Neurocognitive Outcome Following Recovery from Severe Acute Respiratory Syndrome - Coronavirus-1 (SARS-CoV-1).

OBJECTIVE: Severe acute respiratory syndrome (SARS) is a highly contagious viral respiratory illness associated with hypoxia and dyspnea. Many of those who contracted and recovered from SARS during the 2002-2003 outbreak reported persistent physical, psychological, and cognitive difficulties. Here, we investigated the residual influences of SARS on cognition for a subset of healthcare professionals who recovered and were referred for neuropsychological evaluation through their workplace insurance. METHOD: Twenty-eight healthcare professionals were evaluated on neuropsychological and mood functioning approximately 1.5 years post-recovery from a severe respiratory illness. Test scores were compared with age-matched normative data, and correlations were examined between mood, self-report memory scales, subjective complaints (e.g., poor concentration, pain, fatigue), illness severity (i.e., length of hospitalization, oxygen use during hospital stay), and cognitive performance. RESULTS: Participants performed within age expectations on the majority of cognitive measures including overall memory ability. Although processing speed was generally within normal limits, 43% showed significant speed-accuracy trade-offs favoring accuracy over maintaining speed. Deficits were observed on measures of complex attention, such as working memory and the ability to sustain attention under conditions of distraction. Participants endorsed poorer memory ability than same-age peers on a meta-memory measure and mild to moderate depression and anxiety symptoms. Objective test performance was largely uncorrelated with self-reports, mood, or illness severity, except for moderate correlations between complex attention and participants' subjective ratings of Everyday Task-Oriented Memory. CONCLUSIONS: These findings demonstrate specific long-term cognitive deficits associated with SARS and provide further evidence of the cognitive effects of hypoxic illnesses.

The Impact of Memory Change on Everyday Life Among Older Adults: Association with Cognition and Self-Reported Memory.

OBJECTIVES: Many older adults experience memory changes that can have a meaningful impact on their everyday lives, such as restrictions to lifestyle activities and negative emotions. Older adults also report a variety of positive coping responses that help them manage these changes. The purpose of this study was to determine how objective cognitive performance and self-reported memory are related to the everyday impact of memory change. METHODS: We examined these associations in a sample of 94 older adults (age 60-89, 52% female) along a cognitive ability continuum from normal cognition to mild cognitive impairment. RESULTS: Correlational analyses revealed that greater restrictions to lifestyle activities (|rs| = .36-.66), more negative emotion associated with memory change (|rs| = .27-.76), and an overall greater burden of memory change on everyday living (|rs| = .28-.61) were associated with poorer objective memory performance and lower self-reported memory ability and satisfaction. Performance on objective measures of executive attention was unrelated to the impact of memory change. Self-reported strategy use was positively related to positive coping with memory change (|r| = .26), but self-reported strategy use was associated with more negative emotions regarding memory change (|r| = .23). CONCLUSIONS: Given the prevalence of memory complaints among older adults, it is important to understand the experience of memory change and its impact on everyday functioning in order to develop services that target the specific needs of this population.

Examining the factor structure of the Multifactorial Memory Questionnaire.

Many adults report memory changes as they age. The Multifactorial Memory Questionnaire (MMQ) measures different aspects of self-reported memory, including satisfaction with one's memory, self-appraisal of memory ability, and compensatory strategy use. This questionnaire has been extensively used for clinical and research purposes, with studies reporting differences in the factor structure (three or four factors) underlying this measure. The current study evaluates previously reported factor configurations of the MMQ using best measurement practices. Confirmatory factor analyses were conducted on data from 560 cognitively - normal adults, ranging in age from 50 to 90 years old. Our results demonstrate support for both 3-factor model (with Satisfaction, Ability and Strategy scales) and 4-factor model structure (with Satisfaction, Ability, Internal Strategy and External Strategy scales) of this instrument. These results harmonise the existing literature which, in separate studies using exploratory analyses, supports the validity of one model or the other. The confirmation of multiple Strategy scales will provide clinicians and researchers with additional relevant information about how older adults compensate for their memory changes, enabling a broader understanding of the experience of age-related memory change. We contextualise these results within existing research identifying conceptual differences between internal and external strategy implementation.

Assessing one's sense of normalcy: psychometric properties of the subjective normalcy inventory.

OBJECTIVES: Individuals facing a personal challenge, such as age-related memory changes, may feel that their experiences are abnormal or pathological. Previous qualitative research on a group intervention that focuses on memory changes in older adulthood revealed that one of the greatest benefits derived by participants was the realization that their experience with memory changes was normal. In order to quantify this experience, we developed and validated a new measure, the 26-item Subjective Normalcy Inventory (SNI). METHOD: Reliability and validity were assessed with a sample of 167 community-dwelling adults between the ages of 55 and 90. Questionnaire responsiveness was assessed with an additional sample of 29 older adults who completed a 5-session memory intervention program known to cultivate normalization. RESULTS: The SNI exhibited a two-factor structure, excellent test-retest reliability, ICC = .79, excellent internal consistency, Cronbach's α = .91, and good convergent, |rs| = .46-.58, and discriminant, rs = .02-.06, validity. The measure was also responsive to change, as participants who completed the memory intervention program reported a greater sense of normalcy relative to nonintervention controls, η2p = 0.17. CONCLUSION: The SNI has the potential to provide novel and useful outcome information for interventions designed to improve one's sense of normalcy and may be applied in both clinical and research settings. The SNI can also be modified, validated, and used to assess subjective normalcy with respect to other personal challenges outside of memory and attention changes.

Methods for Improving Screening for Vascular Cognitive Impairment Using the Montreal Cognitive Assessment.

BACKGROUND: Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke. AIM: We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery. METHODS: We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone. RESULTS: Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%. CONCLUSIONS: The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.

The measurement of participant-reported memory across diverse populations and settings: a systematic review and meta-analysis of the Multifactorial Memory Questionnaire.

The Multifactorial Memory Questionnaire (MMQ) is a participant-reported measure of memory satisfaction, ability, and strategy use. Initially validated with healthy older adults, it has since been used in many different populations and settings for a variety of purposes. We conducted a systematic review and meta-analysis of the measurement properties of the MMQ across multiple, diverse studies. METHODS: The study was designed using the Consensus-Based Standards for the Selection of Health Measurement Instruments and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We calculated aggregate statistics and evaluated the methodological quality of 29 studies retrieved from PsycINFO, MEDLINE, EMBASE, and Web of Science. RESULTS: Analyses revealed high-quality evidence for internal consistency, stability, measurement error, convergent validity, and known-groups validity of the three MMQ scales. There was moderate-quality evidence for responsiveness and structural validity, with some studies identifying separate factors for internal and external memory strategy use. Measurement properties were similar across languages, participant samples, and study designs. CONCLUSIONS: The MMQ is a valid, reliable, and responsive measure across diverse settings and populations. Future research is needed to determine whether more detailed information can be obtained from the scales, specifically, internal versus external strategy use.

A brief psychoeducational intervention improves memory contentment in breast cancer survivors with cognitive concerns: results of a single-arm prospective study.

PURPOSE: One in three breast cancer survivors experiences persistent cognitive changes that can negatively impact daily functioning and quality of life. In our cancer center, the largest tertiary cancer center in Canada, patients with self-reported cancer-related cognitive dysfunction (CRCD) are offered psychoeducation intended to reduce distress about CRCD symptoms and improve everyday cognitive performance, but evidence regarding this intervention's impact is lacking. Here, we assess whether a 1-hour (h), individual psychoeducational intervention designed to promote self-management of CRCD symptoms can improve attitudes and coping with memory-related difficulties in women with breast cancer. METHODS: Breast cancer survivors with self-reported CRCD (N = 100) were assessed immediately before, immediately after, and 6 weeks following the intervention. Participants' memory contentment, knowledge of CRCD, symptom distress, and self-efficacy to cope with symptoms were measured. RESULTS: Participants showed improvements in memory contentment immediately after the intervention (Cohen's d effect size and 95% CI = 0.87 [0.58, 1.16]) and 6 weeks later (d = 0.77 [0.48, 1.05]). Significant improvements in secondary study outcomes, including knowledge of CRCD (d = 1.32 [1.01, 1.63]), symptom distress (d = - 0.82 [- 1.11, - 0.53]), and self-efficacy to cope with cognitive symptoms (d = 1.45 [1.14, 1.76]), were also observed. CONCLUSIONS: A single, 1-hour psychoeducational intervention can achieve lasting and improved adjustment to memory symptoms in breast cancer survivors with self-reported CRCD. Further investigation using a randomized controlled study design is warranted. Comparisons with previously reported psychoeducational interventions for CRCD are made, and next steps for this research are discussed.

Executive functioning impairment in women treated with chemotherapy for breast cancer: a systematic review.

PURPOSE: Women with breast cancer have reported adverse cognitive effects following chemotherapy. Evidence is mixed on whether executive functioning is particularly impaired in women treated with chemotherapy, in part due to the wide range of tasks used to measure executive processes. We performed a systematic review of the published literature to evaluate whether some subcomponents of executive functioning are more vulnerable to impairment than others among breast cancer survivors who had been treated with chemotherapy. METHODS: Studies published as of April 2017 were identified using three electronic databases (MEDLINE, PsycINFO, and Web of Science) and a manual search of relevant reference lists. The methodological quality of included studies was assessed using a checklist of predefined criteria. RESULTS: Of 1280 identified articles, a total of 41 were included for review. Study findings were categorized into three primary subdomains of executive functioning: inhibition, shifting, and updating. Although there was heterogeneity in the neuropsychological measures used to assess executive functioning, tests could be grouped into the subcomponents they assessed. Inhibition appears relatively spared from the effects of chemotherapy, whereas impairments in shifting and updating are more commonly found following chemotherapy. CONCLUSIONS: Examination of subcomponents of executive functioning is recommended to better characterize the nature of executive dysfunction in women treated with chemotherapy. Future studies should include executive functioning tasks of varying complexity, use of multiple tasks to increase reliability, and alternative indices to capture performance, such as within-person variability.

Intraindividual variability in reaction time before and after neoadjuvant chemotherapy in women diagnosed with breast cancer.

OBJECTIVE: Women treated with chemotherapy for breast cancer experience subtle cognitive deficits. Research has focused on mean performance level, yet recent work suggests that within-person variability in reaction time performance may underlie cognitive symptoms. We examined intraindividual variability (IIV) in women diagnosed with breast cancer and treated with neoadjuvant chemotherapy. METHODS: Patients (n = 28) were assessed at baseline before chemotherapy (T1), approximately 1 month after chemotherapy but prior to surgery (T2), and after surgery about 9 months post chemotherapy (T3). Healthy women of similar age and education (n = 20) were assessed at comparable time intervals. Using a standardized regression-based approach, we examined changes in mean performance level and IIV (eg, intraindividual standard deviation) on a Stroop task and self-report measures of cognitive function from T1 to T2 and T1 to T3. RESULTS: At T1, women with breast cancer were more variable than controls as task complexity increased. Change scores from T1 to T2 were similar between groups on all Stroop performance measures. From T1 to T3, controls improved more than women with breast cancer. IIV was more sensitive than mean reaction time in capturing group differences. Additional analyses showed increased cognitive symptoms reported by women with breast cancer from T1 to T3. Specifically, change in language symptoms was positively correlated with change in variability. CONCLUSIONS: Women with breast cancer declined in attention and inhibitory control relative to pretreatment performance. Future studies should include measures of variability, because they are an important sensitive indicator of change in cognitive function.

Pretreatment Differences in Intraindividual Variability in Reaction Time between Women Diagnosed with Breast Cancer and Healthy Controls.

OBJECTIVES: Chemotherapy has adverse effects on cognitive performance in women treated for breast cancer, but less is known about the period before chemotherapy. Studies have focused on mean level of performance, yet there is increasing recognition that variability in performance within an individual is also an important behavioral indicator of cognitive functioning and underlying neural integrity. METHODS: We examined intraindividual variability (IIV) before chemotherapy and surgery in women diagnosed with breast cancer (n=31), and a healthy control group matched on age and education (n=25). IIV was calculated across trials of a computerized Stroop task, including an examination of the slowest and fastest trials of reaction time (RT) responses. RESULTS: The groups were equivalent on overall accuracy and speed, and participants in both groups were less accurate and slower on incongruent trials compared with congruent trials. However, women with breast cancer became more variable with increased task difficulty relative to healthy controls. Among the slowest RT responses, women with breast cancer were significantly more variable than healthy controls on incongruent trials. This suggests that a specific variability-producing process (e.g., attentional lapses) occurs in task conditions that require executive control (e.g., incongruent trials). CONCLUSIONS: Results are consistent with other evidence of executive dysfunction among women treated for breast cancer. These findings highlight the importance of pretreatment assessment and show that variability in performance provides information about cognition that measures of central tendency do not.

Evaluating functional abilities within the context of memory assessment: A practice survey of neuropsychologists.

Objective: Functioning in daily life is an important consideration when differentiating between individuals with normal cognition, mild neurocognitive disorder, and major neurocognitive disorder. Despite this, there is no gold standard measurement approach for assessing functional abilities and few guidelines on how to do so. The objective of this study was to examine neuropsychologists' practices regarding the assessment of functional abilities across the spectrum of memory ability. Method: A total of 278 psychologists who routinely conduct neuropsychological assessments completed an online survey (estimated 15% response rate) querying their practices and perspectives with respect to the assessment of functional abilities. Results: Respondents identified that changes to several components of daily functioning, including activities of daily living, were important when evaluating functional abilities. Respondents reported utilizing a variety of instruments to assess functioning, with an overwhelming majority indicating the use of semi-structured interviews. Although most respondents are satisfied with existing tools, a quarter of respondents felt strongly that there was a need for more instruments of everyday functioning. Respondents further indicated that their recommendations to patients, particularly regarding compensatory strategies and follow-up with other professionals, were informed by results of their functional assessment. Conclusions: Overall, our survey results indicate that neuropsychologists perceive multiple factors of daily life to be important considerations when evaluating functioning, use a variety of techniques to assess functioning, and perceive a need for more measures of functional abilities.

An Agile Development Cycle of an Online Memory Program for Healthy Older Adults.

Online interventions for older adults should be tailored to their unique needs to increase the efficacy of and adherence to the intervention. The agile development cycle is a dynamic model to solicit and incorporate feedback from older adults during the design process. We combined this approach with the framework of Harvard University's clinical and translational phases that provide a clear structure for evaluating new health programs before they are offered in the community. We based our online memory program on the empirically validated in-person Memory and Aging Program. The aim of the present study was to combine the agile development cycle with the clinical and translational phases framework to develop and pilot an online memory program tailored to the unique needs of older adults. Study 1 involved piloting individual program modules on site and integrating participant feedback into the program's design to optimize usability. Study 2 involved two sequential pilots of the program accessed remotely to evaluate preliminary clinical outcomes and obtain feedback for iterative modifications. Plans for further validation and limitations are discussed. The successful application of the agile development cycle implemented in this series of studies can be adapted by others seeking to offer online content for targeted end users.

Evaluating the effectiveness of compensatory memory interventions in adults with acquired brain injury: A systematic review and meta-analysis of memory and everyday outcomes.

OBJECTIVE: Adults with acquired brain injury (ABI) often experience memory impairments that are persistent and difficult to treat. Although evidence has shown that rehabilitation programs may improve cognitive performance in persons with ABI, there is an opportunity to look more closely at the benefits provided by specific interventions. We conducted a systematic review and meta-analysis to evaluate whether compensation-based memory programs improve memory or everyday outcomes (e.g., mood, quality of life, community integration, everyday functioning). METHOD: The review was limited to published, English-language controlled trials that evaluated compensatory memory interventions for adults (18 +) with ABI using at least one memory or everyday outcome. The final search was conducted in April 2021 using PsychINFO, Medline, EMBASE, the Cochrane Review database, Google Scholar, and the reference lists of relevant articles. RESULTS: Of 2,817 identified articles, 22 controlled trials met inclusion criteria, of which 12 provided sufficient data to include in the meta-analyses. Risk of bias assessment identified problems with recruitment and masking procedures. Results indicate that compared to controls, these interventions produce positive effects on outcomes of immediate verbal recall (g = 0.43), participant-reported memory (g = 0.28), and strategy use (g = 0.39) and that these improvements are maintained at follow-up. CONCLUSIONS: Compensatory memory programs produce meaningful memory improvements and are a promising avenue for reducing ABI-related memory impairment. Future research focusing on specific subsets of ABI populations and a broader range of participant-reported outcomes is needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prospective memory in amnestic mild cognitive impairment.

Individuals with amnestic mild cognitive impairment (aMCI) often complain of difficulty remembering to carry out intended actions, consistent with findings of impaired prospective memory (PM) in this population. In this study, individuals with aMCI (N = 27) performed worse than healthy controls (N = 27) on the Memory for Intentions Screening Test (Raskin, 2004), including on time- and event-based subscales, and recognition of the intentions. The aMCI participants made more errors overall, but the proportion of the various error types did not differ between the two groups. Across all error types, both groups made more retrospective than prospective errors, especially on event-based PM tasks. Overall, the findings suggest that PM impairment in aMCI is associated with deficient cue detection involving both automatic (as in event-based tasks) and more strategic detection (as in time-based tasks) processes. These difficulties are likely due to a combination of problematic retrospective episodic memory (e.g., reduced encoding and/or consolidation of cue-intention pairings) and executive functions (e.g., decreased self-initiation, attention switching, and/or inhibition on memory tasks). Formal assessment of PM may help characterize the nature of the memory impairment among individuals with aMCI in clinical neuropsychological evaluations.

Errorless learning and elaborative self-generation in healthy older adults and individuals with amnestic mild cognitive impairment: mnemonic benefits and mechanisms.

Errorless learning is an intervention that benefits memory performance in healthy older adults and a variety of clinical populations. A limitation of the errorless learning technique is that it is passive and does not involve elaborative processing. We report two studies investigating the added benefits of elaborative, self-generated learning to the errorless learning advantage. We also explored the mnemonic mechanisms of the errorless learning advantage. In both studies, older adults and individuals with amnestic mild cognitive impairment (aMCI) completed four encoding conditions representing the crossing of errorless/errorful learning and self-generated/experimenter-provided learning. Self-generation enhanced the errorless learning benefit in cued recall and cued recognition, but not in free recall or item recognition. An errorless learning advantage was observed for priming of target words, and this effect was amplified for participants with aMCI after self-generated learning. Moreover, the aMCI group showed significant priming of prior self-generated errors. These results demonstrate that self-generation enhances the errorless learning advantage when study and test conditions match. The data also support the argument that errorless learning eliminates the misleading implicit influence of prior errors, as well as the need for explicit memory processes to distinguish targets from errors.

The impact of memory-strategy training interventions on participant-reported outcomes in healthy older adults: A systematic review and meta-analysis.

A number of memory-strategy training interventions have been developed to target and reduce the impact of normal age-related memory decline. Most outcome studies to date have used objective memory measures to evaluate the efficacy of such interventions. Participant-reported outcomes, well-suited to capture the extent to which such interventions address the expressed concerns of aging persons, have been less closely examined. We conducted a systematic review and meta-analysis to examine whether memory-strategy training interventions improve participant-reported outcomes in healthy older adults with age-related memory changes. Of 536 identified articles, a total of 18 randomized controlled trials met the inclusion criteria for the review, and 15 of these provided relevant data to include in the meta-analyses. A systematic risk of bias assessment identified common problems with recruitment and masking procedures. Results from the meta-analyses indicate that memory interventions produce positive effects on several participant-reported outcomes, including improvements in perceived memory ability, memory self-efficacy, strategy use, memory-related affect, psychological well-being, and quality of life. Memory-strategy training interventions have a meaningful perceived impact on healthy older adults experiencing age-related memory changes. Future research utilizing stronger study designs (e.g., masking participants and study staff) and more closely investigating everyday functional impact is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development and Psychometric Validation of a Questionnaire Assessing the Impact of Memory Changes in Older Adults.

BACKGROUND AND OBJECTIVES: Many healthy older adults experience age-related memory changes that can impact their day-to-day functioning. Qualitative interviews have been useful in gaining insight into the experience of older adults who are facing memory difficulties. To enhance this insight, there is a need for a reliable and valid measure that quantifies the impact of normal memory changes on daily living. The primary objective of this study was to develop and validate a new instrument, the Memory Impact Questionnaire (MIQ). RESEARCH DESIGN AND METHODS: We examined the underlying component structure and psychometric properties of the MIQ in a sample of 205 community-dwelling older adults. RESULTS: Principal component analysis revealed three clusters: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. Comparisons of the corresponding subscale scores with scores on other instruments revealed good convergent and discriminant validity. In addition, the MIQ subscales and the total score showed good test-retest reliability (rs = 0.65-0.91) and internal consistency (αs = 0.87-0.93). DISCUSSION AND IMPLICATIONS: This novel questionnaire can be used in both clinical and research settings to better understand the impact of memory changes on the day-to-day functioning of older adults and to monitor outcomes of support programs for this population.

Cognitive impairment in breast cancer survivors treated with chemotherapy depends on control group type and cognitive domains assessed: A multilevel meta-analysis.

Women with breast cancer can experience persisting cognitive deficits post treatment. We conducted a multilevel meta-analysis of cognitive function in survivors treated with chemotherapy (Ch+) to estimate the magnitude of cognitive impairment relative to healthy (HC) and chemo-negative (Ch-) controls. Seventy-two studies published up to October 2016 involving 2939 Ch+ yielded 1594 effect sizes. Ch+ demonstrated overall cognitive impairment in comparison with HC but not with Ch-. Relative to HC, Ch+ showed impairment in attention/concentration, processing speed, language, immediate recall, delayed recall, and executive function. Deficits in memory recall and executive function remained significant after adjusting for prechemotherapy group differences. Ch+ performed worse than Ch- in attention/concentration and executive function, and the groups performed equivalently after accounting for prechemotherapy neurocognitive differences. These results demonstrate that cognitive deficits in Ch+ depend in large part on the comparison group, the cognitive domains examined, and whether prechemotherapy baseline neurocognition is measured. Cancer and/or other treatment-related factors contribute to subtle memory recall and executive function impairments in breast cancer survivors.

Implicit memory varies across the menstrual cycle: estrogen effects in young women.

Evidence that ovarian steroid hormones such as estrogen and progesterone affect cognition comes from studies of memory in older women receiving estrogen replacement therapy and studies of sexually dimorphic skills in young women across the menstrual cycle. Sixteen women (ages 18-28) completed tests of memory (implicit category exemplar generation, category-cued recall, implicit fragmented object identification) and sexually dimorphic skills (fine motor coordination, verbal fluency, mental rotations) at the early follicular (low estrogen and progesterone) and midluteal (high estrogen and progesterone) phases of the menstrual cycle. Performance on category exemplar generation, a test of conceptual implicit memory, was better at the midluteal than the follicular phase. In contrast, performance on a test of explicit memory, category-cued recall, did not vary across the menstrual cycle. At Session 1, women in the follicular phase performed better on the fragmented object identification task than did those in the midluteal phase. This unexpected finding suggests that high levels of ovarian hormones might inhibit perceptual object priming. Results confirmed previous reports of decreased mental rotations and improved motor skills and fluency in the midluteal phase. Estradiol levels correlated positively with verbal fluency and negatively with mental rotations and perceptual priming, which suggest that estrogen, and not progesterone, was responsible for the observed changes in cognition. Mood did not vary across the cycle phases. Overall, the findings suggest that estrogen may facilitate the automatic activation of verbal representations in memory.