Vitamin D status and cognitive performance in community-dwelling adults: A dose-response meta-analysis of observational studies.

Low vitamin D status is linked with poorer cognition in adults while findings in relation to high levels are mixed.We performed a systematic review and meta-analyses to examine dose-response associations between 25-hydroxyvitamin D (25OHD) levelsand cognitive performance in community-dwelling adults. Thirty-eight observational studies were included in dose-response meta-analyses. Positive, nonlinear associations were identified between baseline25OHD levels and global cognition incross-sectional and longitudinal analyses, and for performance in memory and executive function in longitudinal analyses. When restricted to studies involving older adults, thepattern emerged forspecific domains in cross-sectional analyses. Poorer performance was associated with low 25OHD levels, while a sharp improvement was associated withlevels up to 60-70 nM/L. Further improvement was observed only for longitudinal global cognition. Our findings support the association between low vitamin D and poorer cognition and suggest levels of at least 60 nM/L are associated with better cognition during ageing.

Deciphering the interplay between psychopathological symptoms, sensorimotor, cognitive and global functioning: a transdiagnostic network analysis.

BACKGROUND: Understanding the relationship between psychopathology and major domains of human neurobehavioral functioning may identify new transdiagnostic treatment targets. However, studies examining the interrelationship between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample are lacking. We hypothesized a close relationship between sensorimotor and cognitive functioning in a transdiagnostic patient sample. METHODS: We applied network analysis and community detection methods to examine the interplay and centrality [expected influence (EI) and strength] between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample consisting of 174 schizophrenia spectrum (SSD) and 38 mood disorder (MOD) patients. All patients (n = 212) were examined with the Positive and Negative Syndrome Scale (PANSS), the Heidelberg Neurological Soft Signs Scale (NSS), the Global Assessment of Functioning (GAF), and the Brief Cognitive Assessment Tool for Schizophrenia consisted of trail making test B (TMT-B), category fluency (CF) and digit symbol substitution test (DSST). RESULTS: NSS showed closer connections with TMT-B, CF, and DSST than with GAF and PANSS. DSST, PANSS general, and NSS motor coordination scores showed the highest EI. Sensory integration, DSST, and CF showed the highest strength. CONCLUSIONS: The close connection between sensorimotor and cognitive impairment as well as the high centrality of sensorimotor symptoms suggests that both domains share aspects of SSD and MOD pathophysiology. But, because the majority of the study population was diagnosed with SSD, the question as to whether sensorimotor symptoms are really a transdiagnostic therapeutic target needs to be examined in future studies including more balanced diagnostic groups.

Are All Negotiations Equally Favorable? The Role of Adolescents' Negotiation Style, Social Domain, and Mothers' Authoritarian Beliefs and Family History.

Although negotiation is generally considered an adaptive means for adolescents to express disagreement in the parent-child relationship, previous research on the correlates of adolescents' negotiation has reported rather mixed results. This may be because parents do not always positively appraise and respond to adolescents' negotiation. The key aim of the present study was to better understand variability in mothers' appraisals and responses to adolescents' negotiation attempts. This was done by examining whether their appraisals and responses vary as a function of adolescents' negotiation style, social domain, and mothers' personal characteristics (i.e., authoritarian beliefs and their own history of being parented). A total of 476 mothers of 9th and 10th grade adolescents in Belgium (Mage mothers = 44.93 years old, SD = 4.07; Mage adolescents = 14.88, SD = 0.75, 51.7% boys) participated in a vignette-based experimental study. Mothers completed questionnaires assessing authoritarian beliefs and their own history of being parented, and read a vignette-based scenario depicting an adolescent's negotiation attempt. Using a between-person 2 × 2 design, adolescents' negotiation style (autonomy-supportive versus controlling) and social domain (personal versus multifaceted) were experimentally manipulated. Mothers were more likely to positively appraise and respond in more constructive ways if adolescents adopted an autonomy-supportive instead of a controlling negotiation style, and when the situation involved a personal rather than a multifaceted issue. Mothers with high authoritarian beliefs and those with a history of being parented in a psychologically controlling way, had a more negative attitude towards adolescents' negotiation. Overall, the results suggest that the success of adolescents' negotiation depends on how, about what, and with whom they negotiate.

Associations between physical activity, sedentary behaviour and cognitive domain performance of people living with mild cognitive impairment in the community.

INTRODUCTION: Physical activity is known to positively influence cognitive performance. For adults with mild cognitive impairment (MCI), the relationship between physical activity levels and cognitive performance is unknown. This cross-sectional study aimed to determine if cognitive performance [as measured by the Montreal Cognitive Assessment (MoCA)] of people living in the community with MCI is associated with their physical activity levels or sedentary behaviour. METHODS: ActivPAL™ accelerometers were used to objectively measure physical activity and sedentary behaviour for seven full days. Cognitive performance was measured using the MoCA. CONSUMER AND COMMUNITY INVOLVEMENT: No involvement other than as research participants RESULTS: Eighty-two participants from the Balance on the Brain randomised controlled trial were included. Most participants were retired (88%), with 33 (40%) reporting a fall in the last year. The median MoCA score was 24 (IQR 22-26). Participants achieved a mean of 6296 (±2420) steps per day and were sedentary for 10.6 (±2) hours per day. The only physical activity outcomes that had a fair, positive correlation were moderate- to vigorous-intensity physical activity measures of total stepping time and total number of steps (with a cadence of ≥100 steps/min) with the orientation MoCA domain score (r(82) = 0.36, p ≤ 0.001 and r(82) = 0.37, p ≤ 0.001, respectively). Higher total sedentary time had a weak, positive correlation with better visuospatial/executive performance (r(82) = 0.23, p = 0.041). The orientation outcomes remained significant when analysed in an adjusted logistic regression model. CONCLUSION: This study found that performance in the MoCA orientation domain had a fair-positive correlation with moderate-intensity physical activity (i.e., stepping time and step count with a cadence of ≥100 steps/min) as measured by a thigh-worn accelerometer for community-dwelling older adults with MCI. When considering the relationship between cognitive domains and sedentary behaviour, consideration may be needed regarding whether cognitive enhancing activities (such as crosswords and other brain games) are being performed, which may confound this relationship. Further investigation is required to confirm these results.

Dynamics, association, and temporal sequence of cognitive function and frailty: a longitudinal study among Chinese community-dwelling older adults.

BACKGROUND: Little is known about the association of longitudinal dynamics between cognitive function and frailty in Chinese older adults. The temporal sequences between cognitive function and frailty remains unclear. Our study investigates this directionality association using longitudinal data. METHODS: Latent growth and multivariate latent growth models were employed to examine dynamics of cognition and frailty and their association among 2824 older adults in China. Cross-lagged panel analyses were used to assess the temporal sequences between frailty and cognition. The relation between cognitive domains and frailty was also examined using aforementioned methods. RESULTS: Cognitive function was negatively associated with frailty status. Higher initial level of cognition indicated lower baseline level (ß=-0.175, P < 0.001) and change rate (ß=-0.041, P = 0.002) of frailty. We observed a reciprocal association between frailty and cognitive function rather than a unidirectional causal relationship. The initial cognitive performance for all components were negatively associated with baseline (ß ranged between - 0.098 to -0.023) and change rate (ß ranged between - 0.007 to -0.024) of frail status. No consistent associations between change rate of cognitive components and either initial level or change rate of frailty were detected. CONCLUSIONS: Our study detected a reciprocal association between cognition and frailty rather than a unidirectional causal relationship. Our results also revealed different connections between cognitive performance and frailty across diverse cognitive domains.

Differential spatial distribution of white matter lesions in Parkinson's and Alzheimer's diseases and cognitive sequelae.

White Matter Lesions (WML) are a radiological finding common in aged subjects. We explored the impact of WML on underlying neurodegenerative processes. We focused on the impact of WML on two neurodegenerative diseases with different pathology. In this cross-sectional study of 137 subjects (78 female, 59 men, mean age 67.2; 43-87 years), we compared WML in healthy controls (HC; n = 55), patients with Alzheimer's disease and amnestic Mild Cognitive Impairment (aMCI), and Parkinson's disease patients with normal cognition and with MCI. Subjects with AD and aMCI were treated as one group (n = 40), subjects with PD and PDMCI were another group (n = 42). MRI T2_FLAIR sequences were analyzed. WML were divided into periventricular (pWML) or subcortical (sWML) depending on their distance from the ventricles. Subjects from the AD + aMCI group, had a significantly greater volume of WML than both HC and the PD + PDMCI group. The volume of WML was greater in the PD + PDMCI than in HC but the difference was not significant. In AD + aMCI subjects, sWML and not pWML were related to a decrease in global cognitive functioning despite greater volume of pWML. In PD + PDMCI, pWML correlate with decline in executive functions and working memory. In HC, pWML correlated with the multidomain decrease corresponding with the aging. This points to a difference between normal aging and pathological aging due to AD and PD brain pathology. The WML location together with underlying disease related neurodegeneration may play a role in determining the effect of WML on cognition. Our results suggest that the impact of WML is not uniform in all patients; rather, their volume, location and cognitive effect may be disease-specific.

The impact of work-related stress on the cognition domain of executive functioning of health care workers during the COVID-19 pandemic.

PURPOSE: The current study addressed work-related stress and burnout experienced by health care workers (HCWs) in Cairo University isolation hospital and its impact on the cognitive domain of their executive functioning. METHODS: Arabic validated questionnaires of Beverly Potter for sources of work-related burnout and Maslach Burnout Inventory Human Services Survey for evaluation of burnout degree of 81 HCWs were used. Wisconsin Card Sorting Test was used to examine the HCWs cognitive executive functioning during hospital work and 2 weeks after home isolation. RESULTS: A high degree of work-related stress was evident by a high score on Beverly questionnaire with a mean ± SD of (132.08 ± 12.573). A high degree of burnout was marked with a mean ± SD of (28.48 ± 6.622) for Emotional Exhaustion module, (31.85 ± 5.439) Personal Achievement, and (17.52 ± 6.707) Depersonalization. Health care workers experienced impairment of executive functioning in the form of increased total errors of Wisconsin Card Sorting Test during hospital shifts compared to 2 weeks after. There is a positive significant correlation between work-related stress level and Maslach Burnout Inventory and the total errors of Wisconsin Card Sorting Test results during the hospital stay (p = < 0.001), as well as 2 weeks after (p = < 0.001).This cognitive decline manifested in increased errors during HCWs' clinical work. CONCLUSIONS: Health care workers on the front line experienced a high degree of work-related stress in addition to burnout in the form of Emotional Exhaustion, Depersonalization, and reduced Personal Achievement. They also suffered from impaired cognitive executive functioning due to such stressful exposure.

[Mechanism of Impaired Cognitive Function in Patients with Chronic Kidney Disease].

Each stage of chronic kidney disease has a high risk of cognitive dysfunction.The decline of cognitive function will affect the daily life and treatment compliance of the patients with chronic kidney disease and increase the patients' risk of death and public health burden,which has aroused widespread concern.However,the specific mechanism of cognitive impairment in the patients with chronic kidney disease remains unclear.This paper summarizes the possible association mechanisms,related indicators,and impaired cognitive domains,aiming to provide a theoretical basis for the early diagnosis and slow down the progression of the cognitive impairment associated with chronic kidney disease.

Adolescents' Judgment of Homophobic Name-Calling: The Role of Peer/Friend Context and Emotional Response.

Adolescents use some types of homophobic language (e.g., "that's so gay") as a form of banter, while other types are directly targeted as an intentional insult (e.g., calling someone a "fag, dyke, homo"). Little research has investigated adolescents' use and judgments about these types of homophobic language and whether judgments differ if they are used among friends or directed toward non-friend peers. This study investigated how relationship context and victim's (N = 477, Mage = 14.7, SD = 1.63) emotional responses related to judgments about anti-gay banter and homophobic name-calling. Adolescents evaluated homophobic name-calling as more wrong than anti-gay banter. While adolescents' evaluations of homophobic name-calling did not differ based on relationship context, adolescents did differentiate between anti-gay banter perpetrated by a friend vs. a peer. Further, emotional responses mediated these relationships in the anti-gay banter situation. These results suggest that adolescents' judgments about homophobic language are related to the relationship context and the type of homophobic language used.

Transdiagnostic validity of the MATRICS Consensus Cognitive Battery across the autism-schizophrenia spectrum.

BACKGROUND: Autism Spectrum Disorder (ASD) and schizophrenia are neurodevelopmental disorders which share substantial overlap in cognitive deficits during adulthood. However, treatment evaluation in ASD and treatment comparisons across ASD and schizophrenia are limited by a dearth of empirical work establishing the validity of a standard cognitive battery across ASD and schizophrenia. Promisingly, the MATRICS Consensus Cognitive Battery (MCCB) has been validated in schizophrenia and encompasses cognitive domains that are impacted in ASD. Thus, this study aimed to establish MCCB's generalizability from schizophrenia to ASD. METHODS: Community-residing adults with schizophrenia (N = 100) and ASD (N = 113) underwent MCCB assessment. Using multigroup confirmatory factor analysis, MCCB's transdiagnostic validity was evaluated by examining whether schizophrenia and ASD demonstrate the same configuration, magnitude, and directionality of relationships within and among measures and their underlying cognitive domains. RESULTS: Across schizophrenia and ASD, the same subsets of MCCB measures inform three cognitive domains: processing speed, attention/working memory, and learning. Except for group means in category fluency, continuous performance, and spatial span, both groups show vastly comparable factor structures and characteristics. CONCLUSIONS: To our knowledge, this study is the first to establish the validity of a standard cognitive battery in adults with ASD and furthermore the first to establish a cognitive battery's comparability across ASD and schizophrenia. Cognitive domain scores can be compared across new samples using weighted sums of MCCB scores resulting from this study. These findings highlight MCCB's applicability to ASD and support its utility for standardizing treatment evaluation of cognitive outcomes across the autism-schizophrenia spectrum.

Neuropsychological assessment in acute stroke patients.

BACKGROUND AND PURPOSE: The number of people suffering from stroke is strongly increasing, giving rise to multiple cognitive deficits which frequently prevent a full recovery. The identification of both spared and impaired cognitive domains has a key role to plan adequate interventions. However, the existing standard tests are either too expensive in terms of time and efforts for patients in acute stage or they derived from instruments addressing different pathologies such as dementia. METHODS: We developed a brief neuropsychological battery (mental performance in acute stroke, MEPS) to assess different cognitive domains (language, memory, praxis, visual perception) in acute stroke patients. MEPS was validated by enrolling a sample of 204 patients suffering from stroke in acute stage, and 263 healthy controls participants. RESULTS: The results indicated an adequate construct validity and a high ability in discriminating patients from healthy controls. CONCLUSIONS: MEPS can be considered a simple and highly valuable bedside battery, easy to administer, with values of sensitivity and specificity suitable to be proposed as a screening tool for patients with acute stroke.

Comparison of performance on written and OSCE assessment during end semester pediatric examination.

OBJECTIVE: To compare the scores obtained on written and OSCE examination during pediatrics end semester examination and to find out the reasons for the discrepancies among the scores obtained. METHODS: This co-relational study was carried out in pediatric department, Liaquat University of Medical and Health Sciences (LUMHS). The performance of medical students who were posted in the pediatric department for one semester (November 2016 to October 2017) was compared on the basis of scores obtained in their written and OSCE during end semester examination. To find out the reasons for discrepancies qualitative data was collected by using likert scale on Pre-designed questionnaire distributed among the students at the end of assessment. Frequencies of their responses were calculated. RESULTS: Data of 160 students who participated in study was analyzed by SPSS version 22. The mean and standard deviation of participant's score was 51.25 ± 12.19. Females performed better in written as well as in OSCE. Moderate correlation was seen between MCQ and SAQ scores (r=0.5, p <0.01). Around 60% considered OSCE as their preferred mode of assessment. Deep learning approach and group discussion was found in female students (65%). CONCLUSION: Our study concluded that students performed better in OSCE than in written assessment. However, in OSCE they had shown unsatisfactory performance for some important competencies like clinical examination methods and procedural skills. Female students performed better in both segments of assessment.

Pattern of cognitive deficits in vascular dementia.

Background & objectives: There is a paucity of literature on the cognitive profiles of vascular dementia (VaD) in India. The current study was undertaken to investigate the pattern of cognitive deficits in patients with VaD. Methods: Fifty patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV criteria of dementia and National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria for VaD were assessed using Mini Mental State Examination, Kolkata Cognitive Screening Battery and other relevant tests including magnetic resonance imaging of brain. Results: Twenty patients had small vessel dementia, whereas the least common was haemorrhagic dementia in four patients. In patients with small vessel dementia, apart from memory, all patients had problem in attention and executive function, whereas 12 patients had visuoconstructional deficit and eight patients had language problem. In a total of 12 patients with large vessel dementia, apart from memory, executive dysfunction and visuoconstructional deficit were noted in 10 patients, whereas attention deficit was noted in eight patients. Attention was found to be more involved in small-vessel dementia than large-vessel dementia though all had memory impairment (P<0.01). Interpretation & conclusions: Small vessel dementia was the commonest subtype of VaD in our study. Memory, attention and executive functions were predominantly affected in patients with VaD. Attention was significantly more involved in small vessel dementia than large vessel dementia. Further studies with large sample size need to be done in different regions of the country.

HIV-associated cognitive disorders in perinatally infected children and adolescents: a novel composite cognitive domains score.

Accurate assessment of HIV-associated cognitive disorders in perinatally infected children and adolescents is challenging. Assessments of general intellectual functioning, or global cognition, may not provide information regarding domain-specific strengths and weaknesses, and may therefore fail to detect, impaired trajectories of development within particular cognitive domains. We compare the efficacy of global cognitive scores to that of composite cognitive domain scores in detecting cognitive disorders in a sample of perinatally HIV-infected children, and a demographically matched HIV negative control group, drawn from the Cape Town Adolescent Antiretroviral Cohort (CTAAC) study. All children were administered a comprehensive neuropsychological test battery. Using data from that test battery, we created ten separate composite cognitive domains: general intellectual functioning, attention, working memory, visual memory, verbal memory, language, visual spatial ability, motor coordination, processing speed and executive function. Within each domain, each test bore a high level of association with each of the other tests in that domain (Cronbach's α ≥ .70 for all domains). We found that composite domain scores calculated on whole-sample data were significantly higher than those calculated using control-sample data. Our comparison of a global cognitive score to composite domain scores suggested that the latter provided more detailed information (regarding strengths, weaknesses, areas of impairment), and when compared to global scores, were more sensitive in detecting HIV-associated cognitive disorders, and were able to distinguish HIV-infected patients from uninfected controls. Hence, we recommend using this method of composite cognitive domains scores, rather than global aggregate scores, when assessing cognitive function in paediatric HIV. This method provides a convenient and relatively accurate assessment that might help with cross-cultural and cross-region comparisons as researchers try to detect cognitive impairment patterns in HIV-infected children and adolescents globally.

Dynamic Patterns of Brain Structure-Behavior Correlation Across the Lifespan.

Although the brain/behavior correlation is one of the premises of cognitive neuroscience, there is still no consensus about the relationship between brain measures and cognitive function, and only little is known about the effect of age on this relationship. We investigated the age-associated variations on the spatial patterns of cortical thickness correlates of four cognitive domains. We showed that the spatial distribution of the cortical thickness correlates of each cognitive domain is distinctive and depicts varying age-association differences across the adult lifespan. Specifically, the present study provides evidence that distinct cognitive domains are associated with unique structural patterns in three adulthood periods: Early, middle, and late adulthood. These findings suggest a dynamic interaction between multiple neural substrates supporting each cognitive domain across the adult lifespan.

When Do Adolescents Accept or Defy to Maternal Prohibitions? The Role of Social Domain and Communication Style.

Drawing upon both Social-Cognitive Domain Theory and Self-Determination Theory, the goal of the present multi-informant study was to test whether the correlates of maternal prohibitions depend on what is prohibited (i.e., the content of the social domain involved), thereby contrasting moral with friendship prohibitions, as well on how the prohibition is communicated, thereby contrasting an autonomy-supportive with a controlling communication style. In a sample of adolescents (N = 196; mean age = 13.9 years; 63 % female) and their mothers (N = 185; mean age = 44 years), we first examined mean-level differences between the two domains in terms of mothers' degree and style of prohibition, as well as on a number of developmental outcomes (i.e., adolescents' legitimacy perceptions, internalization, and oppositional defiance). Both adolescents and mothers reported more maternal involvement in the moral domain (e.g., higher scores for degree of prohibition and controlling communication style). In addition, adolescents reported greater perceived legitimacy and less oppositional defiance in the moral domain (as compared to the friendships domain). Second, we tested whether associations between degree and style of prohibition and the developmental outcomes were moderated by social domain. Whereas associations between degree of prohibition and developmental outcomes either were non-significant or moderated by domain, the associations with communication style were more domain-invariant, with an autonomy-supportive style generally yielding an adaptive pattern of correlates and with a controlling style relating to maladaptive outcomes. The discussion focuses on similarities and differences in the characteristics and correlates of both types of prohibitions.

Are MMSE and HDS-R neuropsychological tests adequate for screening HIV-associated neurocognitive disorders?

HIV-associated neurocognitive disorders (HAND) are one of major comorbidities in patients with HIV-1 infection. There are currently no standardized tests for screening HAND in such patients. The sensitivity of the cognitive function tests routinely used in clinical practice, such as the Mini-Mental State Examination and the Revised Hasegawa's Dementia Scale, is inadequate to rule out HAND, even in patients with clear abnormal behavior. We report a 41-year-old man with HIV-associated dementia, the most severe form of HAND, in whom the simplified methods did not show abnormal results, and a comprehensive battery of neuropsychological tests which covering several cognitive domains was needed to detect cognitive impairment.

Effects of the Acute and Chronic Administration of Cannabidiol on Cognition in Humans and Animals: A Systematic Review.

Introduction: The effects of cannabidiol (CBD) on cognition has been investigated in recent years to determine the therapeutic potential of this cannabinoid for a broad gamut of medical conditions, including neuropsychiatric disorders. The aim of the present study was to perform a systematic review of studies that analyzed the effects of the acute and chronic administration of CBD on cognition in humans and animals both to assess the cognitive safety of CBD and to determine a beneficial potential of CBD on cognition. Methods: The PubMed, Web of Science, PsycINFO, and Scopus databases were searched in December of 2022 for relevant articles using the following combinations of keywords: ("cannabidiol" OR "CBD") AND ("cognition" OR "processing cognitive" OR "memory" OR "language" OR "attention" OR "executive function" OR "social cognition" OR "perceptual motor ability" OR "processing speed"). Results: Fifty-nine articles were included in the present review (36 preclinical and 23 clinical trials). CBD seems not to have any negative effect on cognitive processing in rats. The clinical trials confirmed these findings in humans. One study found that repeated dosing with CBD may improve cognitive in people who use cannabis heavily but not individuals with neuropsychiatric disorders. Considering the context of neuropsychiatric disorders in animal models, CBD seems to reverse the harm caused by the experimental paradigms, such that the performance of these animals becomes similar to that of control animals. Conclusions: The results demonstrate that the chronic and acute administration of CBD seems not to impair cognition in humans without neuropsychiatric disorders. In addition, preclinical studies report promising results regarding the effects of CBD on the cognitive processing of animals. Future double-blind, placebo-controlled, randomized clinical trials with larger, less selective samples, with standardized tests, and using different doses of CBD in outpatients are of particular interest to elucidate the cognitive effects of CBD.

Cognitive impairment in diffuse axonal injury patients with favorable outcome.

Background and purpose: Traumatic brain injury (TBI), especially the severe TBI are often followed by persistent cognitive sequalae, including decision-making difficulties, reduced neural processing speed and memory deficits. Diffuse axonal injury (DAI) is classified as one of the severe types of TBI. Part of DAI patients are marginalized from social life due to cognitive impairment, even if they are rated as favorable outcome. The purpose of this study was to elucidate the specific type and severity of cognitive impairment in DAI patients with favorable outcome. Methods: The neurocognition of 46 DAI patients with favorable outcome was evaluated by the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC), and the differences in the domains of cognitive impairment caused by different grades of DAI were analyzed after data conversion of scores of nine cognitive domains of MoCA-BC by Pearson correlation analysis. Results: Among the 46 DAI patients with favorable outcome, eight had normal cognitive function (MoCA-BC ≥ 26), and 38 had cognitive impairment (MoCA-BC < 26). The MoCA-BC scores were positively correlated with pupillary light reflex (r = 0.361, p = 0.014), admission Glasgow Coma Scale (GCS) (r = 0.402, p = 0.006), and years of education (r = 0.581, p < 0.001). Return of consciousness (r = -0.753, p < 0.001), Marshall CT (r = -0.328, p = 0.026), age (r = -0.654, p < 0.001), and DAI grade (r = -0.403, p = 0.006) were found to be negatively correlated with the MoCA-BC scores. In patients with DAI grade 1, the actually deducted scores (Ads) of memory (r = 0.838, p < 0.001), abstraction (r = 0.843, p < 0.001), and calculation (r = 0.782, p < 0.001) were most related to the Ads of MoCA-BC. The Ads of nine cognitive domains and MoCA-BC were all proved to be correlated, among patients with DAI grade 2. However, In the DAI grade 3 patients, the highest correlation with the Ads of MoCA-BC were the Ads of memory (r = 0.904, p < 0.001), calculation (r = 0.799, p = 0.006), orientation (r = 0.801, p = 0.005), and executive function (r = 0.869, p = 0.001). Conclusion: DAI patients with favorable outcome may still be plagued by cognitive impairment, and different grades of DAI cause different domains of cognitive impairment.

Influence of game-based learning in mathematics education on the students' cognitive and affective domain: A systematic review.

Introduction: Game-based learning (GBL) is one of the modern trends in education in the 21st century. Numerous research studies have been carried out to investigate the influence of teaching on the students' academic attainment. It is crucial to integrate the cognitive and affective domains into teaching and learning strategies. This study aims to review journal articles from 2018 to 2022 concerning the influence of GBL in mathematics T&L on the students' cognitive and affective domains. Methods: A research methodology based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used for the survey on the basis of the Scopus and Web of Science (WOS) databases wherein 773 articles relating to game-based learning (GBL) in mathematics were discovered. Based on the study topic, study design, study technique, and analysis, only 28 open-access articles were chosen for further evaluation. Two types of cognitive domain and five types of affective domain were identified as related to the implications of GBL on the students' T&L of mathematics. Results: The study results show that GBL has positively impacted students when they are learning mathematics. It is comprised of two types of cognitive domain (knowledge and mathematical skills) and five types of affective domain (achievement, attitude, motivation, interest, and engagement). The findings of this study are anticipated to encourage educators in the classrooms more effectively. Discussion: GBL in education is now one of the major learning trends of the 21st century. Since 2019, the number of studies relating to game-based learning has increased. There is an influence on the cognitive and affective domains due to T&L Mathematics utilizing a game-based learning (GBL) approach.