Discrepancies in hand motor performance and executive function in older adults.

There is increasing interest in using motor function tests to identify risk of cognitive impairment in older adults (OA). This study examined associations among grip strength, with and without adjustment for muscle mass, manual dexterity and Trail Making Test (TMT) A and B in 77 OA (73.4 ± 5.2 years) with globally intact cognition. A subset of OA who exhibited mismatched motor function (e.g., in the highest strength and lowest dexterity tertiles, or vice versa) was identified and analyzed. Dexterity showed stronger associations with TMT-A and -B than grip strength (absolute or adjusted). OA with mismatched motor function scored worse on tests of TMT-B, but not -A than those with matched motor function. Dexterity may have more promise than grip strength for identifying increased risk of cognitive impairment. Intriguing, though limited, data suggest that mismatched motor function (strength vs. dexterity) in OAs might be an even more robust marker of such risk.

Subjective memory in adults over 50 years of age: associations with affective and physiological markers of emotion regulation.

OBJECTIVES: To examine associations among subjective memory reports, psychophysiological markers of emotion regulation, and cognitive performance in healthy adults over 50 years of age. METHOD: A cross-sectional laboratory study was conducted with healthy, community-dwelling, non-depressed adults (M age = 60.4 years, SD = 8.4). The Metamemory in Adulthood (MIA) questionnaire provided reports of subjective memory capacity and stability (versus decline) and anxiety about memory. Poorer emotion regulation was marked by greater negative affect (NA) and lower high frequency heart rate variability (HF-HRV) responses to a challenging working memory task. Regression models were used to identify associations between subjective memory and emotion regulation markers, and structural equation modeling was used to explore whether emotion regulation mediated associations between subjective memory and objective task performance. RESULTS: A total of 115 participants were included in the final sample. Subjective memory decline (indicated by lower scores on memory stability) was associated with lower HF-HRV response and worse working memory performance. Poorer subjective memory capacity and more anxiety about memory were both associated with greater negative affect in response to the working memory task. There was an indirect effect of subjective memory capacity on working memory performance through negative affect response. CONCLUSIONS: The findings here suggest that worse subjective memory may signal reduced capacity for emotion regulation. Along with known cognitive risks of depression and anxiety, more subtle emotion regulation difficulties may be involved in pathways of poor cognitive aging.

Anxiety sensitivity and intolerance of uncertainty are unique and interactive risk factors for COVID-19 safety behaviors and worries.

Intolerance of uncertainty (IU) and anxiety sensitivity (AS) predict distress during the COVID-19 pandemic. However, little is known about how AS and IU jointly predict COVID-19 worries and behaviors. Structural equation modeling was used to examine the direct and interactive effects of AS and IU as related to COVID-19 worries and behaviors in two samples of community adults recruited in April 2020 (N = 642; M age = 38.50 years, SD = 10.00) and May 2020 (N = 435; M age = 34.92 years, SD = 14.98). In sample 1, there was a significant AS by IU interaction predicting COVID-19-related catastrophizing worries, stockpiling, and cleaning behaviors such that the relationship of AS to COVID-19-related behaviors was stronger at high levels of IU. However, although AS predicted some COVID-19 related worries and behaviors, AS and IU did not interact in sample 2. Across samples, AS was directly related to financial and health worries, whereas IU was not a significant predictor after controlling for AS. These findings suggest AS consistently impacts COVID-19 worries and behaviors, particularly among individuals with high IU. Brief interventions targeting AS and IU may help people cope during the COVID-19 pandemic and reintegrate following the pandemic.

Insomnia during the COVID-19 pandemic: the role of depression and COVID-19-related risk factors.

The COVID-19 pandemic has resulted in dramatic changes to sleep patterns and higher prevalence of insomnia, which threaten overall mental and physical health. We examined whether safety behaviors in response to COVID-19, worry in response to COVID-19, and depression predicted insomnia, with age, race, and sex as covariates. A community sample from the United States (n = 321, Mage = 40.02, SD = 10.54; 53.6% female) recruited using online crowdsourcing completed self-report measures in May of 2020 and again three months later. At baseline, our model accounted for 68.1% of the variance in insomnia, with depression as the only significant predictor (ß = .70, p < .001). In the longitudinal analyses, only baseline insomnia symptoms predicted 3-month follow-up insomnia symptoms (ß = .70, p < .001; 67.1% of variance). Of note, COVID-19 worry and some COVID-19 safety behaviors were related to 3-month follow-up safety behaviors, but not insomnia. Our findings demonstrated that depression is an important factor to consider for concurrent insomnia symptoms. Our results have implications regarding the development of interventions for insomnia during the COVID-19 pandemic and suggest that clinicians should consider depression when assessing for and treating insomnia symptoms.

Examination of the relationship between iron status and cognitive function among healthy young women with and without a recent history of blood donation.

BACKGROUND: With growing awareness of the prevalence of nonanemic iron deficiency among blood donors, there is a need to explore the extent of potential negative consequences. This study examined the relationship between various measures of iron status, blood donation history, and neuropsychological and psychosocial functioning in healthy young women. STUDY DESIGN AND METHODS: Using a cross-sectional design, 160 female undergraduates completed neuropsychology tests and measures of sleep, fatigue, quality of life, and depression before providing a blood sample. Correlational analyses examined the relationship between iron status (ferritin, iron, hemoglobin, and zinc protoporphyrin) and cognitive and psychosocial functioning. Performance on these measures was also examined as a function of recent blood donation history (zero, one, more than one donation in the past year). RESULTS: Iron status (low ferritin, iron, or hemoglobin or high zinc protoporphyrin) was not associated with poorer performance on the cognitive tasks. Further, participants who reported donating once in the previous year performed better, rather than worse, than those with no recent donation history on several measures of executive function, even when controlling for ferritin levels. Although there was some evidence of greater fatigue among those who had donated more than once in the past year, this effect was not accounted for by ferritin levels. CONCLUSION: The present findings are consistent with prior evidence that nonanemic iron deficiency is not associated with cognitive impairment or psychosocial dysfunction in healthy young females. Because these results are based on cross-sectional evidence, further study using longitudinal research is needed to confirm these findings.

The Relationship of MMPI-2-RF Scales to Treatment Engagement and Alliance.

Clients' personality characteristics can be important correlates of treatment engagement and alliance. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is one of the most comprehensive and widely used personality measures in clinical settings and includes measures of symptom validity. A few prior studies using the MMPI-2 and MMPI-2-RF suggest that externalizing characteristics and the validity scales might be associated with treatment engagement, but no studies to date have examined MMPI correlates of treatment alliance. This study examined the relationship of MMPI-2-RF scales to treatment engagement and alliance in 134 individuals seeking outpatient treatment at a psychology department training clinic. It was predicted that validity scales and externalizing scales would be related to treatment engagement (premature termination, no-show rate) and to alliance. Contrary to expectations, MMPI-2-RF validity scales were not related to premature termination but high scores on F-r were related to higher no-show rates and high scores on Symptom Validity (FBS-r) were related to lower alliance. As predicted, higher scores on scales assessing externalizing psychopathology were related to premature termination and higher no-show rate. Exploratory analyses also suggested higher scores on somatic and interpersonal scales were related to lower alliance. Accuracy statistics using clinical cutoffs on MMPI scales are provided.

Assessment of cognitive function and sleep-wake rhythms in community-dwelling older adults.

Disruption of the circadian rhythm and sleep-wake cycles is a consequence of aging and is associated with the cognitive decline and many neurodegenerative conditions. We investigated the bedtime, wake-up time, sleep timing (midpoint between bedtime and wake-up time), and sleep timing standard deviation (SD) using the actigraphy among 80 consecutive volunteers aged ≥ 60 years. Global cognitive function and executive function of detailed cognitive domains were evaluated using the mini-mental state examination (MMSE) and Wisconsin card sorting test (WCST) and subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). The category achievement (CA), total errors (TE), perseverative errors of Nelson (PEN), non-perseverative errors (NPE), and difficulties in maintaining set (DMS) on the WCST were significantly correlated with sleep timing SD (CA: r = - 0.276, p = 0.013, TE: r = 0.311, p = 0.005, PEN: r = 0.241, p = 0.032, NPE: r = 0.250, p = 0.025, DMS: r = 0.235, p = 0.036), but not with the MMSE score. Multiple regression analyses with the stepwise forward selection method including age, ESS score, bedtime, sleep timing, and sleep timing SD, revealed that the ESS score, and sleep timing SD were significant factors related to CA on the WCST (ESS score: ß = - 0.322, p = 0.004; sleep timing SD: ß = - 0.250, p = 0.022). Assessment of sleep-wake rhythms, daytime sleepiness, and cognitive function using the MMSE and WCST is valuable for the prediction of cognitive decline in the geriatric population.

Gender differences in the serial position among older adults.

INTRODUCTION: There are gender disparities in age of diagnosis with Mild Cognitive Impairment (MCI) or dementia, which may be related to general female advantages in verbal memory across aging. Further examination of the serial position effect (SPE) may provide an avenue for earlier diagnosis of MCI/dementia among women. METHOD: 338 cognitively healthy adults aged 50+ (110 men; 228 women) were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) List Learning task as part of dementia screening. We examined whether the SPE could be demonstrated on Trial 1 and delayed recall, and whether SPE patterns were consistent across genders, using mixed measure ANOVAs. Using regression, we also examined whether gender, SPE components, or their interactions predicted RBANS Delayed Memory Index (DMI) performance. Using cluster analyses, we identified a group with reduced primacy relative to recency on Trial 1 and a group without. We used ANOVA to examine whether clusters differed in DMI scores and whether this was moderated by gender. RESULTS: We demonstrated the prototypical SPE on Trial 1. On delayed recall, we found reduced recency compared to primacy and middle performance. As expected, men exhibited worse performance on the DMI. However, gender did not interact with SPE. Primacy and middle, but not recency, performance on Trial 1 predicted DMI scores, as did the recency ratio. These relationships were not moderated by gender. Finally, participants with better primacy than recency on Trial 1 (N = 187) exhibited higher performance on DMI than participants with better recency than primacy (N = 151). Gender did not interact with cluster membership. CONCLUSION: Our results have important clinical implications in assessment, where focusing on Trial 1 primacy performance and loss of recency between Trial 1 and delayed recall may help to address gender-related delays in age of diagnosis of MCI or dementia.

Time of Day Effects in the Relationships Between Daytime Sleepiness, Current Arousal, and Cognitive Performance.

OBJECTIVE: Daytime sleepiness is commonly reported among older adults. Additionally, aging is associated with a shift toward greater alertness in the morning that wanes throughout the day. The impact of time of day of testing on the relationships between daytime sleepiness and cognition is unknown. METHODS: We explored the effects of time of testing in relation to self-reported daytime sleepiness/current arousal and cognition among 133 older adults. RESULTS: Time of testing moderated the relationship between daytime sleepiness and immediate learning/memory, with greater sleepiness being associated with poorer performance in the afternoon, but not morning. Time of testing also moderated the relationship between current arousal and processing speed, with lower arousal being associated with worse performance in the afternoon. CONCLUSIONS: These findings suggest that time of testing is important to account for when assessing sleepiness and cognition in older adults and that consideration should be given to how sleepiness is measured.

Executively-mediated language skills are related to performance-based social functioning in the early psychosis spectrum.

Social impairment is a core deficit in psychotic spectrum disorders (PSDs). Prior work shows that language abnormalities can predict psychosis onset and are related to social outcomes in PSDs. Few studies have investigated nuanced relationships between language/verbal abilities and social functioning in the early psychosis spectrum, including at-risk (schizotypy) and first episode of psychosis (FEP) individuals. This study aimed to examine the relationship to between language/verbal performance and performance-based and examiner-rated social functioning. We also aimed to replicate prior models that demonstrate neurocognition is related to social functioning through negative symptoms and social cognition. Low schizotypy (n = 42), high schizotypy (n = 44), and FEP (n = 15) participants completed a battery of language/verbal, social cognition, and social functioning measures. Regression analyses revealed that Proverb Test performance was uniquely and significantly associated with performance-based but not examiner-rated social functioning. Other language/verbal measures were not significantly related to social functioning. In mediational analyses, language/verbal performance was indirectly related to social functioning through negative traits, and also through social cognition. Findings extend support for negative symptom and social cognitive intervention in the early psychosis spectrum, and uniquely suggest that executively-mediated language skills may be an additional target to improve social functioning.

Clinical assessment in the time of COVID-19: Introduction to the special issue.

The COVID-19 pandemic placed much of the practice of psychological assessment in unchartered territory-including assessment via telehealth, assessment with masks or other safety measures, and accounting for the impact of a major global event in measuring performance or psychopathology. The goal of this special issue was to highlight research that addresses the numerous ways in which the pandemic impacted psychological assessment, covering three broad areas. Several articles addressed pandemic restrictions (i.e., telehealth assessment due to lockdown or social distancing, masks) and their impact on the assessment process or test validity. Another set of articles examined the impact of the pandemic on psychopathology and assessment performance more broadly, highlighting the impact on assessment and normative expectations, including in the areas of neuropsychological performance, academic achievement, and levels of psychopathology. Finally, several articles examined the validity of measures developed specifically to assess COVID-19 pandemic-related experiences. Each study is briefly reviewed, and implications for clinical practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The relation of ApoE and COMT gene-gene interactions to cognitive and motor function in community-dwelling older adults: a pilot study.

Introduction: Certain genes increase the risk of age-related neurological dysfunction and/or disease. For instance, ApoE is a well-known gene carrying risk for Alzheimer's disease, while COMT has been associated with age-related reductions in motor function. There is growing interest in the interrelationship between age-related changes in cognitive and motor function, and examining gene-gene interactions in this context. In this pilot study we examined the relations of the ApoE and COMT genes and their interaction to both cognitive and motor performance in community-dwelling older adults. Methods: We leveraged an archived dataset from a prior study on age-related muscle weakness in community-dwelling older adults. Sample size was between 72 and 82 individuals based on missing data. We examined the relationship of ApoE (Ɛ4 presence/absence), rs4680 SNP on the COMT gene (Val/Met, Val/Val, Met/Met), and sex on (1) overall cognitive functioning and specific cognitive domains known to decline in aging (processing speed, immediate and delayed memory, semantic and phonemic fluency, and executive functioning), and (2) indices of motor function (four square step test, short physical performance battery, grip strength/forearm lean mass, and purdue pegboard test). Results: Homozygous COMT genotypes were associated with worse global cognitive performance, immediate memory, and semantic fluency, but only for older adults with at least one ApoE Ɛ4 allele. There were main effects for COMT for delayed memory and a main effect for both COMT and ApoE for coding and phonemic fluency. Women scored higher than men in overall cognition, immediate and delayed memory, and semantic fluency. There were no main effects or gene interactions for a measure of executive functioning (trial making test part B) or any of the measures of motor function. Discussion: COMT, ApoE, and their interaction influence cognitive performance, but not motor functioning, in community dwelling older adults. Our work supports prior literature concluding that a heterozygous COMT genotype may be beneficial to sustain healthy cognitive functioning with advancing age for those who have a higher ApoE genetic risk status (at least one Ɛ4 allele). Future research should investigate interactions between COMT and ApoE in larger samples with comprehensive assessment of cognition and motor functioning.

Neuropsychological functioning in migraine: clinical and research implications.

AIM: We review the research literature examining neuropsychological performance in migraine. Findings were organized by neuropsychological construct assessed and results were reported using effect size conventions. Factors considered in explaining results included sample characteristics, migraine factors, and control for non-migraine variables. FINDINGS: There is weak evidence for deficits in processing speed, attention, verbal memory, verbal skills, working memory, sustained attention, and inhibition in migraine relative to healthy controls. There are mixed results regarding deficits in visual memory, motor dexterity, visuospatial/constructional skills, visual reasoning, and mental flexibility in migraine relative to healthy controls. Mixed findings do not seem to be consistently related to study characteristics or presence of aura; other important migraine factors (such as migraine severity or presence of neuroradiological findings) remain understudied. Relative to non-healthy control groups, however, there is weak evidence for an effect of migraine in any cognitive domain. Longitudinal studies provide little evidence that neuropsychological functioning worsens over time in migraine or that migraine is a risk factor for Alzheimer's disease. RESEARCH IMPLICATIONS: It remains possible that cognitive dysfunction is seen in only a subset of migraine sufferers, perhaps those with more severe illness or neurological involvement; however, more research is needed to examine this issue. Non-migraine differences among migraine sufferers, including medical and psychiatric comorbidities and variables associated with treatment seeking, may partially account for inconsistent findings and should be evaluated for in future research. CLINICAL IMPLICATIONS: Clinicians should refer migraine patients for comprehensive neuropsychological evaluation only when there is sufficient evidence for concern. Such evaluations should include consideration of other psychological, neurological, and medical contributors to both migraine and cognitive status.

Sleep disturbance and older adults' inflammatory responses to acute stress.

OBJECTIVES: Poor sleep diminishes mental and physical health. The objective of this study was to examine associations between sleep disturbance and interleukin-6 (IL-6) responses to acute mental stress in older adults. DESIGN: Observational study of community-dwelling, healthy older adults. SETTING: Participants completed the study in a clinical research laboratory of a mid-sized university. PARTICIPANTS: Generally healthy, community-dwelling men and women age 50 and older. MEASUREMENTS: IL-6 and negative affect at rest and following a series of challenging cognitive tests; sleep quality; depressive symptoms; perceived stress; loneliness. RESULTS: Participants categorized as poor sleepers on the basis of Pittsburgh Sleep Quality Index scores had significantly larger IL-6 responses to the cognitive stressors than good sleepers. The association between poor sleep and heightened IL-6 response to acute stress was not explained by other psychosocial factors previously linked to immune dysregulation, including depressive symptoms, perceived stress, and loneliness. CONCLUSIONS: Findings add to the growing evidence for poor sleep as an independent risk factor for poor mental and physical health. Older adults may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulation.

Systematic Review of Correlates of Internal and External Memory Strategy Use in Older Adults.

Memory strategies promote independence during aging. We systematically reviewed literature on correlates and predictors of internal and external memory strategy use for older adults. Of 212 articles identified, 29 met inclusion criteria. Overall, increasing age was associated with decreasing internal but increasing external memory strategy use. Females reported more external memory strategy use, though findings were mixed regarding internal memory strategies. Clinical status appeared to alter the relationship between cognition and internal and external memory strategy use. There were mixed results regarding the relationship between memory strategy use and education, psychological functioning, and health variables. In addition to identifying areas for future research, we provide recommendations to develop primary prevention strategies for intervention and promote successful aging.

Susceptibility of functional impairment ratings to noncredible reporting in postsecondary students undergoing screening for ADHD.

Objective: Clinical evaluation for attention-deficit/hyperactivity disorder (ADHD) not only requires assessment of symptoms, but also consideration of the degree to which symptoms lead to impairment within various functional domains. However, ADHD evaluations in adulthood often rely on self-reported functional impairment, which might be vulnerable to malingering/noncredible responding. The present study utilized a clinical sample/known groups design to examine the relationship of noncredible presentation to functional impairment ratings by analyzing differential associations with both symptom and performance validity tests (SVTs and PVTs). Method: Participants were 168 postsecondary students who completed psychoeducational assessments for ADHD to determine their eligibility for academic accommodations and/or medications. Impairment ratings on the Weiss Functional Impairment Rating Scale (WFIRS) of 71 students who presented in a noncredible fashion were compared to 72 students who appeared to present credibly (controls) and 25 students diagnosed with ADHD who appeared to present credibly (clinical controls). Results: Relative to both control groups, individuals who presented noncredibly reported higher levels of disability on most functional domains and a higher percentage provided responses that fell in the impaired range on all functional domains of the WFIRS. Conclusions: Findings provide additional evidence that ADHD-related functional impairment ratings are susceptible to noncredible presentation and highlight the need for assessors to include both SVTs and PVTs in ADHD evaluations.

Relationship of psychological/mild traumatic brain injury (mTBI) history and invalid reporting to self-reported executive function.

Individuals with mild traumatic brain injury (mTBI) often complain of executive functioning (EF) difficulties. There is a discrepancy between self-reported EF impairment and EF deficits on neuropsychological tests, with some arguing that self-report EF is more related to real-world functioning than EF tests. However, research suggests that self-reported EF may be related more to emotional distress and is vulnerable to invalid reporting. We examined the vulnerability of the short form Barkley Deficits in Executive Functioning Scale (BDEFS) to invalid reporting, using a simulated mTBI paradigm. We included four groups: individuals simulating mTBI with (N = 24) and without (N = 21) histories of mTBI/other psychological conditions and controls with (N = 21) and without (N = 25) histories of mTBI/other psychological conditions. As hypothesized, simulators performed worse on the BDEFS Total Score and EF Symptom Count relative to controls; however, this effect was larger within those who had no self-reported history of mTBI/other psychological conditions. We identified a preliminary cutoff on the EF Symptom Count that detected 42.8% of simulators, with 95% specificity relative to the controls with histories of mTBI/other psychological conditions. The present study emphasizes the need for validity scales on self-report EF measures such as the BDEFS.

Are correlations among behavioral decision making tasks moderated by simulated cognitive impairment?

Behavioral decision making tasks are common in research settings, with only the Iowa Gambling Task available for clinical assessments. However, correlations among these tasks are low, indicating each may assess a distinct component of decision making. In addition, it is unclear whether these tasks are sensitive to invalid performance or even simulated impairment. The present study examined relationships among decision making tasks and whether simulated impairment moderates the relationships among them. Across two studies (Study 1: n = 166, Study 2: n = 130), undergraduate student participants were asked to try their best or to simulate a specific diagnosis (Attention-Deficit/Hyperactivity Disorder; Study 1), decision making impairment (Study 2), or general cognitive impairment (Study 2). They then completed a battery of tests including embedded and standalone performance validity tests (PVTs) and three behavioral decision making tasks. Across studies, participants simulating impairment were not distinguishable from controls on any of the behavioral tasks. Few significant correlations emerged among tasks across studies and the pattern of relationships between tasks did not differ on the basis of simulator or PVT failure status. Collectively, our findings suggest that these tasks may not be vulnerable to simulated cognitive impairment, and that the tasks measure largely non-overlapping aspects of decision making.

Shift happens: The gender composition in clinical neuropsychology over five decades.

OBJECTIVE: The current study utilizes five decades of data to demonstrate cohort differences in gender representation in governance, speaking at conferences, serving on editorial boards, and in scholarly productivity in clinical neuropsychology. Broadly examining gender disparities across domains of professional attainment helps illuminate the areas in which inequity in clinical neuropsychology is most pronounced and in need of ameliorative resources. METHODS: Data from 1967 to 2017 were coded from publicly available information from the four major professional associations for clinical neuropsychology in the U.S. (i.e. INS, AACN, NAN, & SCN). Gender differences were examined in (1) speaking at a national conference, (2) holding an office in a professional organization, (3) serving on the editorial team for a journal affiliated with a professional organization, and (4) scholarly activity as coded from Google Scholar. RESULTS: The percentage of men in the field significantly declined across time, whereas the percentage of women significantly increased; the number of women exceeded the number of men in approximately 1992. Gender differences in conference speakers, editorial board members, and research citations were greater in the earlier than in more recent cohorts of clinical neuropsychologists but gender inequity in conference speaking and editorial activities is evident in the most recent cohorts. DISCUSSION: Gender differences in conference speakers, editorial board members, and in earning research citations have diminished over time, but early career women still face disadvantages in speaking at conferences and serving on editorial boards. We provide strategies to increase and sustain women's participation in leadership in neuropsychology.