interestingly, some participants drew clocks with numbers as they appear in digital clocks. By re-running the statistical analyses after removing these atypical clocks, four out of the five formal scores showed a significant correlation with MMSE; furthermore, CDT specificity slightly increased for all scoring systems including naïve ratings. CONCLUSIONS: CDT is not affected by sociodemographic variables. The finding of some clocks with digitally represented numbers suggests the need to align neuropsychological assessments with demands from an increasing digitalized environment. Moreover, the occurrence of high false-positives and possible digital contaminations suggest great caution in interpreting the clinical significance of CDT.

Does episodic future thinking improve prospective remembering?

Extant findings suggest interesting avenues for the investigation of the potential relationship between EFT and PM. However, as they stand, they are inconclusive as to the causal role that EFT may play in aiding prospective remembering. In one Experiment, we showed that accuracy in a prospective memory (PM) task performed on the second day was significantly higher when participants, on the first day, had mentally simulated the sequence of events expected to occur on the second day, including the PM task, than when they had performed control tasks. These data extend previous findings on the functional benefit of future simulations in different domains by revealing a substantial facilitation effect of future-oriented thoughts on PM performance when the mentally simulated future task matched the actually executed task.

What makes us more susceptible to false memories in the era of COVID-19? A focus on vaccines and Green Pass.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an overabundance of fake news increasing the risk of developing false memories (FMs). Previous studies have shown that the relationship between fake news and FMs could be mediated by some individual variables, including attitudinal biases. We explored the role of these variables in true memories (TMs) and FMs formation, with special emphasis on vaccine- and Green Pass (GP)-related topics. METHOD: We set up a large online survey exploring several constructs including media usage, attitude toward vaccines and GP, perceived (PK) and objective knowledge (OK) about COVID-19-related information, fear of the disease, depression and anxiety symptoms, coping mechanisms, and reasoning skills. Then, we asked participants whether they remembered certain news (true or fake), providing confidence ratings. RESULTS: Data from 289 respondents (198 females) from the general population were analyzed. Participants with positive attitude reported a greater fear that their loved ones contracted the COVID-19, a more frequent use of traditional media, and a higher PK when compared with respondents with negative attitude. On the whole sample, participants reported higher confidence levels when required to judge their memory of true than fake news; however, participants with positive attitude reported a higher confidence for both true and fake news. The relationship between attitude and TM confidence was mediated by the PK, whereas the relationship between attitude and FM confidence was probably affected by OK. CONCLUSION: Attitude can modulate individual behaviors in the context of health issues. The PK and OK may interact with attitude in the memory formation.

The assessment of executive functions to test the integrity of the nigrostriatal network: A pilot study.

Background: Parkinson's disease (PD) is a chronic neurodegenerative disorder characterized by motor and non-motor symptoms. The latter mainly include affective, sleep, and cognitive deficits. Non-demented PD patients often demonstrate impairments in several executive domains following neuropsychological evaluation. The current pilot study aims at assessing the discriminatory power of the Frontal Assessment Battery-15 (FAB15) in differentiating (i) non-demented PD patients and healthy controls and (ii) PD patients with more and less pronounced motor symptoms. Methods: Thirty-nine non-demented early-stage PD patients in the "on" dopamine state (26 females, mean age = 64.51 years, SD = 6.47, mean disease duration = 5.49 years, SD = 2.28) and 39 healthy participants (24 females, mean age = 62.60 years, SD = 5.51) were included in the study. All participants completed the FAB15. Motor symptoms of PD patients were quantified via the Unified Parkinson's Disease Rating Scale-Part III (UPDRS-Part III) and Hoehn and Yahr staging scale (H&Y). Results: The FAB15 score, adjusted according to normative data for sex, age, and education, proved to be sufficiently able to discriminate PD patients from healthy controls (AUC = 0.69 [95% CI 0.60-0.75], SE = 0.06, p = 0.04, optimal cutoff = 11.29). Conversely, the battery lacked sufficient discriminative capability to differentiate PD patients based on the severity of motor symptoms. Conclusion: The FAB15 may be a valid tool for distinguishing PD patients from healthy controls. However, it might be less sensitive in identifying clinical phenotypes characterized by visuospatial impairments resulting from posteroparietal and/or temporal dysfunctions. In line with previous evidence, the battery demonstrated to be not expendable in the clinical practice for monitoring the severity of PD-related motor symptoms.

What differentiates episodic future thinking from complex scene imagery?

We investigated the contributions of familiarity of setting, self-relevance and self-projection in time to episodic future thinking. The role of familiarity of setting was assessed, in Experiment 1, by comparing episodic future thoughts to autobiographical future events supposed to occur in unfamiliar settings. The role of self-relevance was assessed, in Experiment 2, by comparing episodic future thoughts to future events involving familiar others. The role of self-projection in time was assessed, in both Experiments, by comparing episodic future thoughts to autobiographical events that were not temporal in nature. Results indicated that episodic future thoughts were more clearly represented than autobiographical future events occurring in unfamiliar setting and future events involving familiar others. Our results also revealed that episodic future thoughts were indistinguishable from autobiographical atemporal events with respect to both subjective and objective detail ratings. These results suggest that future and atemporal events are mentally represented in a similar way.

Normative data for a battery of free recall, cued recall and recognition tests in the elderly Italian population.

The present study aimed to provide normative data on a large sample of the elderly Italian population (N = 464; range of age = 49-94; range of education = 3-25) on both the word and the picture versions of a battery of free recall, cued recall, and recognition tests of memory. Results from multiple regression analyses showed that both age and education were significant predictors of performance. Therefore, norms were calculated taking into account these demographic variables. The availability of normative data based on a large sample will allow a more reliable use of the battery for clinical assessment in Italian-speaking dementia population.

Understanding of Numerical Information during the COVID-19 Pandemic.

Media news during the Coronavirus Disease 2019 (COVID-19) pandemic often entail complex numerical concepts such as exponential increase or reproduction number. This study investigated whether people have difficulties in understanding such information and whether these difficulties are related to numerical competence, reflective thinking, and risk proneness. One hundred sixty-three participants provided answers to a numeracy scale focusing on complex numerical concepts relevant to COVID-19 (COV Numeracy Scale). They also provided responses to well-established objective and subjective scales, questions about affective states, and questions about the COVID-19 pandemic. Higher scores on the COV Numeracy Scale correlated with higher scores on the Health Numeracy Scale, in the Cognitive Reflection Test (CRT), and in self-assessments of verbal comprehension, mathematical intelligence, and subjective numeracy. Interestingly, scores on the COV Numeracy Scale also positively correlated with the number of consulted information sources about COVID-19. Accuracy in the CRT emerged as a significant predictor, explaining ca. 14% of variance on the COV Numeracy Scale. The results suggest that people with lower reflective thinking skills and lower subjective and objective numerical competence can be more at disadvantage when confronted with COVID-related numerical information in everyday life. These findings advise caution in the communication of relevant public health information that entails complex numerical concepts.

Objective Knowledge Mediates the Relationship between the Use of Social Media and COVID-19-Related False Memories.

The exposure to relevant social and/or historical events can increase the generation of false memories (FMs). The Coronavirus Disease 2019 (COVID-19) pandemic is a calamity challenging health, political, and journalistic bodies, with media generating confusion that has facilitated the spread of fake news. In this respect, our study aims at investigating the relationships between memories (true memories, TMs vs. FMs) for COVID-19-related news and different individual variables (i.e., use of traditional and social media, COVID-19 perceived and objective knowledge, fear of the disease, depression and anxiety symptoms, reasoning skills, and coping mechanisms). One hundred and seventy-one university students (131 females) were surveyed. Overall, our results suggested that depression and anxiety symptoms, reasoning skills, and coping mechanisms did not affect the formation of FMs. Conversely, the fear of loved ones contracting the infection was found to be negatively associated with FMs. This finding might be due to an empathy/prosociality-based positive bias boosting memory abilities, also explained by the young age of participants. Furthermore, objective knowledge (i) predicted an increase in TMs and decrease in FMs and (ii) significantly mediated the relationships between the use of social media and development of both TMs and FMs. In particular, higher levels of objective knowledge strengthened the formation of TMs and decreased the development of FMs following use of social media. These results may lead to reconsidering the idea of social media as the main source of fake news. This claim is further supported by either the lack of substantial differences between the use of traditional and social media among participants reporting FMs or the positive association between use of social media and levels of objective knowledge. The knowledge about the topic rather than the type of source would make a difference in the process of memory formation.

Age-related differences in the attention network test (ANT).

This study investigates the effect of aging on alerting, orienting, and conflict resolution by assessing younger (mean age = 25.8) and older (mean age = 67.9) adults' performance in the Attention Network Test that combines, in a single experimental paradigm, a flanker task with alerting and orienting cues. The analyses of response times indicated equivalent orienting and conflict resolution effects in younger and older adults. By contrast, alerting was found to be significantly reduced in the elderly. This result is only marginally in accordance with recent studies addressing the issues of age-related differences in alerting, which provide mixed results. The possible role of methodological differences across studies in accounting for the controversial results concerning the aging affect on alerting is discussed.

Normative data for the Pyramids and Palm Trees Test in the elderly Italian population.

The Pyramids and Palm Tree Test (PPT) is a semantic memory test that measures the capacity to access detailed semantic information about words and pictures, necessary for the identification of the analogies, which link conceptually two perceptually, and functionally distinct entities. The present study aimed to provide normative data on a large sample of the elderly Italian population (N = 464; range of age = 49-94; range of education = 3-25) on both the word and the picture versions of the PPT. Results from multiple regression analyses showed that both age and education were significant predictors of performance in both the word and the picture versions of the PPT. Therefore, norms were calculated taking into account these demographic variables. The availability of normative data based on a large sample will allow a more reliable use of the PPT for clinical assessment in Italian-speaking dementia population.

The Impact of Failures and Successes on Affect and Self-Esteem in Young and Older Adults.

Older adults are assumed to change their affect states in reaction to positive and negative stimuli across the life span. However, little is known about the impact of success and failure events on age-related changes in affect states and, particularly, in self-esteem levels. To fill this gap in the literature, in the present study changes in affect and self-esteem in 100 young (19-30 years) and 102 older adults (65-81 years) were assessed after participants experienced success and failure in a demanding cognitive task. Overall, the success-failure manipulation induced changes on affect states and on state self-esteem, not on trait self-esteem. Regarding age differences, older and young adults were affected to the same extent by experiences of successes and failures. Theoretical considerations of the empirical findings are provided in the general discussion.

Normal aging affects decisions under ambiguity, but not decisions under risk.

Old adults have to face many situations that require important decisions. In the present investigation, the authors examined the effects of aging on both decisions under ambiguity and decisions under risk. To this purpose, healthy young and old adults completed the Iowa Gambling Task (IGT) and the Probability-Associated Gambling task (PAG task). Old adults performed the PAG task as well as young adults, demonstrating ability to make decisions when full information about the problem situation, the options' probabilities and the associated gains and losses was given. Differently, old adults showed poor performance on the IGT relative to young adults, indicating difficulty in making advantageous decisions under ambiguous conditions. Indeed, in the IGT, participants are not aware of the rules for gains and losses and have to learn about the utility of their selections through experience. Results of our analyses point to the contribution of executive functions to all types of decisions. Our findings have also practical implications, suggesting that old people can make advantageous decisions when complete information about the decision situation is available.

Characterizing cognitive inhibitory deficits in mild cognitive impairment.

Individuals with mild cognitive impairment -MCI- show relative weaknesses in executive functioning (EF), as well as poor memory, but the inhibition-related mechanisms behind EF impairment in MCI have not been examined systematically. The aim of the present study was to systematically investigate inhibitory function in individuals with MCI to ascertain whether pathological aging is characterized by deficits in inhibitory processes and whether such impairment is confined to specific inhibition-related mechanisms. Tasks assessing inhibition-related functions - i.e. prepotent response inhibition (measured with the Color Stroop test), response to distracters (assessed using a text with distracters task), and resistance to proactive interference (assessed with a proactive interference task) - were administered to individuals with MCI and to healthy older controls. Individuals with MCI made more intrusion errors in the proactive interference task than controls, while the two groups' performance was comparable in prepotent response inhibition and response to distracters. This pattern of findings suggests that MCI is associated with specific inhibition problems.ty.

Effects of self-generated versus experimenter-provided cues on the representation of future events.

Most experimental studies of prospection focused on episodic forms of future events prompted by means of verbal cues. However, there is evidence suggesting that future events differ considerably according to whether they are produced in response to external, experimenter-provided verbal cues or they are self-generated. In the present study, we compared the quality, the phenomenal characteristics, the temporal distribution, and the content of imagined events prompted by experimenter-provided cues (i.e., cue-words and short verbal sentences) or elicited by means of verbal cues that were self-generated in an autobiographical fluency task. The results showed that future events prompted by means of self-generated cues contained fewer event-specific details than future events prompted by experimenter-provided cues. However, future events elicited by means of self-generated and by experimenter-provided cues did not differ with respect to their phenomenal characteristics. The temporal distribution and the thematic content of future representations were also affected by the type of cue used to elicit prospection. These results offer a holistic view of the properties of future thinking and suggest that the content and the characteristics of envisioned future events may be affected by the method used to elicit prospection.

Age differences and the identity negative priming effect: an updated meta-analysis.

A recent meta-analysis (P. Verhaeghen & L. De Meersman, 1998a) revealed that older adults show a reliable but significantly reduced negative priming effect compared with young adults. The present study provides an updated quantitative review on the effect of aging on the magnitude of the negative priming effect in identity tasks. This analysis demonstrated that the negative priming effect was not significantly different between young and old adults. This result differs from P. Verhaeghen and L. De Meersman's study. The implications of this finding for inhibitory-based theories of cognitive aging are discussed.

Future thinking in Parkinson's disease: an executive function?

Contrary to what was originally thought (Hassabis, Kumaran, Vann, & Maguire, 2007) recent data have shown that imagining the future is not entirely dependent on the hippocampus (Squire et al., 2010) and neuroimaging studies have demonstrated a frontopolar activation during future thinking tasks (Okuda et al., 2003). The present study investigated whether the performance of people with Parkinson's disease (PD) on future simulation tasks was dependent on memory or executive control. Thirty-one PD patients, asked to imagine possible future scenarios, generated fewer future episodic details than matched controls. The seven patients who clearly performed below the range of controls in future thinking, were also significantly poorer on the Frontal Assessment Battery (FAB), a battery assessing executive control, but showed no deficits in immediate or delayed memory tests. These results suggest that poor performance in the future thinking task is associated with poor executive control and less so with memory impairment. Flexible searching activities of past details might be crucial capacities for envisaging one's own future.

The role of past in the simulation of autobiographical future episodes.

Human beings' ability to envisage the future has been recently assumed to rely on the reconstructive nature of episodic memory (Schacter & Addis, 2007). In the present research, young adults mentally reexperienced and preexperienced temporally close and distant autobiographical episodes, and rated their phenomenal characteristics as well as their novelty. Additionally, they performed a delayed recognition task including remember-know judgments on new, old-remember, and old-imagine words. Results showed that past and future temporally close episodes included more phenomenal details than distant episodes, in line with earlier studies. However, future events were occasionally rated as already occurred in the past. Furthermore, in the recognition task, participants falsely attributed old-imagine words to remembered episodes. While partially in line with previous results, these findings call for a more subtle analysis in order to discriminate representations of past episodes from true future events simulations.