The Postoperative Effects of Anesthesia Exposure on Cognitive Decline in Older Adults: A Narrative Review.

BACKGROUND: As modern medicine continues to make strides in effective surgical treatments, we must also consider the critical impact of anesthesia on neuropsychological outcomes. Recent evidence suggests that anesthesia exposure may be a risk factor for postoperative cognitive decline and the eventual development of dementia. OBJECTIVES: To explore the vulnerability of the aging brain in the context of anesthesia exposure in surgery, studies will be reviewed, and pertinent findings will be highlighted and explored to better understand risks and possible factors that need to be considered when contemplating surgery. METHODS: A narrative review was conducted using a combination of MEDLINE and APA PsycINFO databases to shed light on themes across studies assessing general trends regarding the influence of anesthesia on postoperative cognitive decline. RESULTS: A search of relevant literature identified 388 articles. Excluding results outside the parameters of this study, the review includes quality assessments for 24 articles. CONCLUSION: While findings are inconclusive, suggestions for further investigation into the relationship between anesthesia exposure and increased risk for postoperative cognitive decline are discussed, in addition to factors that may allow for greater informed disclosure of potential risks of anesthesia in older adults.

Performing arts as a non-pharmacological intervention for people with dementia and care-partners: a community case study.

Participation in psychosocial enrichment activities, such as music and arts programming, have shown potential to delay or reduce functional decline - without adverse effects that can be associated with pharmaceuticals. The performing-arts programming described in this community case study was inspired by a community music program called B-Sharp Music Wellness, located in Phoenix, Arizona, which involved small groups of musicians who provided symphony performances for people with dementia. Our community programming sought to engage people with dementia and their informal care partner (typically a spouse) in existing performing-arts programs in their local community, providing social hours and season tickets for either symphony, dance (ballet), or non-musical theater performances. This case study describes the program history and design, including outcomes and lessons learned from the program evaluation of the last full season (2018-19) and partial season (2019-20), when the program was halted due to the COVID-19 pandemic. Program outcomes suggest strategies for, and benefits of, design for performing-arts programs as psychosocial interventions in other communities.

Feasibility of an adaptive riding pilot study and acceptability to dementia care partners: "Your spirits are lifted".

OBJECTIVES: We sought to assess the feasibility and acceptability of an adaptive riding program with dyads (persons living with dementia, family care partners) and a gardening comparison condition. DESIGN: This is a two-arm (adaptive riding and adaptive gardening), mixed methods, convergent, feasibility study that occurred February 2019-June 2019. INTERVENTIONS: Upon enrollment, dyads (n=9) self-selected into either community-based adaptive riding (n=5) or adaptive gardening (n=4), two complementary interventions in Northern Colorado. Interventions occurred for hour-long, weekly sessions for eight weeks. OUTCOME MEASURES: Feasibility was measured with recruitment (actual/planned, response rate, participants enrolled/month) retention, adherence to study procedures (attendance, retention, fidelity), and data collection processes (planned versus collected); and analyzed with descriptive statistics. Acceptability of adaptive riding was measured with pre/post care partner interviews and analyzed using thematic analysis. Afterwards, findings were converged. RESULTS: We recruited n=10/24 dyads (6 dyads per month), with the highest response rates for referrals and in-person events, n=9 dyads enrolled. We adhered to study procedures with attendance (6/8 gardening, 8/8 riding), retention (100%), fidelity (100%) and data collected (98%). Care partners (n=5) found the adaptive riding intervention acceptable with two themes Overall hopes: "Joy in the present moment" and "Experience as a Whole: "Your spirits are lifted," affirming quantitative attendance and retention data. CONCLUSION: Findings underscore the feasibility and acceptability of including care partners of persons living with dementia in complementary interventions involving horsemanship activities. Feasibility data can guide study designs and implementation processes for other nature-based complementary interventions for this population.

A Systematic Review of Prospective Memory Interventions Across Stages of Dementia-Related Disorders.

BACKGROUND: There is a critical need to develop effective interventions for cognitive impairments associated with dementia-related disorders (i.e., Alzheimer's disease, frontotemporal dementia, mild cognitive impairment). Prospective memory (PM), or the ability to create and carry out future intentions, is one cognitive domain that is impaired in individuals with dementia-related disorders. Effective treatment of PM could significantly improve daily functioning, level of independence, and quality of life. OBJECTIVE: To date, there have been a number of studies investigating potential interventions, but these interventions have not been comprehensively reviewed and compared across the stages of dementia-related disorders, as is the aim of the current review. METHODS: This review examined 21 studies on the success of intervention strategies for prospective memory in patients with dementia-related disorders. RESULTS: All the studies demonstrated positive effects of intervention on PM abilities, but there are questions concerning ecological validity, length of positive effects on PM, and a lack of diversity of interventions across the different stages of dementia-related disorders. CONCLUSION: Future research should address these issues by incorporating daily functioning activities and caregiver support into the intervention process, as well as investigating these interventions at more severe stages of dementia-related disorders.

Surviving and Thriving: Qualitative Results from a Multi-Year, Multidimensional Intervention to Promote Well-Being among Caregivers of Adults with Dementia.

(1) Introduction: Caring for an adult with dementia is both challenging and rewarding. Research indicates that community-based, social support, and/or arts engagement interventions can play a key role in ameliorating the negative outcomes associated with caregiving while enhancing its more positive attributes. This study explores the psychosocial outcomes experienced by dementia caregivers who participated in a multi-year, multidimensional intervention aimed at promoting caregiver and care recipient well-being. This intervention included bringing caregivers and people with Alzheimer's disease or related dementias (ADRD) to local symphony performances, hosting a social reception prior to the performance, and assessing the outcomes of participation for both caregiver and the care recipient. (2) Materials, Methods, and Analysis: Qualitative data from participant phone interviews (n = 55) as well as focus groups are analyzed using thematic analysis from a phenomenological perspective. (3) Results: Across three years of participation, caregivers reported three main program benefits: relationship building (both with other participants as well as within the broader community); restored humanity (experiencing a greater sense of personal dignity and momentary return to normalcy), and positivity (experiencing positive emotions during the program). (4) Discussion: These findings point to the value of creating caregiver programming that brings together multiple dimensions of successful interventions in order to enhance caregiver experiences and positive intervention outcomes.

B Sharp-The cognitive effects of a pilot community music program for people with dementia-related disorders.

INTRODUCTION: Dementia has been described as the greatest global challenge for healthcare in the 21st century. Pharmaceutical interventions have dominated dementia treatment despite limited efficacy. There is increasing interest in alternatives to delay the progression of cognitive decline, such as community-based programs, promoting social and stimulating experiences. This article discusses a pilot music-based community program (B Sharp) for persons with dementia-related disorders. METHOD: In the pilot study, we assessed 23 persons with dementia-related disorders who, with their caregivers, attended the symphony season and accompanying social hours over a 10-month period. Participants completed a baseline and follow-up brief neuropsychological test to assess cognitive changes. RESULTS: Significant improvements were observed between the pre- and post-B Sharp program assessments (P < .010). DISCUSSION: Results support the feasibility of the B Sharp program as a community-based program to target cognitive decline. Additional research is needed to understand the mechanisms involved in the improvements observed in this program.

Attentional and Neural Processing of Affective and Alcohol-Related Images in University-Attending Emerging Adults.

High-risk drinking is prevalent in university-attending emerging adults. This coincides with a critical time for the development of higher level cognitive and emotional processing and underlying neurobiological mechanisms. Cognitive and emotional processing seems to have a particularly sensitive relationship with alcohol. The current study sought to examine the relationship between alcohol use and neurophysiology in an emerging adult, university-attending population. Neurophysiological response, defined as event-related potentials, to alcohol-related and emotionally affective images were evaluated in 23 drinkers and 21 nondrinkers. Drinkers had a greater attentional response to alcohol, positive, and negative images compared to nondrinkers. No differences were found between groups for attentional response (P2) to neutral images or for later emotional processing (late positive potential) for any stimuli type. These data suggest that this drinking population processes alcohol stimuli and affective images similarly and more robustly than nondrinking peers. These data support a relationship between alcohol and emotional processing in emerging adults.

Cognitive functioning, aging, and work: A review and recommendations for research and practice.

There is a larger proportion and number of older adults in the labor force than ever before. Furthermore, older adults in the workforce are working until later ages. Although a great deal of research has examined physical health and well-being of working older adults, less research has focused on cognitive functioning. The purpose of this article is to provide a broad contemporary and multidisciplinary review of the intersection between cognitive functioning, aging, and work as a follow-up to a paper previously written by Fisher et al. (2014). We begin by providing definitions and background about cognitive functioning and how it changes over the life span. Next we discuss theories relevant to the intersection of cognitive functioning and work, including the use-it-or-lose-it hypothesis, the cognitive reserve hypothesis, hypotheses regarding environmental influences on intellectual functioning, and the job-demands-resources model. Then we summarize recent research about the effects of work on cognitive functioning, as well as ways that cognitive functioning may influence work motivation, learning, development, training, and safety. We conclude by emphasizing the importance of person-environment fit, suggesting avenues for future research, and discussing practical implications for the field of occupational health psychology. (PsycINFO Database Record

Neurophysiology for Detection of High Risk for Psychosis.

Schizophrenia is a complex and often disabling disorder that is characterized by a wide range of social, emotional, and cognitive deficits. Increasing research suggests that the greatest social and cognitive therapeutic impact comes from early identification. The present study applied a well-established neurophysiological paradigm in the schizophrenia literature, mismatch negativity (MMN), to college students identified as high risk (HR) for psychosis to investigate MMN as a potential biomarker for the onset of psychosis. The hypothesis was that HR would exhibit attenuated MMN amplitudes compared to controls, as has been established in individuals with chronic schizophrenia. Participants (N = 121) were separated into Group 1 (controls) (n 1 = 72) and Group 2 (HR) (n 2 = 49) based on the established cutoff score of the 16-item Prodromal Questionnaire. Participants then completed a time based MMN paradigm during which brain activity was recorded with EEG. For all electrode locations, controls demonstrated significantly more negative amplitudes than HR (Cz: F(1,119) = 8.09, p = .005; Fz: F(1, 119) = 5.74, p = .018; Pz: F(1,119) = 5.88, p = .017). Results suggested that MMN may assist in identifying those who appear high-functioning but may be at risk for later development of psychosis or cognitive and psychological difficulties associated with psychosis.

Investigating metacognition, cognition, and behavioral deficits of college students with acute traumatic brain injuries.

OBJECTIVE: Executive dysfunction in college students who have had an acute traumatic brain injury (TBI) was investigated. The cognitive, behavioral, and metacognitive effects on college students who endorsed experiencing a brain injury were specifically explored. PARTICIPANTS: Participants were 121 college students who endorsed a mild TBI, and 121 college students with no history of a TBI were matched on sex and ethnicity to examine potential differences between groups. METHODS: Participants completed the Dysexecutive Questionnaire (DEX). RESULTS: A Rasch analysis indicated that the TBI group had significantly higher total scores on the DEX than the control group. Moreover, when compared with the control group, the students with a TBI had higher scores on all 3 subcomponents of the DEX. CONCLUSION: These findings suggest that students who endorse brain injuries may experience more difficulty with specific facets of college. Thus, the importance of academic and personal resources available for students with a TBI is discussed.

A Systematic Review of Metacognitive Differences Between Alzheimer's Disease and Frontotemporal Dementia.

Clinicians often have difficulty distinguishing between various forms of dementia to achieve a correct diagnosis. Little research has been done to examine whether awareness of one's cognitive deficits, or metacognitive monitoring, might differ between dementia diagnoses, thereby providing an additional means of differentiating between dementia subtypes. We review articles examining metacognitive comparisons between two of the most common dementia subtypes: Alzheimer's disease and frontotemporal dementia. Greater monitoring deficits were apparent in frontotemporal dementia than in Alzheimer's disease, and participants with frontotemporal dementia were less likely to utilize task experience to update and improve the accuracy of subsequent monitoring judgments. Results provide evidence for the utility of metacognitive measures as a means of distinguishing between Alzheimer's disease and frontotemporal dementia.

Levels of attention and task difficulty in the modulation of interval duration mismatch negativity.

Time perception has been described as a fundamental skill needed to engage in a number of higher level cognitive processes essential to successfully navigate everyday life (e.g., planning, sequencing, etc.) Temporal processing is often thought of as a basic neural process that impacts a variety of other cognitive processes. Others, however, have argued that timing in the brain can be affected by a number of variables such as attention and motivation. In an effort to better understand timing in the brain at a basic level with minimal attentional demands, researchers have often employed use of the mismatch negativity (MMN). MMN, specifically duration MMN (dMMN) and interval MMN (iMMN) have been popular methods for studying temporal processing in populations for which attention or motivation may be an issue (e.g., clinical populations, early developmental studies). There are, however, select studies which suggest that attention may in fact modify both temporal processing in general and the MMN event-related potential. It is unclear the degree to which attention affects MMN or whether the effects differ depending on the complexity or difficulty of the MMN paradigm. The iMMN indexes temporal processing and is elicited by introducing a deviant interval duration amid a series of standards. A greater degree of difference in the deviant from the standard elicits a heightened iMMN. Unlike past studies, in which attention was intentionally directed toward a closed-captioned move, the current study had participants partake in tasks involving varying degrees of attention (passive, low, and high) with varying degrees of deviants (small, medium, and large) to better understand the role of attention on the iMMN and to assess whether level of attention paired with changes in task difficulty differentially influence the iMMN electrophysiological responses. Data from 19 subjects were recorded in an iMMN paradigm. The amplitude of the iMMN waveform showed an increase with attention, particularly for intervals that were the most distinct from a standard interval (p < 0.02). Results suggest that the role of attention on the iMMN is complex. Both the degree of attention paid as well as the level of difficulty of the MMN task likely influence the neuronal response within a timing network. These results suggest that electrophysiological perception of time is modified by attention and that the design of the iMMN study is critical to minimize the possible confounding effects of attention. In addition, the implications of these results for future studies assessing interval duration-based MMN in clinical populations is also addressed.

Prospective memory in schizophrenia: a review.

The wide range of psychological and cognitive symptoms associated with schizophrenia can often affect the level of independence that individuals with schizophrenia can achieve in their lives. Prospective memory (PM), or memory associated with future intentions, has been proposed as a useful indicator of select independent living skills. Currently, there is limited research with regards to prospective memory in schizophrenia. The current review systematically summarizes the literature focusing on prospective memory in schizophrenia and concludes that individuals with schizophrenia exhibited both an impairment in PM when compared to healthy controls and a general lack of awareness regarding these deficits. The existing research also suggests that PM deficits are not related to chronicity of illness or medications associated with schizophrenia. Limited findings suggest that PM deficits in individuals with schizophrenia may be associated with the ability to live independently and instrumental activities of daily living.

Neuropsychological functioning in childhood-onset psychosis and attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) and childhood-onset psychosis (COP) are chronic, heterogeneous disorders with symptoms that frequently co-occur, but the etiology of their comorbidity is unknown. Studies of each disorder indicate that both ADHD and COP are associated with a range of neuropsychological weaknesses, but few neuropsychological studies have directly compared groups with ADHD and COP. METHODS: Groups with ADHD only (32 F, 48 M), COP only (5 F, 5 M), ADHD + COP (9 F, 21 M), and a control group with neither disorder (25 F, 44 M) completed a neuropsychological battery that included measures of verbal working memory, response inhibition, response speed and variability, and selective attention. RESULTS: All three clinical groups exhibited significantly lower performance versus the control group on all neuropsychological measures, whereas the only significant difference between the clinical groups was a significantly larger weakness in verbal working memory in the groups with COP. CONCLUSIONS: The frequent co-occurrence between COP and ADHD may reflect shared neuropsychological weaknesses that are most pronounced on measures of working memory and response variability.

Cognitive function predicts neural activity associated with pre-attentive temporal processing.

Temporal processing, or processing time-related information, appears to play a significant role in a variety of vital psychological functions. One of the main confounds to assessing the neural underpinnings and cognitive correlates of temporal processing is that behavioral measures of timing are generally confounded by other supporting cognitive processes, such as attention. Further, much theorizing in this field has relied on findings from clinical populations (e.g., individuals with schizophrenia) known to have temporal processing deficits. In this study, we attempted to avoid these difficulties by comparing temporal processing assessed by a pre-attentive event-related brain potential (ERP) waveform, the mismatch negativity (MMN) elicited by time-based stimulus features, to a number of cognitive functions within a non-clinical sample. We studied healthy older adults (without dementia), as this population inherently ensures more prominent variability in cognitive function than a younger adult sample, allowing for the detection of significant relationships between variables. Using hierarchical regression analyses, we found that verbal memory and executive functions (i.e., planning and conditional inhibition, but not set-shifting) uniquely predicted variance in temporal processing beyond that predicted by the demographic variables of age, gender, and hearing loss. These findings are consistent with a frontotemporal model of MMN waveform generation in response to changes in the temporal features of auditory stimuli.

Untreated prenatal maternal depression and the potential risks to offspring: a review.

Research exploring the effects of prenatal maternal depression on a developing fetus and child is underrepresented in the literature. Empirical papers have typically focused on the effects of postpartum depression (after birth) instead of prepartum depression (before birth). Disparate empirical findings have produced ongoing debate regarding the effects of prenatal depression on a developing fetus and later in infancy and early childhood. Even more controversial is determining the role of antidepressant medication on offspring outcomes and whether research that does not include the proper control population (e.g., unmedicated depressed participants) can adequately address questions about risks and benefits of treatment during pregnancy. The current review systematically summarizes the literature focusing on unmedicated prenatal depression and offspring outcome and concludes that prepartum depression is highly prevalent, is associated with negative outcomes in offspring, and remains understudied.

Metacognition and depressive realism: evidence for the level-of-depression account.

Introduction. The present study examined the relationship between metacognition (i.e., "thinking about thinking") and depression. More specifically, the depressive realism hypothesis (Alloy & Abramson, 1979), which posits that depressed people have a more accurate view of reality than nondepressed people, was tested. Methods. Nondepressed, mildly depressed, and moderately depressed individuals predicted their memory performance by making judgements of learning after each studied item. These predictions were then compared with actual performance on a free recall task to assess calibration, an index of metacognitive accuracy. Results and conclusions. Consistent with the depressive realism hypothesis, mild depression was associated with better calibration than nondepression. However, this "sadder but wiser" phenomenon appears to only exist to point, as moderate depression and nondepression showed no calibration differences. Thus, the level-of-depression account of depressive realism is supported.