Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe.

INTRODUCTION: Harmonized neuropsychological assessment for neurocognitive disorders, an international priority for valid and reliable diagnostic procedures, has been achieved only in specific countries or research contexts. METHODS: To harmonize the assessment of mild cognitive impairment in Europe, a workshop (Geneva, May 2018) convened stakeholders, methodologists, academic, and non-academic clinicians and experts from European, US, and Australian harmonization initiatives. RESULTS: With formal presentations and thematic working-groups we defined a standard battery consistent with the U.S. Uniform DataSet, version 3, and homogeneous methodology to obtain consistent normative data across tests and languages. Adaptations consist of including two tests specific to typical Alzheimer's disease and behavioral variant frontotemporal dementia. The methodology for harmonized normative data includes consensus definition of cognitively normal controls, classification of confounding factors (age, sex, and education), and calculation of minimum sample sizes. DISCUSSION: This expert consensus allows harmonizing the diagnosis of neurocognitive disorders across European countries and possibly beyond.

I could do it now, but I'd rather (forget to) do it later: examining links between procrastination and prospective memory failures.

Prospective memory (PM) represents the ability to remember to perform planned actions after a certain delay. As previous studies suggest that even brief task-delays can negatively affect PM performance, the current study set out to examine whether procrastination (intentionally delaying task execution despite possible negative consequences) may represent a factor contributing to PM failures. Specifically, we assessed procrastination (via a standardized questionnaire as well as an objective behavioral measure) and PM failures (via a naturalistic PM task) in 92 young adults. Results show that participants' self-reports as well as their actual procrastination behavior predicted the number of PM failures, corroborating the impact of procrastination on PM. Subsequent cluster analyses suggest three distinct procrastination profiles (non-procrastinators, conscious procrastinators and unconscious procrastinators), providing new conceptual insights into different mechanisms of how procrastinating may lead to forgetting to perform planned tasks.

Prospective memory errors in everyday life: does instruction matter?

Previous research on prospective memory (PM, the ability to remember executing an intention in the future) suggests that PM errors constitute the majority of all everyday memory errors in younger adults. However, no study so far has investigated this ratio from an ageing perspective, nor examined whether different instructions may influence PM error reporting. In the present study, 64 younger and 64 older adults completed a 5-day diary on PM, memory and cognition errors following different reporting instructions: participants had to either focus on (1) PM errors only, (2) any daily memory errors (prospective or retrospective) or (3) any kind of cognitive error. Error descriptions were coded into subcategories and analysed both quantitatively and qualitatively. Independently of given instructions, PM was the most frequent everyday error for both age groups. Overall, results confirm age differences for everyday PM (but not for retrospective memory and cognition), suggesting that everyday PM might be spared from age-related decline. From a qualitative point of view, there seem to be differences in the type of missed intentions, which correspond with existent theories of ageing. In conclusion, the present study allowed for a deeper insight into everyday PM functioning in younger and older adults.

Distinct effects of cognitive versus somatic anxiety on cognitive performance in old age: the role of working memory capacity.

Objective: The adverse effects of anxiety on cognition are widely recognized. According to Attentional Control Theory, worry (i.e. facet of cognitive anxiety) is the component that is responsible for these effects, and working memory capacity (WMC) plays an important role in regulating them. Despite the increasing importance of this problem with aging, little is known about how these mechanisms interact in old age. In this study, we explored the distinct contributions of the somatic and cognitive components of anxiety to neuropsychological performance, and the potential moderating role of WMC.Method: We administered cognitive tasks testing processing speed, cognitive flexibility and working memory to 605 older adults, who also underwent depression and test anxiety assessments (data from VLV study).Results: Multiple regression analyses showed that cognitive (but not somatic) aspects of anxiety affected cognitive flexibility. The effect of cognitive anxiety on processing speed was moderated by WMC: the anxiety-performance association was lower for participants with greater WMC.Conclusion: Results confirmed the specific role of worry in the anxiety-performance relationship in old age and supported the hypothesis that working memory resources regulates its deleterious effect on cognition. The absence of a moderation effect in the more costly switching task may reflect a limitation of resources with aging.

Stress and prospective memory: What is the role of cortisol?

Studies investigating effects of acute stress on Prospective Memory (PM) so far yielded heterogeneous findings. Although results were commonly attributed to stress-induced changes in cortisol, past research did not disentangle effects of cortisol from the effects of sympathetic nervous system (SNS) activation and cognitive reappraisal. The present study therefore aimed at investigating the mere effect of cortisol on PM tasks that differently involve prefrontal brain regions (nonfocal vs. focal PM tasks) via a placebo-controlled oral pharmacological intake of 10 mg hydrocortisone mimicking physiological responses to stress. Contrary to our prediction, enhanced levels of cortisol did not affect PM accuracy and monitoring costs, neither for the focal nor the nonfocal PM tasks. These results suggest that changes of cortisol levels do not underlie potential stress effects on PM. Further exploratory results revealed that PM performance was higher in the 3 pm than in the 1 pm placebo group. This means that PM performance, independently of effects of cortisol, seem to vary throughout the day.

Prospective Memory Relates to Attentional Control: Differential Patterns in Old Age.

AIMS: We investigated the associations of prospective memory (PM) with memory, attentional control, and conscientiousness and whether they differed between young-old (YO) and old-old adults (OO). METHODS: We analyzed data from 562 older adults (mean = 80.04 years) who were tested on four PM tasks, memory (immediate and delayed cued recall), attentional control (letter and category fluency), and reported conscientiousness. RESULTS: Latent variable analyses showed that in both YO and OO PM was associated with memory and attentional control (but not conscientiousness). Notably, testing for moderation effects revealed that the relation between PM and attentional control was significantly stronger in YO than in OO. CONCLUSION: YO may be able to better (than OO) achieve a good PM performance with good attentional control.

The interplay of intention maintenance and cue monitoring in younger and older adults' prospective memory.

The retention phase of a prospective memory (PM) task poses different challenges, including demands to store or maintain an intended action and to realize the right moment for action execution. The interplay of these processes in younger and older adults has not been explored so far. In this study, the authors examined the impact of maintenance load and task focality on PM in 84 younger and in 83 older adults. Results indicated that PM performance and ongoing task response times were strongly affected by maintenance load and age. However, a focality effect only emerged when maintenance load was low but not when attentional resources were deployed for maintaining a more demanding intention. These findings suggest that maintenance and monitoring requirements compete for similar attentional resources. Furthermore, maintenance load may affect postretrieval processes through its impact on working-memory resources, which can restrain the typical advantage of focal over nonfocal PM tasks.

Prospective Memory in Older Adults: Where We Are Now and What Is Next.

The interplay of cognitive abilities that constitute the process of 'remembering to remember' is referred to as prospective memory. Prospective memory is an essential ability to meet everyday life challenges across the life span, constitutes a key element of autonomy and independence and is especially important in old age with increasing social and health-related prospective memory demands. The present paper first presents major findings from the current state of the art in research on age effects in prospective memory. In a second part, it presents four focus areas for future research outlining possible conceptual, methodological, and neuroscientific advancements.

Age differences in prospective memory for everyday life intentions: A diary approach.

The age benefit found in many naturalistic prospective memory (PM) tasks has been taken as evidence that PM performance in real life may be spared from aging. However, this conclusion lacks empirical confirmation. Hence, the aim of the present study was to examine possible age differences in the content of everyday PM intentions and their performance. Everyday PM was assessed in young and older adults using a diary approach. Results confirmed a general age benefit for real-life PM tasks. Importantly, this finding was qualified by revealing that the benefit only held true for specific types of intentions such as health and social intentions. Further, moderation analyses showed that the relationships between cognitive functioning and everyday PM were different for young and older adults. While better inhibition, short-term and long-term memory were related with successful PM performance in the young, this was not the case in the older adults. The present findings suggest that the age benefit found in naturalistic experimenter-given tasks extends to real-life PM performance, but may differ depending on the type of intention. Furthermore, cognitive functioning predicts performance in the young, but not in the older adults.

Mood effects on memory and executive control in a real-life situation.

In the laboratory, studies have shown an inconsistent pattern of whether, and how, mood may affect cognitive functions indicating both mood-related enhancement as well as decline. Surprisingly, little is known about whether there are similar effects in everyday life. Hence, the present study aimed to investigate possible mood effects on memory and executive control in a real-life situation. Mood effects were examined in the context of winning in a sports competition. Sixty-one male handball players were tested with an extensive cognitive test battery (comprising memory and executive control) both after winning a match and after training as neutral baseline. Mood differed significantly between the two testing situations, while physiological arousal and motivation were comparable. Results showed lowered performance after the win compared with training in selected cognitive measures. Specifically, short-term and episodic memory performance was poorer following a win, whereas executive control performance was unaffected by condition. Differences in memory disappeared when emotional states after the match were entered as covariates into the initial analyses. Thus, findings suggest mood-related impairments in memory, but not in executive control processes after a positive real-life event.

A Virtual Week study of prospective memory function in autism spectrum disorders.

Prospective memory (PM) refers to the implementation of delayed intentions, a cognitive ability that plays a critical role in daily life because of its involvement in goal-directed behavior and consequently the development and maintenance of independence. Emerging evidence indicates that PM may be disrupted in autism spectrum disorders (ASDs), potentially contributing to the functional difficulties that characterize this group. However, the degree, nature, and specificity of ASD-related impairment remains poorly understood. In the current study, children between 8 and 12 years of age who were diagnosed with ASDs (n=30) were compared with typically developing children (n=30) on a child-appropriate version of the Virtual Week board game. This measure provides an opportunity to investigate the different sorts of PM failures that occur. The ASD group showed significant PM impairment on measures of time-based (but not event-based) prospective remembering. However, only a subtle difference emerged between regular and irregular PM tasks, and group differences were consistent across these tasks. Because regular and irregular tasks differentially load retrospective memory, these data imply that the PM difficulties seen in ASDs may primarily reflect a monitoring deficit and not an encoding and memory storage deficit. PM performance was poorer under conditions of high ongoing task absorption, but the magnitude of this effect did not vary as a function of group. In both groups, time-based (but not event-based) PM difficulties were associated with functional outcomes in daily life, but only an inconsistent association with executive control emerged.

A focus group study for the design of a web-based tool for improving problem-solving in older adults.

The development of easily accessible and usable social and cognitive enhancement trainings is becoming a priority to reduce the impact of aging on quality of life. Since most activities of daily living (e.g., making a meal) require problem-solving skills, problem-solving interventions could be used to improve and/or maintain functional abilities in aging to prolong independence. To design an effective problem-solving training and increase older adults' adherence to the training, this study examined older adults' perceptions of their challenges in activities of daily living, their skills and difficulties in using information technology (IT), and their motivations and expectations for participating in a web-based problem-solving training activity. Four focus groups (two in Italy and two in the Netherlands) were conducted with older adults aged between 65 and 84 years, a total of 27 participants. The data were analyzed using the Atlas.ti 8 software for the thematic analysis. The analysis identified five thematic areas: interests and activities, difficulties and concerns, experiences and motivations for training, expertise and resources, suggestions for the design of the new training. The results were used to develop a first prototype of a Shared, Web-based, Intelligent Flexible Thinking Training (SWIFT), adapted to future user needs. The participation of older adults in this design phase was critical to understanding their needs, motivations, and expectations regarding the implementation and use of a cognitive enhancement training.

Adult age differences in the psychophysiological response to acute stress.

Age-related differences in the psychophysiology of the acute stress response are poorly understood given the limited number of studies and the high heterogeneity of findings. The present study contributes by investigating age differences in both the psychological and physiological responses to acute stress in a sample of healthy younger (N = 50; 18-30; Mage = 23.06; SD = 2.90) and older adults (N = 50; 65-84; Mage = 71.12; SD = 5.02). Specifically, the effects of psychosocial stress (i.e., age-adapted Trier Social Stress Test) were investigated at numerous timepoints throughout the stress response phases (i.e., baseline, anticipation, reactivity, recovery) on cortisol, heart rate, subjective stress, and anticipatory appraisal of the stressful situation. The study was conducted in a between-subject (younger vs. older) cross-over (stress vs. control) design. Results revealed age-related differences in both physiological and psychological variables: older adults had overall lower salivary cortisol levels in the stress and control conditions and lower stress-induced cortisol increase (i.e., AUCi). In addition, older adults' cortisol reactivity was delayed compared to younger adults. Older adults showed a lower heart rate response in the stress condition while no age differences were observed in the control condition. Finally, older adults reported less subjective stress and a less negative stress appraisal during the anticipation phase than younger adults, which could potentially explain lower physiological reactivity in this age group. Results are discussed in relation to the existing literature, potential underlying mechanisms, and future directions for the field.

Acute stress impacts reaction times in older but not in young adults in a flanker task.

Acute psychosocial stress effects on inhibition have been investigated in young adults, but little is known about these effects in older adults. The present study investigated effects of the Trier Social Stress Test on cognitive inhibition (i.e., ability to ignore distracting information) using a cross-over (stress vs. control) design in healthy young (N = 50; 18-30 years; Mage = 23.06) versus older adults (N = 50; 65-84 years; Mage = 71.12). Cognitive inhibition was measured by a letter flanker task and psychophysiological measures (cortisol, heart rate, subjective stress) validated the stress induction. The results showed that while stress impaired overall accuracy across age groups and sessions, stress (vs. control) made older adults' faster in session 1 and slower in session 2. Given that session 2 effects were likely confounded by practice effects, these results suggest that acute psychosocial stress improved older adults' RTs on a novel flanker task but impaired RTs on a practiced flanker task. That is, the interaction between stress and learning effects might negatively affect response execution when testing older adults on flanker tasks. If confirmed by future research, these results might have important implications especially in settings where repeated cognitive testing is performed under acute stress.

In Older Adults, Perceived Stress and Self-Efficacy Are Associated with Verbal Fluency, Reasoning, and Prospective Memory (Moderated by Socioeconomic Position).

Despite evidence that stress relates negatively to cognitive functioning in older adults, little is known how appraisal of stress and socioeconomic meso-level factors influence different types of cognitive functions in older adults. Here, we assess the relationship between perceived stress (PSS scale) and a battery of cognitive functions, including prospective memory in 1054 older adults (65+). A moderator analysis assessed whether this relationship varies with neighborhood socioeconomic status using an area-based measure of Socioeconomic Position (SEP). Perceived stress was associated with worse processing speed, verbal fluency, and inductive reasoning. The perceived self-efficacy subscale of the PSS is related to better performance in these measures. Higher self-efficacy was also associated with better prospective memory; this relationship was more pronounced for people with high neighborhood SEP. These findings indicate that not only do perceived stress and perceived self-efficacy relate to cognitive functioning in older age but also that neighborhood SEP is a moderator of this relationship.

Does older adults' cognition particularly suffer from stress? A systematic review of acute stress effects on cognition in older age.

This literature review provides the first comprehensive qualitative and quantitative systematic synthesis of acute laboratory stress effects on older adults' cognition by specifying the direction and magnitude of those effects both overall and for different cognitive processes separately. A systematic literature search was performed, and effect sizes estimated whenever possible. We found meta-analytical evidence that stress has negative effects on older adults' verbal fluency (gadj = -0.53, 95 % CI [-2.70, 1.63]), null-to-negative effects on episodic memory (gadj = -0.26, 95 % CI [-0.44, -0.08]), null effects on executive functions (gadj = 0.07, 95 % CI [-0.31, 0.46]), and enhancing effects on working memory (gadj = 0.16, 95 % CI [-0.01, 0.33]). Relating these findings to those in young adults, notable differences emerged for some cognitive functions, such as opposing effects on working memory between age groups. Our review further reveals that stress effects on older adults' memory retention, associative memory, prospective memory, interference control or cognitive flexibility are heavily understudied. We provide a conceptual and methodological framework for future studies in older adults.

The Sounds of Memory: Extending the Age-Prospective Memory Paradox to Everyday Behavior and Conversations.

OBJECTIVES: Around the turn of the millennium, the "age-prospective memory (PM) paradox" challenged the classical assumption that older adults necessarily evidence a marked decline in PM functioning. As previous investigations highlighted ecological validity to be a potential explanation, the present study sought to extend established approaches by using novel real-world assessment technologies to examine PM unobtrusively in everyday-life conversations. METHOD: Next to laboratory PM tasks, real-life PM performance of 53 younger adults (19-32 years) and 38 older adults (60-81 years) was assessed from three sources: Over 9 days, participants completed an experimenter-given naturalistic task, a diary-based approach assessing self-assigned intentions, as well as an ambulatory assessment with the Electronically Activated Recorder (EAR), a device that unobtrusively samples ambient sounds to detect spontaneous speech production related to (lapses in) everyday PM. RESULTS: Older adults showed lower performance in laboratory PM only for the time-based task and performed either equally well as or even better than younger adults in everyday PM. With regard to PM performance as captured in real-life ambient audio data, younger adults talked more frequently about PM than older adults, but no significant difference between younger and older adults was found for speech related to PM errors. DISCUSSION: Findings confirmed older adults' preserved PM performance in everyday life across different indicators with increasing ecological validity. Furthermore, as a novel method to assess conversational PM in everyday life, the EAR opens new insights about the awareness of PM lapses and the communication of intentions in real life.

Higher levels of neuroticism in older adults predict lower executive functioning across time: the mediating role of perceived stress.

Neuroticism has been associated with individual differences across multiple cognitive functions. Yet, the literature on its specific association with executive functions (EF) in older adults is scarce, especially using longitudinal designs. To disentangle the specific influence of neuroticism on EF and on coarse cognitive functioning in old adulthood, respectively, we examined the relationship between neuroticism, the Trail Making Test (TMT) and the Mini-Mental State Examination (MMSE) in a 6-year longitudinal study using Bayesian analyses. Data of 768 older adults (M age = 73.51 years at Wave 1) were included in a cross-lagged analysis. Results showed no cross-sectional link between neuroticism and TMT performance at Wave 1 and no longitudinal link between neuroticism at Wave 1 and MMSE at Wave 2. However, neuroticism at Wave 1 predicted TMT performance at Wave 2, indicating that the more neurotic participants were, the lower they performed on the TMT six years later. Additional analyses showed that this relation was fully mediated by participants' perceived stress. Our results suggest that the more neurotic older adults are the more stress they may perceive six years later, which in turn negatively relates to their EF. In sum, this study demonstrates that neuroticism may lead to lower EF in older age across six years. It further suggests older adults' perceived stress as mediator, thereby providing novel insights into the mechanisms underlying this relation. Possible intervention approaches to counter these effects are discussed.

Social Robot Interventions for People with Dementia: A Systematic Review on Effects and Quality of Reporting.

BACKGROUND: Using non-pharmacological interventions is a current approach in dementia care to manage responsive behaviors, to maintain functional capacity, and to reduce emotional stress. Novel technologies such as social robot interventions might be useful to engage people with dementia in activities and interactions as well as to improve their cognitive, emotional, and physical status. OBJECTIVE: Assessing the effects and the quality of reporting of social robot interventions for people with dementia. METHODS: In our systematic review, we included quasi-experimental and experimental studies published in English, French, or German, irrespective of publication year. Searching CINAHL, Cochrane Library, MEDLINE, PsycINFO, and Web of Science Core Collection was supplemented by citation tracking and free web searching. To assess the methodological quality of included studies, we used tools provided by the Joanna Briggs Institute. To assess the reporting of the interventions, we applied CReDECI 2 and TIDieR. RESULTS: We identified sixteen studies published between 2012 and 2018, including two to 415 participants with mostly non-defined type of dementia. Eight studies had an experimental design. The predominant robot types were pet robots (i.e., PARO). Most studies addressed behavioral, emotion-related, and functional outcomes with beneficial, non-beneficial, and mixed results. Predominantly, cognitive outcomes were not improved. Overall, studies were of moderate methodological quality. CONCLUSION: Heterogeneous populations, intervention characteristics, and measured outcomes make it difficult to generalize the results with regard to clinical practice. The impact of social robot interventions on behavioral, emotion-related, and functional outcomes should therefore be assessed considering the severity of dementia and intervention characteristics.

Interactional Effects Between Relational and Cognitive Reserves on Decline in Executive Functioning.

OBJECTIVES: The present study set out to investigate associations of cognitive reserve (as indicated by education) and relational reserve (as indicated by the family network size and indices of emotional support) to decline in executive functioning over 6 years as measured by changes in Trail Making Test (TMT) completion time in older adults and whether education and network size interacted with age and sex as covariates with respect to this longitudinal association. METHOD: We analyzed data from 897 participants tested on TMT parts A and B in two waves 6 years apart. The mean age in the first wave was 74.33 years. Participants reported information on their family networks and their level of education. RESULTS: Latent change score modeling testing for moderation effects revealed a significant interaction of network size in the first wave of data assessment with education. Specifically, for lower levels of cognitive reserve (-1 SD of education), the longitudinal association between relational reserve in the first wave and subsequent changes in executive functioning was not significant. In contrast, for higher levels of cognitive reserve (+1 SD of education), a higher relational reserve in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning). DISCUSSION: The present longitudinal study provides evidence for the interaction between cognitive and relational reserves. This confirms the hypothesis that reserves from different domains are intertwined and their combined effects contribute to less cognitive decline in old age.